By the time we reach 65, most of us will have walked more than 75,000 miles (3 times around the equator), and bore several million tons of weight on our feet. Over time, this abuse takes its toll on our feet and alters the structure of the feet. The most common changes that occur in the feet are listed below.
Predisposing Factors are those conditions that make an individual more susceptible to experiencing foot problems as they age:
- Increase in foot size and width. The changes that take place in the feet are like those that take place in the rest of our body as we age. With time, the ligaments, tendons, and muscles become thinner and weaken, and our bodies lose that youthful size and appearance we once took for granted.
As the foot's muscles, tendons, and ligaments lose some of their elasticity and strength, they don't hold the bones and joints together as tightly as they once did. This causes an increase in foot length and width.
- Measure your feet, length and width, each time you try on new shoes. Stand when your feet are measured, as our feet expand when standing. Make sure you have a little fingers width between your longest toe and the end of your shoe (about a 1/2 inch).
- Try on the shoe size that your foot measured, but be aware that sizes vary among shoe brands and styles, and there is no standard sizing systems for shoes. Therefore, do not select shoes by the size marked inside alone; instead, try them on, and see how they feel.
- Always buy shoes at the end of the day. During the day, our feet swell due to activities and gravity; this swelling is at its maximum near the days end. If the shoes fit at this time, they should never feel too tight.
- Do not purchase shoes that feel too tight, expecting them to "stretch to fit". Most materials, including leather, do not stretch enough to make a difference, and can cause great pain in the process.
- If you have hammertoes, corns, bunions, arthritis of the toes, consider purchasing shoes with a deep and wide toe box (the area of the shoe where that encloses the toes). This extra depth and width may keep the shoes from pressing against the sensitive skin on the tops of the toes. Many foot and ankle specialists recommend Orthofeet Therapeutic Shoes. These shoes not only provide comfort, but also are stylish. Click on these links to view Orthofeet shoes: Men and Women
- The bottoms of the feet lose their fatty pads. The fat pads in the balls of the feet functions as a cushion and shock absorber for the underlying bones, joints, and soft tissue structures. When the pad is not of optimum thickness, the force and weight of each step we take is passed on to the underlying structures, rather than absorbed and whisked away by the fat pad. This eventually produces inflammation and pain in the soft tissues, bones, and joints in the ball of the foot.
The fat pads in the balls of the feet become thinner, or atrophy, due to the constant pressure they have endured for many years. Each time we take a step, we place our entire body's weight on one foot at a time. If we run instead of walking, we place up to five times our body weight on each foot. This continual pressure on the fat pads causes them to gradually become so thin that they no longer provide cushioning and shock absorption to structures of the feet. This can lead to such painful conditions as calluses and metatarsalgia (See the description of this condition under that heading on this site.)
- Wear supportive shoes that fit your feet properly.
- Custom-made orthotics are considered to be the "Gold-Standard" of medical treatment—that treatment most recognized by doctors to be effective in the treatment of a thin fat pad under the balls of the feet. Either a custom-made orthotic or a high quality over-the-counter device is ideal for metatarsalgia (""pain under the balls of the feet, including pain due to the loss of the fat pad""). These arch supports are constructed of comfortable, shock-absorbent "space age" materials that help to replace the foot's natural fatty pad protection. For more information about the options for arch supports please, click here.
- Walking barefoot stresses and thins the foot's protective fat pad. To prevent this, whenever you are weight bearing, wear shoes.
- Keep the skin on the balls of the feet smooth and supple. Dry skin and calluses add to the discomfort and pain caused by a thin fat pad. Moisturize the feet twice a day with a good hydrating lotion, and gently remove dry dead skin. Here are two products that many doctors recommend:
Flattening of The Arch. The normal arch functions as a shock absorber for the entire body. Each time we step down, it places up to 5 times our body weight on the foot, depending on whether we are walking, running, or jumping. If there were no shock absorber in the foot, the force of each step would eventually fracture or dislocate the bones of the foot, leg, and lower back. When the arch is flat (a flat foot), it is "sick" and cannot function properly. If left untreated, this will lead to a completely collapsed foot, that cannot function as a shock absorber at all; and, this in turn will cause constant pain in the foot, and eventually the knee, hip, and lower back. As we age, the muscles, tendons, and ligaments that support the foot's arch become thinner, weaker, and unable to support the arch at its optimum height. This allows the arch to fall and the foot to flatten. Flat feet are not only uncomfortable but can also be the cause of other painful foot problems. For more information about flat feet, please click here.
- Wear shoes that provide support for the arch and stability for the entire foot.
- Do not walk barefoot…always support your arches.
