From the ground up: recognising risk of frailty syndromes and functional decline through foot examination

Foot pathologies in older adults are associated with falls and complications such as amputations and ulcers. We report a case of an older man who presented to the geriatric medicine outpatient clinic. History taking revealed a fall, recent episode of delirium and decline in functional status with the patient reporting he was no longer able to cut his own toenails. Medical history included hypothyroidism, depression and hearing impairment. Physical examination detected very long, thickened toenails with bilateral bony deformities of the foot. Additionally, he had borderline slow gait speed and had difficulty completing a chair stand. Inability to maintain foot care suggested an early insight into a deterioration of overall function and emergence of frailty. An interprofessional team approach to the patient’s care included a medication review, referrals to podiatry, orthotics, physiotherapy and occupational therapy. His toenails were debrided and orthopaedic shoes were prescribed with no further falls.