What you'll need to perform the exercise program
FootHold is designed to be easily transferable to a variety of clinical settings. However, in order to complete the exercises, you will need the following pieces of equipment:
1. Study table and chair
2. Resistance exercise bands (eg: Theraband)
3. Marbles (and a cup or mug to put them in)
4. A large rubber band
5. An archxerciser device (optional). Available for purchase from Elgin (link)
6. A FootGym device (optional). Available from ING Source (link)
A description of how to perform the exercises, number of repetitions and dosage can be found in the DVD booklet, which can also be downloaded as a PDF here:
Foot orthoses
In addition to the FootHold exercise program, participants in the trial also received a pair of foot orthoses. The foot orthoses were prefabricated, full length, dual density orthoses made from a thermoformable cross linked closed cell polyethylene foam with a firm density base and a soft density top cover (Formthotics; Foot Science International, Christchurch, New Zealand):
Consistent with the manufacturer’s instructions, the orthoses were heat moulded to each participant’s foot shape. The orthoses were then appropriately customised using 3 mm thick Poron (Rogers, Rogers, CT), a urethane foam, to redistribute pressure away from plantar lesions, such as calluses, that were identified on the participant’s forefoot.
We found that this approach reduced pressures under the heel by 23% and pressures under the forefoot by 12%, and these changes were largely maintained after 12 months of wear. You can access the research paper here.
Footwear advice
We used a validated footwear assessment form to assess participants’ outdoor footwear. Participants with inappropriate footwear (defined as a heel height >4.5 cm, or any two of no fixation, no heel counter, a heel counter that could be compressed greater than 45 degrees, a fully worn or smooth sole, or a shoe heel width narrower than the participant’s heel by at least 20%) were counselled on the specific identified hazardous features of the footwear and were provided with a handout on what constitutes a safe shoe. They were provided with the contact details of an extra depth and medical grade footwear retailer and asked to purchase a more appropriate pair of shoes.
Both the footwear assessment form and safe shoe handouts can be downloaded below (as PDF files):
Falls prevention advice
We provided each participant in the trial with a booklet (Don't falls for it - falls can be prevented) produced by the Australian Commonwealth Department of Health and Ageing. This booklet provides a general overview of risk factors for falls and outlines strategies to prevent falls. You can download the PDF here:
Falls screening
Most older podiatry patients are already at an elevated risk of falling due to their age and the fact they have foot problems. However, there is still some value in conducting a simple falls screening test to identify those at particularly high risk. There are lots of screening tools available, but we recommend the QuickScreen tool developed by Dr Anne Tiedemann at the University of Sydney. You can purchase the QuickScreen kit (which include an instructional video and other resources) here.
