According to the American Podiatric Medical Association (APMA), the average person will walk 75,000 miles by the age of 50. She will also take up to 10,000 steps on an average day — and that cumulative force adds up to hundreds of tons of foot pressure every day. With proper foot care, older adults will be able to walk thousands of additional miles. An important step in proper foot care is to know what things can go wrong, how they happen, and how to treat and prevent them.
If improperly cared for, the muscles, ligaments, blood vessels, and nerves of the feet — along with the 26 bones and 33 joints on each foot — invite a host of problems and contribute to a senior’s risk of falling. It is estimated by a number of sources that 75 percent of Americans experience foot pain in their lives. Ranging from short-term and painful annoyances to the total loss of ambulation, social isolation, and permanent disability, foot pain is undeniably common.
Women are more likely to have foot pain than men, and smokers are more likely to develop blisters and have fractures. Other risk factors include:
- Improper shoe wear. The leading cause of foot problems, shoes that fail to support or cause pain to feet can cause permanent damage.
- Age. Feet grow wider with age, sole padding thins, and skin becomes drier.
- Medical issues. Any condition that affects a person’s ability to walk. For example, infections resulting from diabetes, gout inflammation, peripheral vascular disease, and the side effects from certain medications can cause damage to the feet.
- Obesity. An excess of weight applied to the feet over an extended period of time can wear them down and cause damage.
- Trauma. Foot injuries occur more frequently among athletes and occupations that require constant use of the feet.
- Heredity. Some conditions, such as flat feet or high arches, can make feet more prone to pain and long-term damage.
Older adults who experience sharp pain in any region of the foot that persists should be examined. Explain to your patients that when they’re in doubt, it’s always best to consult with a healthcare professional. Older adult clients may be referred to a podiatrist, who specializes in the diagnosis and treatment of foot problems. A podiatrist will take a medical history and make a physical examination. He may go further and order X-rays or other imaging studies.
In many cases, foot problems can be treated conservatively with anti-inflammatories, applications of ice, orthotics, and proper shoes. Other times, surgery may become the best or only solution. Feet are complex, and foot surgery is risky, so advise patients to always seek second opinions.
The feet can develop problems as a result of diseases — the inflammation of the big toe from gout and the loss of sensation and slow-healing from diabetes, for example. They can contract fungal diseases and suffer from trauma. Although any number of other things can go wrong with feet, a dozen of the most common problems are:
1. Corns and callouses. A painful, yellowish area of hard and dry skin, especially on the little toe, is a corn. A callous is the same thing, but located on the heel or ball of the foot. Unless patients have crooked toes, the cause is usually shoes or even socks fitting too tight around the toes, loose and sliding shoes, or high heels. Beyond the continuous sliding in loose shoes, if patients have flat feet or do a lot of walking on concrete or some other hard surfaces, callouses can develop. Shoes with wide toe boxes and specialized cushions are the normal remedy.
2. Bunions. Both heredity and ill-fitting shoes cause bunions. Most are metatarsus primus varus, where the first of the two metatarsal bones shifts outward and causes the second to bend inward. When the area at the base of the big toe becomes inflamed and tender, it is likely medial exostosis, while hallux valgus causes the big toe joint to shift so far inward that the second toe is forced to cross over the big toe. Unfortunately, any of these three types of bunions can occur simultaneously — and surgery may be the only effective treatment.
3. In-grown toenails. More common among women, toenails can grow painfully into the skin. Frequently worn open-toed shoes, fungal infections, and foot-related injuries can also lead to in-grown toenails. Trimming toenails straight across goes a long way toward preventing them.
4. Hammertoe. Bunions can sometimes cause enough pressure to push an adjacent toe (usually the toe next to the big toe) into a claw-like position. Shoes with large toe boxes and certain orthotic remedies can be used to both prevent and treat hammertoe.
5. Morton’s neuroma. Pain manifesting as a lightning bolt or cramping sensation between or under an older adult’s third and fourth toes may be the result of nerve inflammation, and it can be exacerbated if she does a lot of standing. Also called interdigital neuroma, this can be treated with padded orthotics, forefoot massages, and by wearing shoes with a wide toe box.
6. Sesamoiditis. Located in the forefoot, two sesamoid bones connect to the first metatarsal bone. Shoes that fit poorly can cause one or both of these bones to become inflamed or rupture. The pain and swelling can be severe enough to limit movement. Anti-inflammatories, rest, and padded stiff-soled padded shoes with low heels usually help.
7. Stress fracture. When combined with shoes light in padding, concussions (as when running on hard surfaces) can cause tiny, incomplete cracks in the bones of the forefoot. If a patient ignores sudden yet persistent pain in the bottom of his foot, especially below the second and third toe, full-blown fractures can ensue. Instruct patients to get enough rest — this will enable them to heal quickly. In addition, suggest that a patient (or his family) buy some low-heeled shoes with stiff soles.
