Foot Disorders, Pain and Physical Disability in Elders

描述（由申请人提供）：关于足部生物力学和足部疾病的人群数据很少，足部病理往往被忽视为老年人身体限制、平衡受损和下肢功能障碍的重要潜在原因。这些问题是主要的公共卫生问题，随着人口老龄化，其重要性只会增加。弗雷明汉足部研究是第一批研究足部疾病和足部疼痛的患病率和模式的研究之一。在过去的五年中，弗雷明汉足部研究为了解特定足部疾病的人群患病率以及这些疾病对身体限制的作用做出了重大贡献。在接下来的五年里，我们建议在这个竞争性的更新申请中，通过使用一种精细的足底压力测量方法，通过检查与身体限制和下肢功能相关的足部生物力学来扩展这一主题。我们计划使用弗雷明汉队列（n~3053）在过去拨款周期中收集的足底压力扫描数据，以及在种族多样化的约翰斯顿县队列（n~3084）中获得的额外足底压力扫描数据。使用这些扫描，我们将确定特定足部区域的峰值压力以及使用定义良好的工程技术和统计工具的压力偏移指数中心。此外，我们建议从约翰斯顿县老年非洲裔美国人和白种人男性和女性中获得有关足部疾病的具体数据。我们将使用这些数据来研究两种不同种族和文化的人群在静态和动态姿势下足部不同区域的足底压力与足部疾病和下肢功能和功能障碍的发生之间的关系。我们的四个具体目标将检验来自两个基于人口的队列（Framingham研究和Johnston县研究）的不同年龄组和种族的男性和女性的足压力测量的横断关系，包括表明旋前和旋后动态测量的压力偏移中心指数，以及足部特定区域的峰值负荷；2)这些足压措施与特定足部疾病、足部疼痛、踝关节、膝关节和髋关节疼痛有关；3)这些足压测量和下肢功能，特别是物理性能测量，肌肉质量和腿部肌肉力量，以及4)纵向确定将预测随时间发生的足部疾病的危险因素。基于初步数据，本研究将为足部生物力学和疾病在男性和女性下肢功能中的作用提供新的重要信息。没有其他项目将老年男性和女性足部疾病的详细信息与不同人群的综合功能、下肢表现、肌肉状态和跌倒联系起来。公共卫生相关性：这项研究将提供新的公共卫生信息，说明老年高加索人和非裔美国人的足部生物力学和特定足部疾病的重要性，因为这些问题以及下肢残疾和跌倒对许多老年人来说是严重的负担。从公共卫生的角度来看，了解该项目中提出的因素是至关重要的，因为社区对足部疾病的了解甚少，并且有可能通过治疗来改变。

DESCRIPTION (provided by applicant): Little population-based data exist on foot biomechanics and foot disorders, and foot pathologies are often overlooked as important potential causes of physical limitations, impaired balance, and lower extremity dysfunction in older persons. These issues represent major public health problems that will only increase in importance as the population ages. The Framingham Foot Study is one of the first studies to examine the prevalence and the pattern of foot disorders and foot pain. For the past five years, the Framingham Foot Study has contributed substantially to understanding population-based prevalence of specific foot disorders and the role of these disorders upon physical limitation. Over the next five years, we are proposing in this competing renewal application to expand on this theme by examining the biomechanics of the foot in relation to physical limitations and lower extremity function, by using a refined measure of plantar pressure in each region of the foot. We plan to use data from plantar pressure scans collected over the past grant cycle in the Framingham cohort (n~3053), along with additional plantar pressure scans to be acquired in the ethnically diverse Johnston County cohort (n~3084). Using these scans, we will determine measures of peak pressures within specific foot regions as well as center of pressure excursion indices using well-defined engineering techniques and statistical tools. In addition, we propose to obtain specific data on foot disorders from the Johnston County cohort of older African-American and Caucasian men and women. We will use the data to examine the relation between plantar pressures in different regions of the foot in static and dynamic postures with the occurrence of foot disorders and lower extremity measures of function and dysfunction across the two ethnically and culturally diverse populations. Our four specific aims will examine the cross-sectional relation of 1) foot pressure measures between different age groups and ethnic groups in men and women from two population- based cohorts (Framingham Study and Johnston County Study), including center of pressure excursion index that indicates dynamic measures of pronation and supination, as well as peak load in specific regions of the foot; 2) these foot pressure measures and specific foot disorders, foot pain, and ankle, knee and hip joint pain; 3) these foot pressure measures and lower extremity function, specifically physical performance measures, muscle mass and leg muscle strength, as well as 4) the longitudinal determination of risk factors that will predict incident foot disorders over time. Based on preliminary data, this study will provide new and important information about the role of foot biomechanics and disorders upon lower extremity function in men and women. No other project has linked detailed information on foot disorders in older men and women to comprehensive function, lower extremity performance, muscle status, and falls in diverse populations. PUBLIC HEALTH RELEVANCE: This study will provide new public health information of the importance of foot biomechanics and specific foot disorders in older populations of Caucasians and African-Americans, as these issues along with lower extremity disability and falls are serious burdens for many older adults. Understanding of the factors proposed in this project is essential from the public health standpoint because foot disorders are so poorly understood in the community, and are potentially modifiable through treatment.