Reform trial and Foothold exercise protocol

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Looking at the REFORM trial and the trial on which the FootHold exercise protocol is based , Spink et al (see below #1 ) what can be deduced ?

In my opinion as follows -

1
Toe curl exercises and marble pick ups do not strengthen the intrinsic toe flexor muscles but , in individuals with foot pain , probably provide enough exercise to reduce inflammation and pain in arthritic foot joints . This pain reduction likely improves early reaction to balance issues leading to reduced falls .

2
The FootHold program is likely to be of most value in patients with foot pain caused by osteo or rheumatoid arthritis and may have very little effect on individuals without foot pain .

#1

49.
Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial.
Spink MJ, Menz HB, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, Lord SR.
BMJ. 2011 Jun 16;342:d3411. doi: 10.1136/bmj.d3411.
PMID:

21680622

Free PMC Article

 

So looking at Spink et al 2011 and Mickle et al (below 1 ) , it seems reasonable to hypothesis that if older patients with pain and foot muscle weakness , associated with osteo and rheumatoid arthritis , are treated by strengthening exercises based around flexing the toes around the MTFJ against progressive resistance , then the health benefits could be enormous .

Any thoughts ?

1
Toe training may keep the elderly upright, VU research finds | Victoria ...

https://www.vu.edu.au/.../toe-training-may-keep-the-elderly-upright-vu-research-finds16 Aug 2016 - Researchers at Victoria University are investigating if toe training ... Karen Mickle, a post-doctoral research fellow at Victoria University, has ..

 

So expanding on the above , other than the number of recruits , the biggest difference between the REFORM trial and that of Spink et al 2011 is in the selection criteria for the cohorts in question .

For the REFORM trial the main inclusion criterion was a visit to a podiatrist in the previous six months but in Spink it was about the presence of disabling foot pain . Both trials used similar exclusion criteria and interventions over and above normal care .

The REFORM trial did not deliver a significant reduction in the rate of falls but Spink's did . ( 36% )

So in my opinion , the value of these studies when taken as a whole likely boils down to the treatment of disabling foot pain by resistance exercise with a subsequent reduction in falls rate .

Reducing the information gathered by the trials down to its essence , I believe it can be represented as " in patients over 65 years of age with disabling foot pain , toe exercise with a resistance component can significantly reduce the rate of falls "

That's valuable information .

For various reasons I do not believe that the ankle exercises used in both of the trials have much of a bearing on anything .

 

Rooting around on the internet it seems apparent that exercising the foot via towel curls (toe curls ) is an accepted method for reducing foot pain from arthritis .(see link below )

Of course this exercise is primarily an exercise for the external toe flexors but it does have an intrinsic muscle component , which although not sufficient to strengthen the intrinsic muscles ,seems to help reduce pain and inflammation .

My question would be how much better would exercises such as used by Mickle et al 2016 (below 2) ,which exercise the intrinsics much more effectively by movement of the toes around the MTFJ , reduce foot pain ,improve foot function and reduce falls .


Link 1
Foot pain - Arthritis Research UK

https://www.arthritisresearchuk.org/~/media/Files/Arthritis.../Foot-pain-pamphlet.ashxWall push a) Facing a wall, put both hands on the wall at shoulder height and place one foot in front of the other. The front foot should be approximately 30 cm.


link 2
Efficacy of a progressive resistance exercise ... - Research Online - UOW

ro.uow.edu.au/cgi/viewcontent.cgi?article=1982&context=ihmriACCEPTED MANUSCRIPT. 1. Efficacy of a Progressive Resistance Exercise Program to Increase Toe Flexor. Strength in Older People. Karen J. Mickle a1.

 

If you take a group of people suffering from rheumatoid arthritis and introduce them to a six week progressive resistance training program ,are there any long term benefits ? One recent study suggests that for the majority of participants the benefits are still accruing years later .

That's worth repeating . One six week program , years of benefit .

Here is the study conclusion -

Conclusions Over 90% of patients who responded found the six week PRT programme worthwhile. More than half (51–75%) of the patients continued a PRT exercise programme. Patients who continued exercises felt better compared with those who did not continue exercises.

This is a link to the relevant study extract .

PARE0004 Patient reported long term effects of six week progressive ...

ard.bmj.com › Archive › Volume 76, Issue Suppl 2
by R Tekkatte - ‎2017 - ‎Related articles
Background We introduced six week physiotherapy led progressive resistance training (PRT)programme for Rheumatoid arthritis (RA) patients to improve ...

 

I haven't seen the full paper , but from the summary Professor Menz has things spot on in this paper (below ) .

Here is an extract -
Conclusion

Foot problems, particularly foot pain, hallux valgus and lesser toe deformity, are associated with falls in older people. Documentation of foot problems and referral to foot care specialists should therefore be a routine component of falls risk assessment and prevention.

-------------------

The one thing I would add is that referring these patients will not only help prevent falls but also help people remain active , fit and self sufficient for longer .
Spend a pound to save a tenner .

Paper
Foot problems as a risk factor for falls in community-dwelling older ...

https://www.researchgate.net/.../328037013_Foot_problems_as_a_risk_factor_for_falls_...1 day ago - Foot problems as a risk factor for falls in community-dwelling older people: a systematic review and meta-analysis. Article in Maturitas · October ...

 

Who gives advice to older people on falls prevention where you live ? In the Strathcylde area where I live ,this task has , in part , been given to Firefighters . I suppose the idea is that when they do safety related home visits fall risks are discussed at the same time as fire risks . Anyway, the point is that no one profession is clearly identified as "the falls prevention profession " .

Now that is understandable since falls may be due to a large number of factors including medication , but it strikes me , since falls are all about balance and feet , that podiatry should be the core "falls prevention profession" .

Looking at the present work of Prof Menz ( regarded by many as the worlds leading podiatrist ) , I see that he is focusing on falls prevention and physiotherapy . Spot on . Again .