8. Achilles tendonitis. If an older adult feels pain between a calf and heel, especially while running, chances are that her Achilles tendon has stiffened and is swollen. If she describes the pain as similar to the feeling of somebody whacking the back of her leg, she may have ruptured it. Specialized insoles and other aids can both treat and prevent this condition.
9. Haglund’s deformity. Wearing shoes with stiff backs and high heels can aggravate the back of the heel, causing a fleshy and painful bump to grow. Heel pads and soft shoes can alleviate this problem.
10. Bursitis of the heel. Beneath the heel bone is a fluid-filled sack called the bursa. When inflamed, this sack makes any weight-bearing activity painful. Wearing pads in the heel of the shoe, ice, and anti-inflammatories are usually enough to ease the pain bursitis can cause, but steroid injections may sometimes be necessary.
11. Tarsal tunnel syndrome. Tingling and burning sensations or numbness along the bottom of the foot might indicate tarsal tunnel syndrome, which is treatable with orthotics. However, this condition mimics more serious issues ranging from pinched spinal nerves to cardiovascular disease and diabetes. Have older adult patients consult their doctors or podiatrists with any questions.
12. Plantar fasciitis. One of the most common foot problems and often of unknown etiology, plantar fasciitis is especially common among athletes who frequently flex the bottoms of their feet, causing plantar (sole) fasciitis (connective tissue pain). A telltale sign of this condition is when the problem feels worse in the morning. Treatments range from stretching exercises (usually the best treatment) to splints, surgery, and Botox injections. Plantar fasciitis is often confused with heel spurs, which are calcified growths that develop on the bottom of the heel. These result from the repeated stretching of the plantar tendon from its attachment to the heel bone. If your patient has heel spurs, padding in the heel of his shoes can add comfort.
The Right Shoes
Talk to your patients about the important of proper footwear. The relationship between foot problems and improper footwear is widely understood. If your patient walks barefoot on hard surfaces or stairs, or wears the same shoes for most occasions, he may be setting himself up for foot problems. For proper foot care, patients should use different shoes for differing purposes.
A healthy shoe is flexible, especially at the ball of the foot, and it has a strong heel, is adequately cushioned, and has a leather upper. Patients should buy new shoes only if they are comfortable, flexible, and conform to the foot. Otherwise, their feet will try to conform to the shoes, and that’s where many problems begin. Provide your older adult patients with the following tips to help them as they purchase and utilize new, more ergnomic shoes:
- Lace-up shoes provide more fit adjustment options.
- Shoes with thin, hard soles enhance one’s ability to feel a surface.
- Rubber soles are especially useful on slippery surfaces.
- Alternate shoes every few days.
- Discard worn-out shoes.
- Put on different shoes after standing for several hours.
- When deciding on shoe size, ensure that there is a half-inch gap between the shoe’s tip and the longest toe.
- Be sure that the toes can be pointed fully upward in the toe box of a shoe before purchasing it.
- If your patient must wear high heels, suggest that she keep their use to a minimum and find a pair that are cushioned and have wide toe boxes.
- Remember that some shoes are better than others for certain occupations, such as steel-toed boots for construction workers.
- For athletic purposes, patients should find shoes specifically designed for their sport and wear them in conjunction with padded, acrylic athletic socks.
- Orthotic shoes may be rigid, semi-rigid, or soft, depending on the foot problem being treated. Older adults should consult with a doctor or podiatrist to determine which orthotics are best for them.
Beyond proper shoes, there are things you can have your patients do to minimize the risk of foot pain. Applying moisturizing creams and scrubbing feet with pumice helps keep the skin supple and prevent cracks. Warm Epsom salt baths soothe the feet, while certain exercises strengthen them and improve flexibility. The APMA recommends that people of all ages:
- Take frequent walks and use the right stance — straight back, erect head, and relaxed, swinging arms;
- Wash and thoroughly dry feet often;
- Avoid walking barefoot;
- Regularly inspect feet for skin cracks or peeling, color and temperature anomalies, or thick and discolored nails;
- Avoid trimming the corners of nails;
- Apply sunscreen to any areas of the feet that are exposed to the sun; and
- Avoid use of over-the-counter corn removal products or home remedies for foot problems.
If a patient has an episode of acute foot pain, RICE is an excellent treatment. An acronym for rest, ice,compression, and elevation, the sooner RICE is utilized, the more effective the treatment. Suggest that your patient get off his feet, apply ice to the injured area 20 minutes each hour, wrap it lightly with an elastic compression bandage, and use pillows to elevate the foot above his knee. If pain or numbness persists, he should consult his doctor or podiatrist.
It’s easy to take feet for granted. As long as they don’t hurt or prohibit walking, they may only come to mind when shoe shopping. If older adults care for their feet proactively, wear the right shoes, and aggressively exercise appropriate foot care when any problems arise, their feet will remain those silent friends that carry them through a high-quality, independent life.