Whoever coined the phrase “you never know how sweet the water is until the well runs dry” could have been referring to foot problems that plague nearly one third of older adults.
Aging feet need special care as the risks for chronic foot problems increase. These conditions often include corns, calluses, nail disorders, bunions, and hammertoes, to name a few. Systemic foot conditions associated with aging patients include arthritis, gout, and diabetes.
Common Foot Problems in Older Adults
Fat Pad Atrophy
Though many aging patients fight the accumulation of weight and fat, others actually lose padding in their feet. Because the pads on the ball and heel of your foot cushion each step, this can become a painful experience. Traditional treatment modalities include wearing shoes with cushions, orthotics, or filler injections to replace the pad.
A neuroma is a benign growth (not actually a tumor), but a thickening of the tissue and inflammation of nerve tissue. A Morton’s Neuroma is a neuroma that’s causes foot pain in the ball of the foot (usually between the third and fourth toes) is often described as feeling as if you are standing on a pebble in your shoe, a shooting pain, or like a big fold in your sock that you are constantly walking on. You may also have burning pain or numbness and foot.
The soles of healthy feet are typically thick, supple, and strong to protect you from the stresses of walking, stepping on surfaces of uneven textures and temperatures. But when you’ve been less-than-diligent about keeping them healthy, your feet – particularly your heels – can dry out, looking ashy and cracked. Cracked heels can hurt to walk on, and the skin can break and bleed more easily than healthy heels. Open wounds on your feet heal slowly because of poor circulation, which increased the chance of developing an infection.
Heel Pain and Plantar Fasciitis
Heel pain and plantar fasciitis are one of the most common presenting complaints to the podiatrists. Although plantar heel pain seems to predominate in this category, we cannot overlook posterior heel pain as an important subset of heel pain syndrome.
An ingrown toenail (Onychocryptosis) is a common discomfort that involves the nail curving down into the surrounding skin as it grows. Interestingly, ingrown toenails are absent in cultures that go barefoot, but that isn’t an option for most of us in the US. Most prevalent in the big toe, ingrown toenails can be painful, display redness, swelling, and infection (yellow drainage). Ingrown toenails frequently resolve without medical treatment; however, chronic or complicated cases may require treatment by a physician.
A corn usually forms on the top of the foot and/or toes, over a joint or bone. At the center of the corn is a dense knot which forms over the point of the greatest compression or friction from your shoe. Corns can cause discomfort and make it harder to walk or run in your shoes. Corns can be soft or hard. Soft corns are supple, tender, and can often be found on the delicate skin between the toes. They are kept moist by sweat and are prone to infection. Hard corns are firmer and drier and form on the knobby toe knuckles and outer edges. Most people develop corns because of wearing shoes that are too tight.
A callus develops in response to excessive rubbing and friction. It looks like a dull yellow, flat, rough layer of skin and is usually found on the sole of the foot. Unlike a corn, a callus has a uniform thickness. Calluses can sometimes be painful or make walking more difficult. Most calluses form when the foot isn’t fitting well in the shoe, and there is space for parts of the foot to move around and rub against the inside of the shoe. Sometimes, a callus may form because of problems with walking. A change in your gait might change the way your foot slides around in your shoe, creating a new area of friction where a callus might develop.
A bunion typically appears as a bony bump on the inside edge of the foot, where the innermost bone of the foot meets the big toe. The visible bump appears when the first metatarsal shifts outward so the head of the bone protrudes on the inside of the foot near the big toe joint. When the bunion develops on the base of the little toe, it is called a tailor’s bunion. Bunions are one of the most common foot problems, affecting between 25-33% of adults. There is a genetic component to them, though not everyone with a bunion has others in their family who suffer from them. Bunions occur the most in women and older adults.
A hammer toe is a fairly common foot problem that occurs when the middle joint of the toe develops an abnormal bend and becomes flexed or bent downward. This is because of a muscle imbalance around the toe joints. This imbalance causes the toe to bend at one or more joints, eventually pushing the middle of the toe upward in a claw-like position. Unfortunately, a hammer toe usually causes pain and does not get better without medical intervention. The sooner it is treated, the better the outcome, and the shorter the recovery time.
