This month, the Journal of the American Podiatric Medical Association (JAPMA) published an entire issue devoted to the subject of the prevention of falls in older people (volume 103, issue 6). This publication represents a landmark contribution from the podiatric profession to this vital public health initiative.
After reading all of the articles presented in November/December 2013 issue of JAPMA, I was struck by the following observations.
* The concept of falls prevention is extremely complicated and research studying risk factors and interventions often demonstrates conflicting results.
* In every article of this JAPMA issue, the authors are very careful to limit their conclusions to the data produced by their investigations. Never do any authors make a sweeping conclusion that we can expect any intervention to predictably reduce the risk of falls in the elderly population.
* In this issue of JAPMA, there is a huge amount of research on interventions that the podiatric physician commonly implements in daily practice. These interventions include foot orthoses, footwear prescription and lower extremity exercise programs, which can specifically address some of the risk factors associated with traumatic falls.
* There was no mention in any of the articles of any positive benefit of using ankle-foot orthoses (AFOs) to prevent falls in the elderly population. This is not surprising since there has been no published research to date showing that AFO devices can provide this benefit.
This landmark issue of JAPMA represents a much needed effort by the American Podiatric Medical Association (APMA) to clarify the role of the podiatric physician in fall prevention in the elderly population. This became necessary after considerable controversy developed in our profession over the use of devices marketed specifically to podiatric physicians with the promise of preventing falls in the elderly.1-3 The collection of stellar articles in this issue of JAPMA clearly illustrates that there is a wealth of sound scientific knowledge from which the podiatric physician can draw when making decisions about interventions that improve the quality of life in the elderly population.
1. Richie D Jr. The truth about AFOs and fall prevention. Available at http://www.podiatrytoday.com/blogged/truth-about-afos-and-fall-prevention  . Published on February 24, 2012. Accessed December 27, 2013.
2. Richie D Jr. Preventing falls in the elderly: where DPMs can have an impact. Podiatry Today. 2012; 25(9):38-51.
3. Christensen JC, Richie D Jr. Point-Counterpoint: Do AFOs have a role in falls prevention? Podiatry Today. 2013; 26(10):42-49.