Jan
20
Written by:
Cherri Choate, DPM
1/20/2010
As our population ages, and remains active, foot health will become more complex. The term "geriatric" leads one to image an elderly patient who is sitting by the window in their easy chair, but in many cases this image is far from the truth. Attempts to formulate a "geriatric" orthotic would be challenging due to the variability of this population. What can be discussed are a few consideration due to the natural process of body aging. Three common changes with age include poor balance, diminished sensation and decreased fat pad. Addressing each of these as you consider an orthotic for a patient later in years may include the following considerations:
1) Balance- Decreased balance can be improved by dispensing a a wide device that is flat posted. The flat post allows the device to sit completely flat in the shoe, therefore avoiding any sensation of movement under the foot. In later years of life, deformities are seldom reducible, so a slightly semi-rigid plate should provide stability, wthout being too rigid.
2) Neuropathy- Providing a multilayer topcover may offer the benefit of cushiioning and decreased friction. A dual layer of either EVA/Poron or EVA/Plastizote, may be options that would work in this situation. If a patient has prominent bone areas, sweet spots are also important to incorporate into the device.
3) Fat pad atrophy- Topcovers are usually an important addition to these devices, as they offer both cushioning for areas of diminished fat pad, as well as space occupation in shoes that are often too spacious for the thinning foot. An EVA, Nylene or Sport topcover will offer these benefits, while avoiding the sense of slipping on a surface such as vinyl.
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