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 | Feet
By Michael Spilane, MD
By age 70, the average person has been standing or walking for over one hundred thousand hours. No wonder the feet ache. It is the exceptional person who reaches older age without a foot problem--there has been too much weight and too much movement for too long.
A foot has dozens of moving parts, all required to work in unison while supporting the weight of the entire body. Faulty function of a foot or ankle part is hard to avoid. And if one part fails the other parts become stressed and susceptible to failure. It is a bit like the dominos thing, one goes and the others follow. The initial problem may be congenital flat feet, an injury, weak ankles, angled knees that don't distribute the weight evenly to the ankles, or long use of improper footwear. Or it could be a disease like diabetes or rheumatoid arthritis that affects the muscles or joints in the feet. The end result is one or more of the common maladies of the worn and deformed footbunions, fallen arches, curled toes, turning of the ankles, calluses, and corns.
I offer some advice to the older person with discomfort caused by deformities of the feet. I am not talking about cures, but hopefully about relief and certainly about prevention of complications.
- It is much easier to fit the shoes to the feet than to surgically conform the feet to the shoes. Make sure you have shoes that fit properly, this is the most important thing you can do if your feet are deformed and hurt. Start by throwing out the high heels. Bunions and curled toes demand shoes with a broad front, fallen arches call for an arch support, and turned ankles require strong rear and side shoe support. It may be worth a visit to a podiatrist just to get advice on the right type of shoes and where to find them. Be prepared to lighten your wallet or purse, but sturdy and accommodating shoes are well worth the money.
- It is a good idea to have two pairs of shoes and to alternate their use. Different shoes distribute the body's weight to different parts of the foot, avoiding a continual burden at one location.
- Surgical correction of a bunion, toe or ankle deformity is an option, but many that are older will appropriately choose to live with the problem and avoid the risks associated with the surgery. If the deformity and symptoms are severe and surgery is being considered, choose a surgeon who is skilled and experienced. Some orthopedic surgeons specialize in problems of the feet and some podiatrists (but not all) are highly trained and competent in the surgical techniques.
- You may think you know what is wrong with your foot and be resigned to living with it. But a correct diagnosis is essential. What you think is the ache of a bunion may be a manifestation of curable gout. Or a treatable circulation problem or disease of the nerves could be the cause of another discomfort.
- Remember that physicians tend to be undertrained in diagnosis and treatment of problems caused by deformities of the feet. Geriatricians do better. Podiatrists do best. A wise approach is to seek help from your physician first. If it is determined that your symptom is related to a deformity and not to a disease, don't be shy about asking for a referral.
- It is best to leave corn and callous removal to your physician or podiatrist. Avoid corn plasters and chemicals that can cause burning and ulceration of the skin. Never attempt removal with a knife or a razor blade. An agile person with good eyesight might use a file or sandpaper to trim a callus, but this is a very bad idea for anyone with diabetes or impairment of foot sensation. It is very important that calluses are kept trimmed--failure to do so invites more pain and even infection.
- Avoid ritualistic soaking of the feet. No, it is not a good thing to soak the feet daily. Over soaking tends to pull moisture from the tissues and result in drying and cracking of the skin. Soaking may provide temporary relief of aches, but it invites fungal infections and other troubles.
- Avoid over-the-counter lineaments, salves, and gooks. The skin of the feet, especially deformed feet, is sensitive and easily harmed by chemicals. Regular use of a simple moisturizing cream (for example, Lubriderm, Wondra, or Keri) after cleansing and drying is helpful.
The feet are among those things that don't last forever. As they age they need more maintenance and TLC. Deformities developed over a lifetime will not be cured, but attention to some simple actions will be rewarded.
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