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，而足部病理经常被忽视，因为它们是老年人身体受限、平衡受损和下肢功能障碍的重要潜在原因。这些问题代表着重大的公共卫生问题，随着人口老龄化，这些问题的重要性只会增加。弗雷明翰足部研究是首批调查足部疾病和足部疼痛的患病率和模式的研究之一。在过去的五年里，弗雷明翰足部研究对了解特定足部疾病的人群流行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扩展这个主题，通过使用脚部每个区域的脚底压力的精确测量来检查与身体限制和腿部功能有关的脚的生物力学。我们计划使用弗雷明翰队列(n~3053)在过去拨款周期中收集的足底压力扫描数据，以及在种族多元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。通过这些扫描，我们将使用定义明确的工程技术和统计工具来确定特定足部区域内的峰值压力测量以及压力中心漂移指数。此外，我们建议从约翰斯顿县老年非裔美国人和高加索人男性和女性队列中获得足部疾病的具体数据。我们将使用这些数据来研究静态和动态姿势下脚底不同区域的压力与足部疾病的发生以及两个种族和文化差异人群的腿部功能和功能障碍的测量之间的关系。我们的四个具体目标将从两个基于人群的队列(弗雷明翰研究和约翰斯顿县研究)考察不同年龄组和种族组男性和女性足部压力测量的横截面关系，包括指示旋前和旋后的动态测量的压力中心漂移指数以及足部特定区域的峰值负荷；2)这些足部压力测量和特定的足部疾病、足部疼痛以及脚踝、膝盖和髋关节疼痛；3)这些足部压力测量和下肢功能，特别是体能测量、肌肉质量和腿部肌肉力量，以及4)将随着时间的推移预测足部疾病发生的风险因素的纵向确定。基于初步数据，这项研究将提供关于足部生物力学和疾病对男性和女性下肢功能的作用的新的和重要的信息。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、下肢功能、肌肉状况和跌倒联系起来。公共卫生相关性：这项研究将提供新的公共卫生信息，说明足部生物力学和特定足部疾病在高加索人和非裔美国人老年人口中的重要性，因为这些问题以及腿部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，理解这个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非常少，而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.