Year

2005

Degree Name

Doctor of Philosophy

Department

Department of Biomedical Science - Faculty of Health and Behavioural Sciences

Abstract

Inappropriate footwear, poor footwear-surface interactions and gait adaptations resulting from musculoskeletal problems, such as arthritis and foot problems, are all factors that contribute to home slips. However, no research was located which identified the effects of interactions between household footwear and household surface characteristics on variables that may predispose older individuals to fall in the home. Therefore, the purpose of this thesis was to identify how different household shoe-surface interactions affected the gait of older people, particularly those with foot problems, to recommend a “safe” household shoe for older people. To achieve this purpose, this thesis was completed in two experimental sections. Experimental Section A comprised surveying 60 men and 68 women aged 65 years and above who lived independently in the community to identify the requirements and attitudes of older people living independently in the community in relation to their household footwear wearing and purchasing habits. Statistical analyses were conducted using chi-square tests, independent t-tests and z-scores to determine whether any relationships existed between the variables as well as the effects of gender. The main health condition reported by both men (37%) and women (50%) was arthritis. Women reported significantly more foot problems (2.3 per woman) than men (1.4 per man) as well as significantly greater foot pain and/or discomfort (59% women, 45% men). Furthermore, a greater number of women (25%) had fallen in the 12 months before the survey compared to men (17%). Shoes were worn in and around the house by 79% respondents, with the most popular household shoe type being the slipper, with 56% respondents indicating they wore both closed back and toe slippers around the home. The type of household shoe worn was significantly related to gender such that women predominantly wore closure-free, non-rigid household shoe types compared to men who tended to wear shoes with closures around the home. Only 30% of respondents did not wear household shoes, with most walking barefoot around the home (89.5%). The most slippery surface reported was that of smooth tiles (40.6%) with several respondents indicating they felt uneasy on wet surfaces, particularly tiles. It was concluded that Experimental Section B should focus upon the walking patterns displayed by older rheumatoid arthritic (RA) females when wearing toe and closed back slippers and walking on typical household surfaces, particularly wet surfaces. Experimental Section B examined the effects of household footwear-surface interactions on the biomechanical parameters characterising initial foot-ground contact, as this phase of the gait cycle most commonly results in slips. Subjective perceptions, kinematic, kinetic and neuromuscular data were collected at initial foot-ground contact as eight community-dwelling older women with RA and eight matched controls walked at a self-selected pace along a 6 m walkway under three footwear conditions (barefoot, closed back slippers, toe slippers) and three surface conditions (carpet, dry vinyl tile, wet vinyl tile). Mixed repeated measures three-way ANOVA were then completed to determine whether subject group, shoe type or surface type significantly (p ≤ 0.05) influenced the gait patterns at initial foot-ground contact. Compared to the control subjects, RA subjects displayed similar activity levels, segmental proportionality and plantar sensation, although increased foot pain and knee flexibility, decreased knee and ankle muscle strength and altered static and dynamic plantar pressure patterns. Despite displaying similar gait characteristics, the RA subjects estimated the walking trials to be significantly more difficult and experienced significantly more pain compared to the control subjects. The within-footwear main effects revealed that when subjects walked in toe slippers they found them to be uncomfortable and slippery, requiring significantly altered muscle activation patterns (earlier vastus lateralis (VL), tibialis anterior (TA) and peroneus longus (PL) onset; earlier gastrocnemius (G) offset; longer PL duration; increased TA intensity) compared to walking in closed back slippers. Within-footwear changes to muscle activation strategies (earlier rectus femoris (RF), VL and PL onset; earlier G offset; longer biceps femoris duration; decreased TA intensity) and kinetic profiles (decreased peak vertical and anteroposterior braking forces) were also evident when subjects walked barefoot compared to walking shod. Furthermore, the within-surface main effects indicated that when subjects walked on the wet vinyl-tile surface, they perceived the surface as more slippery, more difficult to walk upon and less comfortable, requiring significantly altered muscle activation patterns (later RF offset; earlier TA offset; longer RF duration; shorter VL duration; increased RF and semitendinosus (S) intensity), kinetic profiles (decreased peak anteroposterior braking forces) and kinematic profiles (decreased foot/shoe angle and angular velocity). Interestingly, footwear x surface interactions indicated that the subjects displayed significantly altered movement control strategies (longer RF and G duration; increased RF, VL and S intensity; decreased anteroposterior braking forces and foot/shoe angular velocity) and subjective perceptions (increased task difficulty and shoe/surface slipperiness; decreased shoe comfort) when subjects walked barefoot on the wet vinyl tile surface compared to all other conditions. It was concluded that older women, particularly those with RA should wear closed back slippers, in preference to toe slippers, around the home, to reduce their incidence of foot pain and/or discomfort as well as to reduce their slip risk at initial foot-ground contact, particularly when walking on slippery surfaces. Further research is recommended to determine whether the prescription of closed back slippers, considered to be “safe” in the present thesis, does in fact reduce falls, particularly slips, in the homes of older women

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