Still Looking For Documentation That AFOs Effectively Prevent Falls
- Doug Richie Jr. DPM FACFAS
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I am finalizing an upcoming cover story for Podiatry Today’s September issue titled, “Fall Prevention In The Elderly: Can Podiatric Physicians Have An Impact?” After searching the electronic databases, PubMed, Medline, Proquest, CINAHL and Cochrane Controlled Trials, I was astounded to see that more than 5,000 articles have been published that are relevant to the subject of fall prevention.
Companies are now marketing ankle-foot orthoses (AFOs) to podiatric physicians as part of a multifaceted program designed to prevent falls in the elderly. I am interested to read any published research showing that the use of these devices in such a program would be beneficial. So far I can find no such studies.
I want to ensure that my article is timely and accurate. I am, therefore, asking anyone to help me by providing any insight into why webinars are teaching podiatric physicians to combine bilateral AFO devices with established protocols for prevention of traumatic falls in the elderly.
While a systematic review of the literature has validated several multifaceted programs designed to prevent falls in the elderly, none of these programs involved the use of ankle bracing for elderly patients.1,2 If protocols of balance and exercise training, home hazard assessment and vitamin D therapy have already proved efficacious, what is the rationale for adding a new and unproven modality that may actually compromise balance in frail elderly patients?
If I am overlooking something, please provide me with any evidence that podiatric physicians should continue prescribing plastic shell braces for their patients at risk of falling. Otherwise, I look forward to sharing my research and insights about how podiatric physicians can make a positive impact on fall prevention using scientifically valid interventions.
1. Costello E, Edelstein J. Update on falls prevention for community-dwelling older adults: Review of single and multifactorial intervention programs. J Rehab Res Dev. 2008; 45(8):1135-52.
2. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Sys Rev. 2009; 2:CD007146.