Foot pain and foot disorders are common complaints among older people. Foot pain makes it harder to walk and carry out your daily functions. You may also have trouble with your balance and your chance of falling increases. But just because you are getting older, you do not have to put up with foot pain. Being able to walk easily is extremely important, since walking is one of the best ways to exercise and keep fit.  

One of the main causes of foot problems is poor-fitting shoes. Three out of four people over the age of 65 wear shoes that are too small. Narrow or high heeled shoes, shoes with slippery soles, or ones that offer no protection or support may cause serious injury and pain, and increase your chance of a fall.

Most foot problems can be treated effectively. A qualified healthcare professional who specializes in the feet—known as a podiatrist (in Malta may be referred to as a Podologist)—can diagnose your condition and choose the appropriate treatment. Often a change in footwear will do the trick. You do not have to suffer needlessly.

Basic foot care and prompt attention from a podiatrist if you find a problem will help keep you active and independent.

What are Foot Problems in the Elderly?

Decades of standing changes your feet. Much of the natural cushion of padding under your heel and the ball of your foot is lost. The arches get flatter and less flexible, your ankles and foot joints become stiffer, and your whole foot gets wider and longer.

Because of these changes, you may develop foot pain and other problems even if you never had difficulties with your feet before.

Certain medical conditions put you at greater risk of foot problems.  For example, diabetes can cause reduced blood circulation and nerve damage in the feet.

The Most Common Types of Foot Problems

In older adults, the foot complaints encountered most often are:

• Bunions.  A bony growth or misaligned bone at the base of the big toe or sometimes on the small toe. Eventually, the big toe may bend abnormally toward the small toes.
• Calluses and corns.  Dead, yellowish, thickened skin on toes.
• Hammertoes.  Toe joints (usually the first small toe but all the middle toes may be affected) that curl up or under, either rigidly or with some flexibility, often resulting in a permanently dislocated joint.
• Toenail problems.  Ingrown (growing into the skin), thickened, or discoloured toenails.
• Foot problems related to diabetes.  Such as stubborn foot ulcers that are difficult to heal, loss of feeling or circulation problems.
• Foot problems associated with deformities.  These may be caused by arthritis (including rheumatoid arthritis and gout).
• Heel pain.  This pain is present at the back of the arch from heel spurs (bony outgrowth) or plantar fasciitis (an inflamed ligament along the bottom of the foot).

Some other foot problems that are less common but may be encountered among older people include:

• Arch pain – from fallen arches (flat feet), or abnormally high arches
• Tarsal tunnel syndrome – a type of pinched nerve disorder
• Achilles tendonitis – inflammation of the tendon that connects your heel bone to your calf muscle
• Morton’s neuroma – benign nerve growth between the third and fourth toes

How common are Foot Problems?

One in three people over the age of 65 has foot pain, stiffness, or aching feet. Older people who are living in long-term care facilities tend to have even higher rates of foot problems. In the United States, up to 87% of people have painful feet at some time in their lives, no statistics exist for Malta but the percentage is considered to be similarly very high. Most of these problems derive from poorly fitting shoes, such as pointy-toed high-heeled women’s shoes. Older or obese people, women, and people with diabetes, cardiovascular disease, osteoporosis, knee, hip or back pain have much higher rates of foot problems. For women, pain in the toes and ball of the foot is much more common than in men, and it gets worse with age. However, pain in the heel tends to decrease as we get older. 

Older people are more likely to have foot pain if they also have a chronic disease. Foot pain in younger people tends to come from aching muscles and stress on bones.  In older people, pain most often comes from corns, calluses and toe deformities, of which 75% are bunions.  As much as one third of all older people have a bunion. About 30% of older people with foot pain have calluses and about 15% have corns on their toes.

It has been estimated that one-third of all older people have fungal infections in a toenail. The likelihood of having a fungus infection is even higher in older people with diabetes, psoriasis, reduced immunity, poor circulation, or obesity.

Lifestyle & Management

To maintain healthy feet, follow the recommendations listed below:

• Inspect your feet regularly. If this is difficult, have someone else do it.
• Trim your toenails straight across, not at the corners or sides. Clippers may be easier to manage than nail scissors if your nails have thickened.
• Make sure that your shoes fit, and that there is enough room in the toe box (the front of the shoe). Go shoe shopping late in the day, after your feet have swelled from a day of walking, and fit shoes to your larger foot. Try them on while standing, and choose shoes that are at least half an inch longer than your longest toes. 
• Wear soft socks and stockings that are not too tight and have no irritating seams or bumps, ideally use cotton socks and always avoid nylon material.
• Avoid walking in bare feet, even in the house.
• Wash your feet regularly and thoroughly, and dry them well. Several times each week, soak your feet in warm water to which you have added moisturizing bath oil. Apply skin cream often to dry skin on your feet and ankles.
• If you have diabetes, see your podiatrist at least once each year, request a check-up of your peripheral circulation and sensation, and make sure to keep your blood sugar under control.
• Beware of medicated over-the-counter remedies for corns and calluses, which may do more harm than good. If you live with diabetes you should avoid such products at all times. 
• Never cut calluses or corns with a razor or other sharp tool.
• If you have numbness in your feet, use warm water to wash them and always check the temperature with your hand first. Avoid heating pads which may burn your feet or direct exposure to thermal heater or hot water bottle.
• If your circulation is poor- or you suspect it is- do not sit with your legs across since this restricts blood flow.
• Walking, bicycling, swimming, and doing simple foot exercises every day will help keep your feet in shape, maintain and improve circulation and reduce risk of swelling of your extremities.  

Diet and Exercise

If you have diabetes, the health of your feet depends a great deal on how well you can control your blood sugar. A healthy diet is crucial. Follow your dietician or healthcare professional’s recommendations and eat plenty of fresh fruits and vegetables, complex carbohydrates rather than refined foods and sweets, and low-fat proteins. Make sure your fluid intake is adequate. Remember to take your medications at the right times if prescribed.

Regular, gentle low-impact exercise—especially walking, stretching, swimming and bicycling—will help keep the muscles, tendons, and ligaments of your feet flexible and healthy.

Complications

Foot problems can lead to:

• An increased risk for falls and fractures
• Reduced mobility, independence, ability to carry out daily functions
• Chronic pain
• Amputation
• Decline in general health due to restrictions on exercise
• Lower quality of life
• Higher risk of hospitalization and long-term care. 

Caregiver Information

If you are a caregiver or family member looking after an older patient, you need to know how to do an adequate daily foot inspection, particularly for patients with diabetes, poor circulation, foot numbness, poor eyesight, or immune deficiency diseases. A podiatrist can show you what to look for and how to take care of minor problems and perform general foot care such as nail trimming for the elderly patient.