- Many doctors feel that the treatment of choice for flat feet (flat arches) is a high quality arch support. Here is why: treatment must be directed to supporting the individual bones and joints, which make up the arch, and to aid the arch in its job as a shock absorber. The support of the individual components of the arch will help to prevent a total collapse of the arch and pain in the arch, heel, and balls of the feet. Because everyone's arch height and foot structure differs, the most efficient way to support the arch at its optimal height is with a properly fitted arch support. This insures maximum comfort, while guaranteeing that your arch will always be supported at its most efficient height. For more information about arch supports or orthotics for flat feet, click here
- Ligaments And Tendons Become Looser And Weaker. With time, ligaments (strong connective tissue fibers that hold the ends of bones together at a joint) and tendons (tough fibers that connect muscles to bones so that the muscles can move the bones) weaken and become less resilient. Looser ligaments and tendons cannot hold bones and joints together in their proper alignment. The results are a weaker, flatter, more flexible foot that:
- Allows the ankle to roll inward and the foot outward (pronation), increasing the chance for sprains.
- With time, as the tendons become weaker and weaker, the foot rolls further and further outward. As we walk, we irritate and inflame the stretched tendons on the inner side of the foot, especially the tendon of the Posterior Tibial Muscle. Continued irritation of this tendon leads to painful micro-tears within the body of the tendon. This condition is called Posterior Tibial Tendonitis/Dysfunction , and may lead to the inability to bear weight on the foot if medical intervention is not sought.
- The toe joints weaken and cannot hold the toe bones in their normal alignment. This results in the bones moving and becoming visibly prominent and pushing against the skin. Prominent toe bones and loose joints lead to hammertoes, bone spurs, corns, and bunions.
- In general, as the ligaments and tendons weaken, the once straight foot becomes increasingly abnormal in shape, with the toes going off in one direction while the foot and ankle go off in other directions. These changes can lead to loss of balance and abnormal gait patterns.
- Always wear appropriate shoe styles…the shoes need to match the shape of your feet.
- Wear shoes that provide stability, especially if you have pronation or Posterior Tibial Tendonitis…high heels should be out of the question for feet with these deformities.
- Click here for information about choosing the correct shoe size.
- High quality arch supports are considered to be the "Gold-Standard" of medical treatment -- that treatment recognized to be most effective, especially in the prevention and early stages of pronation and Posterior Tibial Tendonitis/Dysfunction. Custom-made orthotics will also stabilize the feet, support the arch, and aid in shock absorption. For information about how our custom made orthotics comfortably treat and help prevent the deforming conditions of the feet, please click here.
Due to the infirmities of age there are changes in circulation often related to Diabetes or other vascular diseases. Varicose veins are also problems encountered in the elderly. Poor circulation may be accompanied by pain in the feet or legs.
These problems will have to be diagnosed and treated by your podiatrist, foot and leg specialist or family physician. Once a proper diagnosis is made, you will need to address proper footgear and hosiery, stockings and socks.
For Venous problems: Mild to moderate compression stockings/socks should be used. There are many types that address this issue. Generally recommended is knee length stockings/socks with 15-25 mm of mercury pressure. They should be put on first thing in the morning before swelling and engorgement occurs.
(These would include the follow brands I suggest: Jobst, Medi, Juzo, Sigvaris, Therafirm, Venonsan)
For Circulation problems and Diabetes: Patients with circulatory (vascular) may also have swelling or concurrent venous problems and they may also benefit from Mild compression hose as well. If there is no venous issues, Circulatory patients may do well with non-binding ankle support. These are soft socks that do not leave ""tight rings"" around the ankle and are very comfortable to wear at all times. These may also be worn to bed at night to keep the feet warm.
(This may include Smartknit which is non binding elastic bands and seamless) (Other diabetic socks in addition to the brands mentioned above would also include Drymax and Trusoft)
In addition to problems with varicose veins and Diabetes, another problem that elderly patients have with the legs would include dry skin; this is a potential problem for leg ulcers. The skin becomes dry, scaly and irritated. In addition to the lubricating products, there are socks that are also very helpful in maintaining a soft and moist skin environment. (Medipeds aloe vera moisturizing hose)
Dry, Flaky Skin. With increasing age, the skin's ability to produce sweat, oil, and other fatty substances diminishes. The skin cells also divide more slowly, and the skin becomes thinner. As a result, the water content of skin is reduced and the skin becomes dry, which in turn leads to age-related dry skin. Here are some common age-related dry skin problems people may experience:
- Peeling and flaking skin
- Itchy skin that bleeds easily when scratched.
- The skin may appear yellow or brown in color, and may become inflamed due to itching and scratching.
- The dry skin may become thick and hard, especially around the edges of the heels.
- The skin may become so dry that it cracks and fissures, which in turn causes pain when walking.
- Dry and cracked skin is prone to bacteria and fungal infections, which can cause serious problems.
For more information about dry skin, please click here
- Moisturize, moisturize, and moisturize again. This is especially true after bathing. Make sure you pat your skin almost dry. While the skin is still damp, apply a high quality moisturizer such as Tripod Labs Hydrostat. This moisturizer will hold the water in, and keep the skin from drying.
- Add some oil to your bath. The oil will soothe dry irritated skin and help the skin "lock in" moisture.
- Avoid nylon and rayon socks, as these materials cause dryness of the skin.
- Most doctors agree that the most effective way to treat dry and cracked skin is to exfoliate, or remove the dry dead skin present, and to moisturize the underlying normal skin. These two steps, exfoliating and moisturizing, will return the skin to its soft, supple, and natural appearance:
Exfoliating dry dead skin allows moisturizers to penetrate deeply into the skin.
