Rehabilitation of Patients with Geriatric Foot Syndrome in Out-patient Settings

Author Name(s): Irina P. Pochitaeva, Andrei N. Ilnitskii, Svetlana G. Gorelik, Margarita V. Koroleva, Elmira E. Satardinova, Elena A. Voronina
Author Email: sggorelik@mail.ru

Abstract

Geriatric (senile) foot, according to various authors, is one of the most common syndromes in the elderly and senile. This geriatric syndrome is polyetiological since local factors take part in its formation – circulatory disorders in the distal extremities, osteoarthritis of the small joints of the foot, age-related decrease in skin sensitivity and other, as well as somatic diseases leading to the development of geriatric syndromes such as dizziness, ataxia, imbalance, which contributes to repeated falls. This article describes the developed and scientifically substantiated tactics of rehabilitation treatment of patients with age-related foot syndrome in a clinic, which consists in identifying geriatric syndromes associated with age-related foot syndrome and the use of a set of measures to prevent their progression and treatment. The following recommendations were added to targeted secondary prevention: 1) technical means of rehabilitation; 2) orthopedic shoes; 3) morning exercises and passive movements in the limbs; 4) the use of canes, walkers. All these measures are recommended for the prevention of the syndrome of falls and sarcopenia, the correction of walking disorders and an increase in general motor activity. Nutritional support, nutrition status correction, and nutrition monitoring are essential for the prevention and correction of malnutrition syndrome. Together, the above additional measures had a clear focus on the prevention and correction of senile asthenia syndrome.

Introduction

Modern approaches to the rehabilitation treatment of elderly and senile people develop along with providing syndromic care, which is ultimately focused on maintenance of the maximum degree of independence and shaping of the highest possible quality of life [1, 2]. Geriatric (senile) foot, according to various authors, is one of the most common syndromes in the elderly and senile. This geriatric syndrome is polyetiological since local factors take part in its formation – circulatory disorders in the distal extremities, osteoarthritis of the small joints of the foot, age-related decrease in skin sensitivity and other, as well as somatic diseases leading to the development of geriatric syndromes such as dizziness, ataxia, imbalance, which contributes to repeated falls [3, 4]. In addition, the domestic literature does not almost distinguish geriatric foot syndrome as an object of rehabilitation treatment. For the first time in domestic literature, geriatric foot syndrome was described in 2014 [5]. To date, there are only a few works that highlight aspects of rehabilitation treatment in this condition. In addition, these programs neglect the prevention of precisely those geriatric syndromes, which then lead to the formation of senile asthenia syndrome, and the development of this condition determines the degree of social insufficiency in elderly and senile people. On the other hand, rehabilitation treatment has the fullest potential for the rehabilitation of the functionality of people of older age groups, which is reflected in the World Health Organization Global Report on Aging (2015)

Conclusion

The effectiveness of the proposed optimized rehabilitation treatment of patients with geriatric foot syndrome receiving medical and social support, which consists in the correction of non-drug and drug therapy, was tested by us in the age group of 70-79 years as a target in the provision of specialized geriatric care. In terms of the effectiveness of therapy and measures, patients were examined according to the “Lower limb functional scale” [5] and evaluated according to changes in geriatric status and the development of geriatric syndromes such as syndromes of fall, malnutrition, sarcopenia, anxiety-depressive syndrome, and senile asthenia syndrome. In addition to the comparative assessment of functional changes in geriatric foot syndrome and geriatric status, an assessment of the quality of life was carried out using the SF 36 scale. It was found that the “Functional scale for the lower limb” in the control group estimated difficulties associated with the state of the lower limb (housekeeping, using the bathroom and toilet, walking, standing on legs, going up and down stairs, putting on socks, etc.) before the start of the observation as 42.5±2.3 points, after 5 months – 41.7±2.2 points, in the main group – 42.6±2.7 points and 61.4±2.4 points, respectively, p<0.05.

 

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