Foot Musculoskeletal Disorders, Pain, and Foot-Related Functional Limitation in Older Persons

Fadi Badlissi, MD, MSc; Julie E. Dunn, PhD; Carol L. Link, PhD; Julie J. Keysor, PhD, PT; John B. McKinlay, PhD; David T. Felson, MD, MPH


J Am Geriatr Soc. 2005;53(6):1029-1033. 

In This Article

Abstract and Introduction

Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain and foot-related functional limitation.
Design: A cross-sectional study using stratified random sampling.
Setting: A residential community.
Participants: Ethnically diverse sample of elderly persons (n=784).
Measurements: Foot disorders (hallux valgus/bunion, pes planus (flat foot), pes cavus (high arch), hammertoe, mallet toe, claw toe, overlapping toes, bunionette, and plantar fasciitis), foot pain, the foot health functional status (FHFS, range 0-100, 100=no problems) scale, and walk time score (range 0-4, 4=fastest).
Results: Most commonly assessed musculoskeletal disorders, including hallux valgus and toe deformities, were not associated with pain or function limitation. Plantar fasciitis and, to a lesser extent, pes cavus were associated with worse FHFS scores; foot pain partially explained this association. Neither foot disorders nor foot pain were significantly associated with slower walk times.
Conclusion: Many foot disorders had little relationship with foot pain or function and may not require clinical attention when asymptomatic. Risk factors and preventive and therapeutic interventions for plantar fasciitis require further longitudinal investigation.

Foot disorders are common in the elderly.[1,2,3,4] A clinical survey of 166 inpatients aged 65 and older found that 50% had foot disorders, including hallux valgus, lesser toe and arch deformities, limited inversion/eversion and ankle motion, and calluses.[1] In a community-based study in England, 52% of 543 elderly subjects reported disorders with their feet, including a range of musculoskeletal, cutaneous, and toenail conditions.[2]

Although foot disorders are common and often the subject of medical attention, it is not clear whether they are associated with pain or functional limitation. Such an association would determine, in part, whether further diagnostic and treatment considerations are warranted. Although foot pain is associated with disability,[3,4] it is not known whether foot disorders themselves are associated with poor functional outcomes independent of pain. This is a critical matter; the need to treat foot pain is clear, but if these disorders are associated with foot-related functional limitation, even in the absence of pain, they may require treatment. There are reasons to believe that musculoskeletal disorders may be linked to functional limitation even if they are not painful. For example, asymptomatic radiographic knee osteoarthritis is associated with disability.[5] One study has suggested that foot disorders per se are associated with functional limitation even after adjustment for foot pain.[6]

This study addresses the association between different foot musculoskeletal disorders and foot pain and functional limitation and attempts to determine whether foot pain mediates that relationship.