Skip to main content
SpringerLink
Log in

Absent pedal pulse and impaired balance in older people: a cross-sectional and longitudinal study

  • Original Articles
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims: The purpose of this study was to determine the relationship between abnormal pedal pulse status and postural balance in older people. Methods: Prospective, population-based cohort study of older residents in the city of Jyväskylä, Finland. A total of 419 individuals aged 75 or 80 at baseline, with known lower extremity pulse status and balance tests performed on a force platform, were eligible for analysis. Results: Cross-sectionally, persons with both dorsal pedal artery pulses absent were found to sway more (p=0.047 anteroposterior velocity, normal standing eyes-open position). The risk of being unable to do the full tandem stance was twofold (OR=2.20, 95% CI 1.29–3.78) for persons without palpable dorsal pedal arteries compared with those with normal pulse status. Balance deterioration was observed at five years (p<0.001for time) but without group-by-time interaction. At ten years, however, the interaction term became significant for the normal standing eyes-closed position (p=0.025 for anteroposterior velocity and p=0.026 for mediolateral velocity), indicating greater balance deterioration among those with both dorsal pedal artery pulses absent. Conclusions: According to our study, the absence of both dorsal pedal artery pulses is associated with impaired balance in older people. The association was observed both cross-sectionally and longitudinally. In addition, as diminished pedal pulses are frequently associated with impaired lower extremity circulation, our results have also produced information on the possible pathophysiological mechanisms of balance deterioration in older people, which warrant further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Era P, Heikkinen E. Postural sway during standing and unexpected disturbance of balance in random samples of men of different ages. J Gerontol 1985; 40: 287–95.

    Article  PubMed  CAS  Google Scholar 

  2. Prieto T, Myklebust J, Hoffman R, Lovett E, Myklebust B. Measures of postural steadiness: differences between healthy young and elderly adults. IEEE Trans Biomed Eng 1996; 43: 956–66.

    Article  PubMed  CAS  Google Scholar 

  3. Choy N, Brauer S, Nitz J. Changes in postural stability in women aged 20 to 80 years. J Gerontol A Biol Sci Med Sci 2003: 58A: M525–30.

    Article  Google Scholar 

  4. Onder G, Penninx B, Lapuerta P, et al. Change in physical performance over time in older women: the women’s health and aging study. J Gerontol A Biol Sci Med Sci 2002; 57A: M289–93.

    Article  Google Scholar 

  5. Era P, Heikkinen E, Gause-Nilsson I, Schroll M. Postural balance in elderly people: changes over a five-year follow-up and its predictive value for survival. Aging Clin Exp Res 2002; 14: 37–46.

    PubMed  Google Scholar 

  6. Bernard S, Leblanc P, Whittom F, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 158: 629–34.

    Article  PubMed  CAS  Google Scholar 

  7. Massie BM, Simonini A, Sahgal P, Wells L, Dudley GA. Relation of systemic and local muscle exercise capacity to skeletal muscle characteristics in men with congestive heart failure. J Am Coll Cardiol 1996; 27: 140–5.

    Article  PubMed  CAS  Google Scholar 

  8. McDermott MM, Criqui MH, Greenland P, et al. Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance. J Vasc Surg 2004; 39: 523–30.

    Article  PubMed  Google Scholar 

  9. McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA 2001; 286: 1599–606.

    Article  PubMed  CAS  Google Scholar 

  10. McDermott MM, Fried L, Simonsick E, Ling S, Guralnik JM. Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning. Circulation 2000; 101: 1007–12.

    Article  PubMed  CAS  Google Scholar 

  11. Gardner AW, Montgomery PS. Impaired balance and higher prevalence of falls in subjects with intermittent claudication. J Gerontol A Biol Sci Med Sci 2001; 56: M454–8.

    Article  PubMed  CAS  Google Scholar 

  12. Brearley S, Simms MH, Shearman CP. Peripheral pulse palpation: an unreliable physical sign. Ann R Coll Surg Engl 1992; 74: 169–71.

    PubMed  CAS  Google Scholar 

  13. Lundin M. Wiksten J-P. Peräkylä T. et al. Distal pulse palpation: is it reliable? World J Surg 1999; 23: 252–55.

    Article  PubMed  CAS  Google Scholar 

  14. Quigley FG, Faris IB, Duncan HJ. A comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes. Clin physiol 1991; 1: 21–5.

