THE FOOT IS A complicated body part – home to 26 bones, says Dr. Neal Houslanger, a podiatrist in private practice at Houslanger & Kassnove Podiatrists in Patchogue, New York. This complexity and the heavy-duty wear-and-tear they endure over the years places a lot of stress and strain on our feet over the years.
"Each bone needs to be in a specific place, but as we age, our bodies are always changing and usually not for the better," Houslanger says. One aspect of this process is that "the cells hold less water, which affects the collagen, tendons and ligaments in the feet. Tendons get tighter and ligaments get looser." When the muscles, tendons, ligaments and bones shift, that can lead to pain and bony growths, among other problems.
In addition to less water in the cells, "our circulation diminishes, so our healing ability lessens" as we age, Houslanger says, making older adults "more prone to infections and other issues." As people are living longer, overuse and joint injuries in the feet are also becoming more common.
After a lifetime of supporting and carrying your weight – while quite possibly encased in ill-fitting shoes – it shouldn't come as a huge surprise that many older adults develop foot problems. Among the most common issues older adults may experience with their feet are:
Bunions. Bunions, also called hallux valgus, are painful, bony bumps that develop on the outside of the big toe joint. They tend to develop slowly over time, as pressure on the big toe joint pushes the toe inward, toward the second toe. This effect is often exacerbated by tight footwear or high heels, and over time, the bone structure changes leading to a bunion.Corns, callouses and dry skin. Corns and callouses are thickened patches of dead skin that form to protect more sensitive areas and may develop in response to constant rubbing from an ill-fitting pair of shoes or other regular irritation. They're often accompanied by dry skin, which can also be painful and lead to cracked skin that's prone to infection.
Hammertoes. The term "hammertoe" refers to a toe that points upward, rather than lying flat. The Cleveland Clinic reports that "the condition is actually a deformity that happens when one of the toe muscles becomes weak and puts pressure on the toe's tendons and joints. This pressure forces the toe to become misshapen and stick up at the joint." Also sometimes called claw toe or mallet toe, these conditions are frequently accompanied by a painful corn that rubs on the inside of the wearer's shoe.
Structural changes. As we age, the fat pads on the bottom of our feet thin, which can lead to pain with each step as well as less support for the arch. Achilles tendonitis and pinched nerves can also develop as the foot ages.
Arthritis. Because the foot has so many joints – 33 in total – osteoarthritis can be a major source of pain and limited mobility for older adults.
Heel pain. Pain at the back of the foot may result from heel spurs – bony growths that develop along the heel bone – or plantar fasciitis – inflammation of the ligament that runs along the bottom of the foot. Both can make standing and walking very painful.
Diabetes-related foot problems. Changes in your overall health can also take a toll on your feet and lower extremities. Specifically, diabetics have a higher rate of vascular issues that can lead to major foot problems that may eventually require amputation, and thus diabetics need to carefully monitor foot health.Fungal infections, ingrown toenails and other toenail issues. Our bodies are host to many different types of bacteria and fungus, and most of the time, these foreign bodies are in balance and can actually be beneficial to our health. But an overgrowth of fungus, such as may occur when the feet are constantly damp, can lead to painful and unsightly infections of the toenails and between the toes. Toenails can also grow at odd angles, leading to ingrown toenails that can be extremely painful and require surgery to correct. Dry and brittle nails are also more common among older adults, as blood flow to the lower extremities weakens.
Pain and soreness. Pain and soreness may accompany any of the other problems cited and can be a problem in and of itself that can prevent you from comfortably standing or walking for longer periods of time.
As with anything, no two people are going to have the same experience of aging and foot health. Depending on what shoes you've worn your whole life, how active you've been and your genetics, you may develop one or more of these problems, or none of them.
Any and all of these conditions may lead you to seek the assistance of a podiatrist, a specialist doctor who focuses on foot health. Dr. Said Atway, a clinical assistant professor of podiatry at The Ohio State University Wexner Medical Center, says that he generally sees two subsets of older patients in his practice, including "the active elderly patient, which we're seeing more of as the general population ages," he says. These older adults are still active and healthy and may develop overuse injuries. Keeping their feet healthy will enable them to continue being as active as they want, with less pain.
The Agony of the Feet
On the other hand, sedentary older adults may also often experience foot problems. "These adults are not in the workforce or active and they're more prone to things like diabetes and vascular disease because the blood flow isn't running as well. They're not maintaining overall health, and they can develop things like pressure wounds or callouses. They may also not be able to reach their feet, or because of vision impairment, they can't see their feet," and this can mean that small problems that could have been corrected early on had they been spotted are allowed to develop into much bigger issues, Atway says.
