Foot and ankle biomechanics during walking in older adults: A systematic review and meta-analysis of observational studies

Abstract

BACKGROUND: The foot and ankle complex undergoes significant structural and functional changes with advancing age. RESEARCH QUESTION: The objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults. METHODS: Electronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. RESULTS: A total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference WMD: -5.15; 95 %CI: -6.47 to -3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference SMD: -0.62; 95 %CI: -0.82 to -0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible. SIGNIFICANCE: Older adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.