The Aged Foot

Original Editors - Scott Buxton

Top Contributors - Scott Buxton, Lucinda hampton, Kim Jackson, 127.0.0.1, Lauren Lopez and Khloud Shreif

Introduction

Foot problems are commonplace in people over the age of 75 moreso than a younger population. Foot impairment contributes to falls, immobility, the progression of frailty and can lead to a quicker progression towards dependence and not independence. It is understandable when you consider how many miles an average person walks in their lifetime. 

The average moderately active person take around 7,500 step/day. If you maintain that daily average and live until 80 years of age, you'll have walked about 216,262,500 steps in your lifetime. Doing the math, the average person with the average stride living until 80 will walk a distance of around 110,000 miles.

The management of the aged foot is typically aimed at achieving comfort through the reduction of pain as well as increasing mobility. Both ultimately preventing dependence and reduce the need and demand for other services. Thankfully most common issues can be treated successfully by Podiatrists as well as Physiotherapists. The aim of this article is highlight the common issues as well as basic methods of management.

Prevalence

It is estimated that around 80% of older people have foot problems however many of these people do not seek medical attention. Multiple studies in many countries have found the same, older people do not seek help for foot problems when something can be done about it.

The most common foot problems are nail problems, calluses, bunions, corns, hallux valgus, generalised pain, swollen feet and circulatory problems.

31% of older people are unable to cut their own toenails because:

• Unable to reach their feet
• Lack finger deterity to the point they are unable to use the clippers
• Get dizzy when bending
• Of visual  impairment
• Thick toenails

Management

Prevention

1. Regular Checks. Long-term conditions increase the likelihood of developing issues particularly those disorders which affect circulation. The signs of deterioration are subtle and therefore long-term vascular issues need to be monitored. It is essential that alongside regular check-ups those most vulnerable seek primary care advice as soon as any new issues arise such as blisters, cracks or obvious changes. Prevention is the best protection, you do this with your eyes, why is it different for your feet?
   
2. Nails. As we age it is increasingly difficult to reach our toe nails but cutting them should not go to the wayside. Poorly looked after nails can become ingrown and infected resulting in pain and immobility. The nails get long, press against shoes, the pressure causes sores, the sores become infected and then ulcerated. You look after your fingernails, why not your toenails?  
3. Skin Quality. As we age our skin becomes dry, cracked, have a reduced circulation and a reduction in fat pad absorption. Once the dryness and cracked skin with sores sets in they are a rife place for infection. Cellulitis is common in elderly people and frequently reoccurs. You care about the skin on your face, why not your feet?
4. Correct Footwear. Optimum alignment and weight distribution is essential to keep joints and soft tissues working effectively. A good pair of closed heel flat shoes with good shock absorption promotes good walking posture and balance whislt reducing any risk of chaffing or rubbing. Additionally they should be roomy enough to allow for minor swelling which occurs during the day. Why do you think runners spend so much on good quality running shoes?