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The ability to walk comfortably without pain is a key part of aging successfully. Foot problems are common among older adults and can lead to both pain and disability, and almost always cause difficulty walking for older adults (see also Walking Problems). When foot problems limit your activity and do not get better, a visit to your physician or podiatrist is in order. Throughout our lives, our feet are constantly stressed from bearing our weight and from the additional impact caused by walking and running. This can lead to inflammatory changes in bone and soft tissue, resulting in one or more foot problems. The risk of serious foot problems as we age increases with congenital deformities and diseases of the blood vessels, nerves, skin, joints, and hormones (eg, diabetes).
General Considerations for Treatment of Foot Problems Treatment for foot problems should be directed at the underlying cause. Most foot problems can be handled conservatively, without drug treatment or surgery. However, if not properly managed, some foot problems, such as infections related to diabetes, can lead to hospitalization and amputation. Many problems can be corrected by simply modifying your shoes. This may mean stretching your current shoes, buying more comfortable shoes, or having shoes specially made to help your specific foot abnormalities. Treatment of corns with corn pads or plasters may reduce pressure on the affected area. Pain relievers (eg, acetaminophen, aspirin, ibuprofen) are often helpful, and those with anti-inflammatory properties are especially useful for minor swelling and redness. Sometimes, weight-bearing activities must be stopped for a few days to control symptoms, but non—weight-bearing exercises (eg, swimming or cycling) should still be done to maintain strength and movement. Sometimes, surgery is needed to correct foot problems, but this is usually a last resort. Surgery can involve quite a bit of discomfort and limit standing and walking for weeks to months. People who undergo foot surgery must be sure to keep up their muscle strength during the recovery period. Types of Foot Problems Foot pain can result from a variety of conditions, including the following:
When these or other conditions cause foot pain, your ability to walk and get around are limited even more, which can make the foot problems worse and lead to a vicious cycle. Pain in the ball of the foot Pain in the ball of the foot has many causes, and it is one of the most common foot problems in older adults. It seems to be more common in women than in men, possibly because many women wear shoes with pointed toes that force the weight to the front of the foot. A variety of conditions can cause pain in the ball of the foot. A bunion is inflammation, swelling, and sometimes bony growth near the joint at the base of the big toe (see Figure). The big toe turns sideways, almost pointing directly toward the little toe on the same foot. This crowds the other toes and causes problems. A bunion can be caused by arthritis in the foot, by congenital deformities, or by years of wearing shoes with pointed toes. Pain can be caused by the bunion itself or by irritation where the bunion rubs against the shoe. Also, as the big toe turns to the side, the second toe may lie on top of the big toe and develop corns on its top surface because of friction with the shoe. Occasionally, the bunion places pressure on the nerves in the foot, resulting in tenderness and tingling in the areas around and just behind the toes. Hammertoe is a general term applied to several deformities caused by the toes contracting (ie, bending under tightly). Other terms include mallet toe, claw toe, and cock-up toe, which are all variations on the same process. These deformities usually develop in the smaller toes, but can occasionally be seen in the big toe. They are related to loss of muscles in the foot and tightening of the tendons. The toes may also turn and sometimes even dislocate. Hammertoes increase the formation of corns, especially if shoes do not fit well. The tips and bases of the toes commonly get larger as we age, resulting in degenerative changes in the toe. Morton’s neuroma is a benign small growth on a nerve. It can form on any of the small nerves in the foot, but usually involves the nerves of the third toe (see Figure). Early on, the growth causes a mild ache in the ball of the foot, and sometimes a mild burning sensation. Pushing on the space at the base of the third or fourth toe brings on the pain. Tarsal tunnel syndrome is caused by trauma (especially a fracture), a foot deformity, or too much movement in the foot and ankle. It is similar to the carpal tunnel syndrome that involves the wrist and hands. The nerve that provides sensation to the foot is squeezed near the ankle, resulting in numbness, tingling, burning pain, and other changes of sensation in the toes and soles of the feet. Sometimes, a pin prick in these areas can’t be felt because of the numbness. Ankle, foot, and leg movements may relieve the pain. Corns and calluses Corns and calluses are caused by friction around bony bumps and are particularly seen when shoes do not fit correctly. Corns are especially common over bunions or other abnormalities in the feet. Corns and calluses