Feet need TLC to beat ageing
View(s):We worry a lot about how ageing affects the face – but maybe we should worry more about the other end of the body, as about 80 per cent of people over 60 have a foot problem. With the help of leading specialists, Diana Pilkington looks at some of the main problems that affect our feet as we age – and what we can do about them…
Fallen arches
As we get older, our feet tend to elongate and widen – sometimes by as much one size every ten years from our 40s onwards – partly because of the arches of the feet lowering. This can be the result of tibialis posterior tendinopathy, a condition where the tendon (fibrous tissue) that helps to support the arch degenerates.
‘With increasing age the tendon tends to become stretched and the arch starts to flatten, usually from your 50s and 60s, explains Htwe Zaw, a consultant orthopaedic surgeon at BMI Healthcare in the UK.
Fallen arches are also a ‘passive consequence’ of osteoarthritis, says Anthony Redmond, a professor in clinical biomechanics from the Leeds Institute for Rheumatic and Musculoskeletal Medicine. ‘When joints in the foot and leg become osteoarthritic, their shape changes, though we don’t know exactly why, and the arch can fall. If your arch falls, you should get checked out for possible arthritis elsewhere in the body.’
Flat feet – whether from birth or linked to ageing – can put a strain on muscles and ligaments (which link bones together), causing pain in the legs and feet when walking. They are also thought to raise the risk of osteoarthritis higher up in the body, as they cause ankles to roll in, which in turn affects the knees.
Action: If you have aches and pains because of flat feet, avoid going barefoot. Orthotics – inserts in your shoes – can help to stabilise the foot and prevent the changes that cause arches to collapse.
Cracked heels
The skin naturally dries out with age, especially for women going through the menopause, when it produces fewer oils. The heels in particular, where skin is less supple, may crack into deep, sore fissures which are at risk of infection. Sajjad Rajpar, consultant dermatologist at the Queen Elizabeth Hospital, Birmingham, explains: ‘The density of the grease-producing glands is at its lowest in the lower limbs, and it gets worse with age.’ Action: When moisturising, don’t neglect your feet. A heel balm containing lactic acid can help to exfoliate the top layers, while the urea in the cream will help to replenish moisture.
Shaky balance
There are receptors in the ankles – called proprioceptors – that we use to maintain balance, sending messages to the brain about where the feet are in space.
As we get older, these receptors switch off, making us more prone to falls, says chartered physiotherapist Sammy Margo. ‘As physios, we start noticing changes, such as women finding it harder to wear high heels, at around 50 to 55.’ Action: Exercises to re-educate your balance receptors can help. Try standing on one foot when brushing your teeth, and then try to perform the same action with your eyes closed.
Rock hard nails
Lengthwise, our nails grow more slowly as we age, because of reduced circulation. But years of bashing them against shoes can make them thicker.
‘It’s as if the body’s protective mechanism against the trauma is going into overdrive,’ explains consultant podiatrist Michael O’Neill, of the UK College of Podiatry.
This can make nails harder to cut. One person in 50 will develop a condition called onychogryphosis – a ram’s horn toenail that ‘looks like a pork scratching’, says Mr O’Neill. ‘It’s not just unsightly, it’s painful when pressing against shoes.’
Action: Use a file and a good pair of nail clippers on thick nails, as these are sharper than scissors, says Mr O’Neill. Have a bath first and, if you have a partner, cut each other’s toes. People with onychogryphosis may need to see a podiatrist to have the nail trimmed with an electronic file.
Pain in mid-foot
One person in six over 50 will develop osteoarthritis in the middle part of the foot, according to a recent study at Keele University’s Arthritis Research UK Primary Care Centre. The condition is characterised by inflammation around the joints, damage to cartilage and swelling, resulting in pain, stiffness and trouble moving, and sometimes bony bumps over the top of the foot.
It is possible to develop osteoarthritis in the feet alone, says Professor Redmond. ‘There are 26 bones in the foot, 12 of which are in the middle section. A big hip joint is well designed to take the whole bodyweight but that same whole bodyweight has to go through each individual small joint in the mid-foot.’
