Kevin Rosenbloom, C.Ped:

I'm Kevin Rosenbloom and I have a practice in Santa Monica, California. The postural stability is a human being's ability to maintain a vertical stance bipedally, so walking around or standing on the horizontal plane. Your ability to keep yourself upright or your patient to keep themselves upright. And things that can get in the way of postural stability have been identified such as dizziness, different gait impairments, which could be from all sorts of things, muscle weakness, decreased range of motion in the musculoskeletal system. History of falling is indicated. Neuropathy, different medications, psychotropic medications, hypertension, diabetes, arthritis, which can come full circle to those other items I just mentioned. As well as visual problems to analyze what's going on with your environment.

There's a lot of things you can do. Getting a full history, of course, and communicating with other providers, your referrals, how that patient ended up in your podiatric office, of course, is very important. And then most importantly, I believe muscle strength is number one that we can look at clinically with our tool set and biomechanically the range of motion and seeing what's available, and then, of course, a gait analysis and things like that. Personally I find one tripping over their own feet being the most common in my practice, and so anecdotally speaking, people who find their way into my office who have a history of falling. And I watch them walk and go through the muscle test, it seems to me off the cuff that some level of foot drop or weakness on one side is what seems to cause a history of falls, tripping over one's foot.

It's interesting because there's a lot of literature that's looked at the correlation of how orthosis can help postural stability, but then not necessarily preventing falls. So there's a couple different viewpoints to look at. One is, if you have good stability, how is it really correlated to falls? We'll talk about that. And then if you have falls and then poor stability, what does the different research show? So we'll look at the different publications on that. And then, of course, anecdotal bit of really what it is we can do with some of the bracing that we can provide considering Medicare's rules and things like that as well.

There's different ways. One, stabilizing the ankle joint, also the subtalar joint and the distal joints as well, and the muscles that could be affected causing falls. And essentially the different ways of looking at a patient that has had a history of falls and what you could do to stabilize that foot and stabilize that ankle. In stabilizing the foot and ankle, I really want people to take away that you have to look at the hip and all the proximal musculoskeletal structures as well. So full analysis, working with a good physical therapist, working with family members and working with patients to educate them and get them on a path of stability and recovery if possible and some of the different brace types that are available.

There's not just one, but there's several different options that are available for you to prescribe, dispense to your patient. And we'll look at all of those different braces as well and some of the considerations from stroke patient who may not have pre hand sole ability on one side, and the difficulty of donning a brace if they live alone. Or it could be someone who has all the help and what their activities are, and what their shoe style preferences and things like that, so there's a lot of little things to consider and questions to ask your patient. So we'll review all those as well, and hopefully take away some actionable ways to help patients in your community prevent falls and stay stable.