can sometimes lead to pressure ulcers (see also Pressure Ulcers). Causalgia is a severe burning pain in the foot that develops after a large (trunk) nerve in the leg has been injured. Plantar warts, which resemble corns and calluses, are flat and surrounded by extra skin growth (see Figure). They can be very tender and may appear anywhere on the sole of the foot. Other conditions, such as flat feet or high arches, can also result in pain in or near the ball of the foot. Treatment for pain in the ball of the foot In general, the goal of treatment is to relieve the pain and improve the ability to walk. Usually, the initial treatment is conservative, such as appropriate footwear, physical therapy, and weight loss for people who are overweight. Most people can be treated initially with simple soft pads in their shoes designed to transfer weight to areas of the foot that are not painful. If this doesn’t work, special devices or special shoes may be necessary. For example, a "metatarsal bar" is a bar placed across the sole of the shoe to transfer weight over a wider area. Corns and calluses that rub on the shoe can be trimmed and padded (with materials such as lamb’s wool, silicone, or foam) to reduce pressure. Ulcers related to corns and calluses usually heal after surgical cleaning (ie, debridement) and appropriate management. However, they may come back unless pressure in the area of the ulcer is reduced and underlying problems (eg, diabetes) are managed. Analgesics and anti-inflammatory drugs (eg, acetaminophen, aspirin, ibuprofen, naproxen sodium) or corticosteroid injections can often relieve the pain from foot problems. Surgery should be considered only when more conservative treatments have not been effective. Heel pain Plantar fasciitis is a common cause of pain in the sole of the foot. The plantar fascia is the long, flat ligament on the bottom of the foot. It can become inflamed from the chronic wear and tear caused by walking, and bone spurs may develop. Pain in the heel is usually caused by stress or tearing where the plantar fascia attaches to the heel bone. Heel pain can also be caused when the shoe rubs on the back of the heel because of bone spurs, poor-fitting shoes, or other conditions. For example, bursitis and bone spurs can develop where the Achilles tendon rubs against the back of the shoe. Treatment: Heel pain is often relieved by placing a pad or a special insert called an orthotic into your shoe to take weight off the heel. Footwear that provides a lot of "cushion," such as shoes with rubber soles, is useful. Pain relievers are also helpful. Sometimes, it is necessary to receive an injection of corticosteroid in the area, which often provides relief for many weeks. Surgery is rarely needed. Toenail problems Toenails problems are common in older adults. Toenails change with age as a result of trauma, the damp and cramped environment of shoes and socks, and the forces associated with walking. Toenails often become thicker, ridged, and discolored. Fungal infections can also settle in the nail, causing it to turn whitish or brownish yellow and become disfigured. Trauma from shoes can cause irritation and bleeding under the nail. If trauma to this area is extensive, an abscess can form, the toenail can fall off, and bone spurs can develop in the front of the toe. Ingrown toenails are fairly common in older adults, because of toe or nail deformities, disease, tight shoes, or improper foot care. Ingrown nails are painful and cause inflammation in the area. If the nail penetrates the skin, an abscess may form. Treatment: Most toenail problems are initially managed by removing pressure and protecting the involved toe. Padding and shoes with a deep and rounded toe can be helpful. Antibiotics, foot soaks, and warm compresses can be used to treat infection. Ingrown nails should be treated early to avoid prolonged pain, infection, or other complications. Surgery to remove ingrown nails or bone spurs may sometimes be needed. Fungal infection in the toenails is usually treated for cosmetic reasons or to prevent complications from diseases like diabetes. Applying preparations such as creams or drops to the skin may be effective, except when the nail is involved. In this case, oral antifungal medications are needed. However, these medications should be used cautiously in older adults, because of possible side effects or interaction with other commonly prescribed medications. Miscellaneous causes of itchy feet Itching of the feet is common in older people and may simply be due to dry, scaly skin. As skin ages, it becomes thinner and drier. Treatment includes moisturizers and special creams to remove scales. Athlete’s foot, which is a fungal infection of the skin surface, is a common cause of itchy feet. It most commonly develops between the toes, where it produces small blisters, cracks, or splits in the skin. Bacterial infections or other complications may develop, especially if circulation in the feet is poor. Treatment of athlete’s foot includes soaking the feet with Epsom salts, applying antifungal creams to the skin, and managing complications. An itchy skin condition called contact dermatitis can result from an allergic reaction to certain materials (eg, leather or latex) in shoes or other footwear. Sometimes, changing