Risk factors include genetic predisposition, injury to the area and overuse, so runners may be more prone.
Action: Good trainer-type shoes will help to minimise stress to the feet, and losing weight can ease pressure on joints. Research using MRI scans at the Leeds Institute for Rheumatic and Musculoskeletal Medicine found that people with mechanical foot pain (pain that varies with activity) had a higher prevalence of lesions in the bone marrow, thought to be a precursor to osteoarthritis. But ‘judicious use of orthotic insoles’ can help to reverse them, says Professor Redmond.
‘If you have pain in the mid-foot or the arch, see a GP or podiatrist and don’t be fobbed off.’
Sores and ulcers
Older feet may be more prone to ulcers and sores, which can become infected if neglected. One reason is the high prevalence of type 2 diabetes, which is most common in the over-40s. In diabetics, the body becomes resistant to the hormone insulin, which mops up sugar from the bloodstream.
A consequence of this is damage to the tiny blood vessels in the nerves.
‘These nerves instruct sweat glands to sweat – if they stop working, the skin on the soles of the feet may become dry and more prone to splitting, infection and ulceration,’ says Neil Baker, principal diabetes specialist at Ipswich Hospital NHS Trust. Loss of sensation caused by nerve damage also means you may not realise when you’ve injured yourself, so small cuts can deteriorate and lead to ulcers.
Another problem is that diabetes can lead to poor blood flow, which means the body is less able to fight infections. If not managed well, the condition can result in amputations – there are about 100 leg amputations a week in the UK. Circulation problems are more common in older people, particularly in those with heart disease or high blood pressure – and as the feet are so far from the heart, they may bear the brunt.
Action: If you have lost sensation in the feet due to diabetes, be vigilant about avoiding injury – don’t cut your own toenails, as you may injure flesh without realising, and use emery boards rather than sharp implements to remove dead skin. Even if you don’t have the condition, watch any cuts carefully, as poor blood flow could affect their ability to heal. Wear correctly fitting footwear – don’t go barefoot.
Worn-out fat pads
Fat under the skin all over the body tends to disappear with age – this includes the protective fat pads on your soles, predominantly under the balls of the feet, says Michael O’Neill. ‘If you’re on your feet for long periods, it can cause pain. Because there’s no protection over the bones and joints it can lead to calluses (hard skin).’
Most people will lose these fat pads by 65, but it can happen from age 50 onwards. The process is unlikely to be speeded up by losing weight, though.
Action: Although you can’t stop fat thinning out, wear shock-absorbent shoes to cushion feet. Silicone insoles may also help.
Painful corns
Years of pressure from footwear, combined with a gradual loss of protective fat in the feet and arthritic changes to the joints, mean we are more prone to painful, toughened areas of skin known as calluses and corns as we age. Michael O’Neill says: ‘Corns tend to form over any joint surface that has pressure – particularly the tips of the metatarsals (the five long bones that extend from the bottom of the toes down the foot), where they press on shoes or the ground.
‘They can also form on the top of knuckle joints where they press on footwear. ‘Most people in their 40s and 50s will have them.’
Action: Ease hard skin by rubbing it with sandpaper-based foot files or metal foot scrapers, but avoid pumice stones, says Michael O’Neill.
‘These harbour dead skin inside the holes, and bacteria can develop as they decompose.’ Better footwear will help to even out the pressure, and surgery can address underlying toe deformity that has led to corns.
PS: But fewer verrucas
There is some good news. Anyone who suffers from verrucas (warts on the soles of the feet, triggered by a virus) will probably find they get fewer of these with age, says dermatologist Sajjad Rajpar. ‘Your tendency to get viral infections decreases with age because you develop immunity once your body has seen a virus before.’
However, fungal infections of the toenails and feet are more likely as you age. ‘Trauma to the nails can make them more vulnerable. Poor circulation probably doesn’t help. Another predisposing factor is diabetes – diabetics have a poorer immune system, so they are prone to infections.’
Action: Make sure your feet are dry before putting on socks. Women using nail varnish should apply a special base coat first to protect the nails from toxins, which can weaken them and allow fungal infections to take hold.
© Daily Mail, London