Houslanger says that walking barefoot isn't a great choice for any of us, but definitely not for older adults and those with diabetes or vascular issues that elevate risk for foot problems. Going barefoot is an issue for a number of reasons, not least of which is the mere possibility of stepping on something. With reduced vascular capacity or neuropathy that often accompanies diabetes and other chronic diseases associated with age, the chances of stepping on something sharp and not feeling it increase. That can lead to dangerous infections.
You should also "avoid going barefoot," Houslanger says, because your foot needs support. Similarly, he says flip-flops are a bad idea. "We see so much trauma in the summer from flip flops." Wearing slippers might seem like a good choice for in the house, but these typically don't provide enough support for the feet and Houslanger cautions that "slippers and socks are a fall hazard. Open back shoes are bad as well," he says, and suggests finding a well-fitting "pair of running shoes," to wear inside and out. If you prefer to remove your shoes indoors for sanitary reasons, he recommends having a second pair of shoes that you wear only inside.
Wearing the right shoes can make a big difference in the health of your feet and can help prevent foot problems from developing. Atway says that many people don't realize that as their feet change, they may need to purchase larger shoe sizes to accommodate how the bones and ligaments have shifted.
When it's time to buy new shoes, Houslanger recommends shopping later in the day. Over the course of the day, gravity makes your feet swell, so your feet may be a bit larger later in the afternoon than they are first thing in the morning. If the shoes fit comfortably in the evening, they'll probably work well any time. And once you bring the new shoes home, wear them around the house for about 20 or 30 minutes to make sure they fit correctly. "It takes about 20 minutes before a problem occurs, so this way if you wear them for a half hour on a carpet," if a problem arises, you can still return them as they won't show wear on the soles as they would if you wore them outside. If they're still comfortable after a half hour, they should work for you longer term, he says.
Atway says that if you're not having specific problems with your feet, seeing a podiatrist once a year is probably adequate. However, if you're having foot pain or have a systemic disease such as diabetes or vascular diseases that increase your risk of developing foot problems, it's important that you see a podiatrist regularly to prevent small problems from developing into bigger issues. He says "skin changes or infections, pain or anything you're not sure about," are good reasons to visit the podiatrist to get it checked out.
Houslanger recommends checking your feet daily. If it's difficult for you to bend over to have a look, "get your partner to look or get a mirror. If you see something different that you haven't seen before, seek treatment. And wash and dry your feet thoroughly, especially between the toes," as that can be a common site for fungal growth. You may even want to use a hair dryer for 5 or 10 seconds after blotting dry to make sure your feet are completely dry.
He also recommends using foot lotion daily, particularly if you live in a dry part of the country. "Winter air dries out the skin, and dried out skin doesn't get as much circulation. Massage the cream in for 30 seconds to help circulation and make the skin more soft and supple. Do that morning and night, and avoid open-backed shoes" to help banish callouses and dry heel skin. He also recommends drinking more water, pointing to houseplants for inspiration. "You see how a dry houseplant gets more vibrant when it's been watered. Our skin and bodies are the same way."
Some older adults may also seek the assistance of a visiting foot care nurse to assist with regular grooming and checking of the feet, particularly if they're dealing with a systemic disease like diabetes or vascular disease. This can be helpful if you're having trouble conducting routine self-care of the feet. If you're going to go hire a visiting foot nurse or other health care provider to assist with foot care, make sure the person is certified and licensed appropriately in your state to provide such care.
Houslanger says your podiatrist is the best bet for clipping your toe nails – which should be cut straight across and not too short. "Never go into the corners to clean out tissue. If you do, that increases the chance of infection by 50 percent. And don't clean out under the nail." He says doing so can separate the nail from the nail bed and make the nail fall off. He cautions that visiting a nail salon for help with problematic feet and toenails isn't a great idea, as infections are common from these facilities and often, workers there don't have specific training in how to appropriately deal with common foot problems.
Lastly, Atway says that for anyone with foot pain, it's important to realize that's not just a normal part of aging. There are treatments that can help you get back to your more active self with less pain. "You should have that evaluated," and your podiatrist can help you find a solution to get you back on your feet, literally. He says many patients may be "candidates for some kind of minor procedure or orthotics or inserts that would keep them active, rather than just accepting (pain) as part of the normal aging process."