    Article  Google Scholar 

  15. Heikkinen E. Background, design and methods of the Evergreen project. J Aging Phys Activity 1998; 6: 106–20.

    Google Scholar 

  16. Era P, Schroll M, Ytting H, Gause-Nilsson I, Heikkinen E, Steen B. Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study. J Gerontol A Biol Sci Med Sci 1996; 51: M53–63.

    Article  PubMed  CAS  Google Scholar 

  17. Robertson GS. Ristic CD. Bullen BR. The incidence of congenitally absent foot pulses. Ann R Coll Surg Engl 1990; 72: 99–100.

    CAS  Google Scholar 

  18. Yamada T, Gloviczki P, Bower TC, Naessens JM, Carmichael SW. Variations of the arterial anatomy of the foot. Am J Surg 1993; 166: 130–5.

    Article  PubMed  CAS  Google Scholar 

  19. McGee SR, Boyko EJ. Physical examination and chronic lowerextremity ischemia: a critical review. Arch Int Med 1998; 158: 1357–64.

    Article  CAS  Google Scholar 

  20. Stoeffers HE, Rester AD, Kaiser V, Rinkens PE, Knottnerus JA. Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practise: a multivariate approach. Med Decis Making 1997; 17: 61–7.

    Article  Google Scholar 

  21. Farinon AM, Marbini A, Gemignani F, et al. Skeletal muscle and peripheral nerve changes caused by chronic arterial insufficiency significance and clinical correlations: a histological, histocenical and ultrastructural study. Clin Neuropathol 1984; 3: 240–52.

    PubMed  CAS  Google Scholar 

  22. Regensteiner JG, Wolfel EE, Brass EP, et al. Chronic changes in skeletal muscle histology and function in peripheral arterial disease. Circulation 1993; 87: 413–21.

    Article  PubMed  CAS  Google Scholar 

  23. Gregg EW, Beckles GLA, Williamson DF, et al. Diabetes and physical disability among older U.S. adults. Diabetes Care 2000; 23: 1272–77.

    Article  CAS  Google Scholar 

  24. Teunissen LL, Notermans NC, Jansen GH, Banga JD, Veldman H, Wokke JH. Thickness of endoneurial vessel basal lamina area in chronic idiopathic axonal polyneuropathy. Acta Neuropathol (Berl) 2000; 100: 445–50.

    Article  CAS  Google Scholar 

  25. Teunissen LL, Veldink J, Notermans NC, Bleys RL. Quantitative assessment of the innervation of epineurial arteries in the peripheral arterial nerve by immunofluorescence: differences between controls and patients with peripheral arterial disease. Acta Neuropathol 2002; 103: 475–80.

    Article  PubMed  CAS  Google Scholar 

  26. Ekdahl C, Jarnlo GB, Andersson SI. Standing balance in healthy subjects. Evaluation of a quantitive test battery on a force platform. Scand J Rehabil Med 1989; 21: 187–95.

    CAS  Google Scholar 

  27. Birmingham TB. Test-retest reliability of lower extremity functional instability measures. Clin J Sport Med 2000; 10: 264–8.

    Article  PubMed  CAS  Google Scholar 

  28. Sihvonen S, Sipilä S, Era P. Changes in postural balance in frail elderly women during 4-week visual feedback training: a randomised controlled study. Gerontology 2004; 50: 87–95.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Jyväskylä Central Hospital, Jyväskylä

    Velipekka Suominen

  2. Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere

    Juha Salenius & Maarit Heikkinen

  3. Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, Jyväskylä, Finland

    Eino Heikkinen & Taina Rantanen

Authors
  1. Velipekka Suominen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juha Salenius
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eino Heikkinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maarit Heikkinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taina Rantanen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Velipekka Suominen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suominen, V., Salenius, J., Heikkinen, E. et al. Absent pedal pulse and impaired balance in older people: a cross-sectional and longitudinal study. Aging Clin Exp Res 18, 388–393 (2006). https://doi.org/10.1007/BF03324835

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324835

Keywords

Search

Navigation