Article Text

Download PDFPDF
From the ground up: recognising risk of frailty syndromes and functional decline through foot examination
  1. Kirstyn James1,2,3,4,
  2. Christian Baglini5 and
  3. Andrea Wershof Schwartz1,3,6
  1. 1New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, USA
  2. 2Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
  3. 3Harvard Medical School, Boston, MA, USA
  4. 4Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
  5. 5Boston College, Chestnut Hill, Massachusetts, USA
  6. 6Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Kirstyn James; kirsjames{at}


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.

  • geriatric medicine
  • memory disorders (psychiatry)
  • dermatology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • KJ and CB contributed equally.

  • Contributors KJ and CB both contributed equally and wish to be listed as co-first authors. KJ and CB contributed to conceptualisation, methodology, writing—original draft, writing—review and editing. AWS contributed to conceptualisation and writing—review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests This material is the result of work supported with resources and the use of facilities at the VA Boston and New England GRECC. The contents do not represent the views of VA or the United States Government.

  • Provenance and peer review Not commissioned; externally peer reviewed.