Ankle arthritis, a form of osteoarthritis, is a degenerative condition in which the articular cartilage of the ankle joint wears thin and eventually breaks down. Without cartilage to protect the bones from the friction of motion, the bones fragment and spurs develop, causing pain and stiffness in the joint. Although many aging adults dismiss the pain as another sign of “old age,” or of an old ankle injury “acting up,” it’s important to seek help for chronic ankle pain. There are treatments that can slow the progress of ankle arthritis, relieve pain, and keep patients on their feet.
Adult-acquired flat foot is not a congenital flat foot but one that develops over time. This is due to damage to the posterior tibial tendon, which is the main tendon supporting the arch of the foot. With a tear in the tendon over many years of abnormal strain, the arch will begin to collapse as the posterior tibial tendon weakens and unravels. Over time, the collapsed arch may go from flexible to rigid as the foot gets “stuck” in the flat position and, therefore, is not freely reducible and correctable. It is important to treat a flexible flatfoot due to posterior tibial tendon tear rapidly prior to the joints becoming rigid due to the severe collapse.
The Achilles tendon is one of the longest tendons in your body, extending from your calf muscles to the bones of your heel. It allows you to extend your foot and point your toes to the floor. Unfortunately, it’s one of the most frequently injured tendons. Inflammation of the tendon, known as Achilles tendinitis, it is a common sports injury. In most cases it can be treated at home under the care of your physician.
Diabetic Foot Ulcer
Diabetic neuropathy — the result of several metabolic and neurovascular factors — causes loss of pain or feeling in the toes, feet, legs, and arms due to nerve damage and poor circulation. Blisters and sores may appear on numb areas of the diabetic’s feet and heel region. Because there is limited or no feeling, the injury goes unnoticed and eventually becomes an entry for bacteria and infection. Risk factors include cigarette smoking, poor glycemic control, previous foot ulceration or amputations, diabetic kidney disease, and poor circulation.
Gout can present in multiple ways, although the most common is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of the cases. Other joints, such as the heels, knees, wrists, and fingers, may also be affected. Joint pain usually begins during the night and peaks within 24 hours of onset. This is mainly due to lower body temperature. Gout is a common condition that can be very painful. Quick and appropriate treatment can provide relief and help prevent joint destruction in the future.
A bone spur is a growth of extra bone. It typically develops where two or more bones meet. These bony projections form as the body tries to repair itself. Bone spurs can feel like a hard lump or bump underneath the skin. The chances of developing a bone spur in the foot increase with age. Its impact on your everyday routine depends on the severity. Some people don’t even notice a bone spur on their foot. Others deal with crippling pain that makes it difficult to walk, stand, or wear shoes.
Bursitis is a painful condition that affects the small, fluid-filled sacs — called bursae — that cushion the bones, tendons, and muscles near your joints. It occurs when bursae becomes inflamed. Bursitis, which increases in frequency with age, typically occurs in the heel and base of the big toe. Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common.
A claw toe is similar to a hammertoe, but instead of just the middle joint being affected, claw toes also affect the joints closest to the tips of your toes. Your toes curl and dig straight down into the floor or the soles of your shoes. Claw toes grow stiffer with age. If you can move them, try strengthening exercises like picking up a marble or piece of paper with your toes.
When people hear the word fracture, they generally think of a broken bone. They associate it with some sort of known traumatic event such as falling or dropping something on their foot. However, not all fractures are due to trauma. There’s another type of fracture called a stress fracture. A stress fracture frequently occurs due to increasing the amount or intensity of an activity too quickly. If there is a lot more pressure over a short period, the bone does not have enough time to adapt thus leading to increased stress to the bone. This causes increased inflammation inside the bone and tiny hairline fractures to outside of the bone.
Athlete’s foot is a very common fungal infection of the skin that affects the web spaces between the toes and soles of the feet. Fungal infections can be contagious as they are passed from one person to the next, especially in public spaces where people go barefoot. This infection is commonly spread on contaminated floors of public spaces such as gyms, swimming pools, or nail salons. Patients often will sometimes present with itching and burning of the feet. The skin itself can be scaly or peeling, as well as red. There can occasionally be some oozing fluid present and blistering. Some patients may not notice anything wrong with their feet and think that it is just “dry skin”. People with a low immune system will typically be more at risk of developing a fungal infection. This includes people with diabetes, HIV/AIDS, and cancer, who have more trouble fighting foreign pathogens in their body.
We hope this information is helpful to you in the important work you do as a family caregiver.
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