footwear is all that is needed. A moisturizing cream may help reduce the itching. If feet are seriously irritated, using a cream or lotion that contains a small amount of corticosteroids may be necessary. Diseases Associated with Foot Problems Diabetes The most important disease affecting foot health in older adults is diabetes (see Diabetes). Diabetes causes blood vessel and tissue problems that increase the risk of infection and slow wound healing. Vision and nerve complications associated with diabetes also make it more difficult for older adults to see problems before they become serious, or to feel the pain associated with them. Many amputations in people with diabetes could be prevented by regular evaluation, early treatment, and education on foot health. If you have diabetes, you (or your caregivers) should examine your feet every day. Proper medical management of diabetes (ie, proper diet, exercise, frequent testing of blood sugar, medication, etc) and proper footwear are essential. Professionally developed programs on foot care and the management of diabetes are available through national and regional diabetes associations. The American Diabetes Association is a useful resource. Foot ulcers are important problems for older adults with diabetes. The most common causes are pressure (eg, from shoes), blood vessel problems, nerve damage, and improper foot care. The feet may appear pale or swollen. Pain is common, especially at night. Treatments for foot ulcers include surgically removing any infected or dead tissue, relieving pressure points, and properly managing wounds with foot soaks, dressings, etc. Many different dressings and medications to use on the wound are available depending on the type of ulcer and its complications. Weight can be shifted away from the affected foot by using crutches, walkers, wheelchairs, and bed rest. Casts, special shoes or boots, braces, or orthotics may be needed. Antibiotic therapy should be started early to avoid serious infection that can threaten the limb. If infection becomes severe (eg, affects the bone), hospitalization and intravenous antibiotics are usually needed. Gout Although gout is most common in middle-aged men, it can develop at any age. In women, gout most often appears after menopause. Usually a painful large joint in the foot or lower leg develops suddenly. Gout tends to flare up from time to time. Gout is usually associated with a high level of uric acid in the blood, which can lead to uric acid crystals being deposited in joints and body tissue. Alcohol use may increase the chance of getting gout. People taking diuretics (ie, "water pills"), heavy drinkers, and people who have recently had a serious illness or surgery are more likely to develop gout. To diagnose gout, healthcare providers use a needle to draw a small sample of fluid from the swollen joint. Needle-shaped uric acid crystals can be seen in the fluid under the microscope. Treatment: There are many effective methods for treating an episode of gout. In most cases, nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen sodium, etc) can reduce the pain and swelling. Colchicine is a drug that helps to prevent the uric acid from forming the crystals that cause the swelling and pain associated with gout. Colchicine can be given intravenously (IV) to treat sudden flare ups and then taken orally to help prevent future episodes of gout. A high uric acid level in the blood does not necessarily need to be treated if there are no signs of illness. However, some people receiving chemotherapy for cancer are given preventive treatment to lower uric acid levels in the blood. Pseudogout is a disease that involves calcium pyrophosphate crystals instead of uric acid crystals. Symptoms, diagnosis, and treatment are similar to those of gout. Arthritis Arthritis is common in older adults, especially in joints that bear weight, eg, the joints in the feet and legs. Arthritis causes pain, swelling, and stiffness. It can limit movement and lead to deformity. Chronic trauma, strain, and obesity make arthritis worse. Most cases of arthritis can be managed with conservative treatment (see Problems with Joints, Bones, and Muscles). Special Shoes and Orthotics Appropriate footwear can prevent serious complications from developing in many disorders of the feet. Various types of shoes and shoe inserts (ie, orthotics) can help relieve pain, and restore and maintain function. Special footwear and orthotics aim to do the following:
Depending on the specific problem(s), shoes can have special soles or extra depth to hold an orthotic. A "depth shoe" has an insole that provides at least 3/16" of additional depth in the shoe and a lot of height in the toe. This allows an orthotic or customized insole to be placed in the shoe, without the top of the foot being pushed against the upper surface of the shoe. An "extra-depth" shoe provides 1/4" additional depth, and a "super-depth" shoe provides an additional 1/2" of depth for larger orthotics or inserts. Medicare provides coverage for some types of therapeutic shoes (eg, depth, super-depth, or custom) and orthotics. To be eligible, you must have the following:
Your healthcare provider can help you determine whether you qualify. |
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Published: 5/5/2005