Effective Moisturizers are those that not only soften and hydrate the skin, but they also heal and protect the skin from further drying.
Click here for doctor recommended products that are effective in exfoliating and moisturizing the skin.
- Thick, Dry, and Discolored Toenails. The toenail changes most commonly associated with the ageing process are thought to be due to:
- A decrease in blood flow to the toes. As we age the small blood vessels in our feet and toes narrow and become thicker. Narrowing of the vessels reduces the amount of fluid and nutrients that get to the ends of our toes, while the thickening of the vessels makes it harder for the fluids and nutrients to get out of the blood vessels and into the tissues and nails. Without proper nourishment the toenails become dry, deformed, and discolored.
- Trauma to the nails over the years gradually destroys the normal appearance of the nails, cuticle, and nail bed.
- Nail fungus is the most common cause of discolored, thick, and deformed toenails in people of all ages, but especially in older individuals. Seniors are especially susceptible to these infections because of reduced circulation to the toes. Less circulation means fewer antibodies and infection fighting blood cells are available to ward off attacks by nail fungi. For more information about Nail Fungus (onychomycosis), please click here.
Self-Help and Treatments:
Help avoid ingrown toenails and nail fungus: clip toenails straight across, and disinfect instruments used to cut nails.
Do not cut or push back toenail cuticles. Feet are enclosed in shoes for 6 to 12 hours a day. The dark, warm, moist environment within our shoes makes for a rich breeding ground for all kinds of organisms, but especially nail fungi. When the cuticles are intact and in place, they keep germs from entering the area where new nail is produced. If the cuticles are breeched, nail infections can easily occur.
Fungi need moisture to survive. People, who have sweaty feet, or those who practice poor foot hygiene, are more susceptible to fungal nail infections. Each day wash and dry feet, and put on a clean pair of socks.
Constantly wearing nail polish prevents the air from getting to the nail plate. Leaving the nails polished for several weeks at a time may also cause white or yellow spotting that is often misdiagnosed as fungus. Fresh air helps to keep nails dry and healthy. Also, the harsh chemicals in the nail polish may help to destroy the normal structure of the nail. This can make it easier for a fungus to invade and penetrate the nail. However, Dr. Remedy's Natural Nail Polish colors the nails beautifully without dangerous chemicals and protects nails from fungal disease.
Some topical medications are uniquely effective in the treatment of fungal nail infections, and can help the nails retain their normal appearance. For information about these effective, doctor recommended products, please click here.
Crooked Toes and Feet. As we age, the ligaments, tendons, and joint capsule (the fibrous tissue that completely encloses a joint) begins to weaken and stretch. When this occurs, the bones, which meet at the joint are not held tightly in their correct position and they begin to move out of alignment. At the same time, the joint's cartilage is wearing down due to the normal wear and tear that joints undergo during our lifetime. This further destabilizes the joint, making it easier for the bones to move out of alignment. The results are thickened joints, toes that are no longer straight and parallel to one another, and lumpy/ bumpy feet.
Self-Help and Treatments need to be directed toward keeping your feet and toes comfortable, because there is no practical way to change the appearance of one's feet. Surgery to cure specific foot problems may improve the appearance of a specific area of the foot; but cosmetic surgery to improve the appearance of all the toes and foot is usually not recommended. Here are recommended ways to help keep lumpy/bumpy feet comfortable:
Measure your feet, length and width, each time you try on new shoes. Stand when your feet are measured, as our feet expand when standing. Make sure you have a little fingers width between your longest toe and the end of your shoe (about a 1/2 inch).
Always wear appropriate shoe styles…the shoes need to match the shape of your feet.
Do not purchase shoes that feel too tight, expecting them to "stretch to fit." Most materials, including leather, do not stretch enough to make a difference.
If you have hammertoes, corns, bunions, arthritis of the toes, consider purchasing shoes with a deep and wide (toe box the area of the shoe where that encloses the toes). This extra depth and width may keep the shoes from pressing against sensitive skin on the tops of the toes. Many foot and ankle specialists recommend Orthofeet Therapeutic Shoes. These shoes not only provide comfort, but also are stylish. Click on these links to view Orthofeet shoes: Men and Women
Custom-made orthotics are made from molds of one's feet, just for that person's foot problems. No matter how bad foot alignment may be, custom-made orthotics can be made which will help to address foot's biomechanical deformities. However, in some cases, a non-custom or semi-custom device may provide sufficient comfort and control. High quality arch supports will:
Gently support the bones of the feet.
Special materials used can mimic the foot's natural fatty pad and eliminate the pain of protruding bones and bone spurs.
Custom-made orthotics will also support the arch and keep it from falling, thus preventing other problems and pains.
They can help keep the foot from turning and twisting while walking, making each step more secure and pain-free.
Click here for more information about our complete line of arch supports and orthotics.
Painful foot conditions may occur anytime during our lives; however, due to everyday wear and tear on our joints, muscles, tendons, and ligaments, seniors appear to suffer more frequently from the following foot disorders than the general public: