Common Foot Problems in Older Adults: Causes and Treatment

Leonardo Da Vinci famously said, “The human foot is a masterpiece of engineering and a work of art.” He was amazed that such a seemingly small part of the human body could carry it for an entire lifetime.

This rings particularly true for our aging population. Factors — such as better health care, innovative strides in medicine and healthier lifestyle habits — have led to an increased life expectancy, especially when people incorporate walking and exercise into their daily routine. The result: a whole lot more wear and tear on these “masterpieces of engineering.”

Estimates show that by the time a person reaches age 65, approximately 90% of the population will have suffered a foot and ankle condition at some point. The foot is a complicated body part — home to 26 bones, 33 joints and a complex matrix of ligaments, tendons and muscles.

Due to the physiological complications that come with aging – such as decreased muscle mass, poor circulation and longer healing times – foot problems and injuries in older people can have complications on their overall health and mobility. Your feet really are your base of support.

[Read: At-Home Foot Care.]

7 Most Common Foot Problems

The most common feet and ankle problems include:

— Plantar fasciitis

— Achilles tendonitis

— Neuromas

— Bunions

— Fat pad atrophy

— Hammertoes

— Gout

1. Plantar fasciitis

One of the most common conditions across all generations is plantar fasciitis, also known as “heel spur syndrome.” Affecting nearly 2 million Americans each year, plantar fasciitis is caused by an inflammation and degeneration of the plantar fascia, the tendon band located on the bottom of the foot. The plantar fascia is responsible for maintaining the structure and stability of the arch.

Long periods of standing, flat feet, high arches and obesity are risk factors for plantar fasciitis.

Patients with plantar fasciitis will often present with sharp or stabbing pain in the heel area with the first step in the morning. The pain typically lasts for a brief period, then decreases in pain and intensity.

2. Achilles tendonitis

Achilles tendonitis is another common foot issue. This condition occurs in the back of the foot in the area where the tendon inserts into the heel bone and the area 1 to 3 inches above where the blood supply is at its lowest. That naturally slower blood flow renders the Achilles tendon less elastic and weaker in structure. Therefore, older patients are more prone to rupturing this area. The pain may also ascend into the leg and the calf muscles.

Regular stretching of the calf muscles and Achilles tendons can help prevent pain.

3. Neuromas

Neuromas, also called interdigital neuromas or a Morton’s neuroma, are nerve enlargements that are often found right below your toes in the front of the foot.

Patients with neuromas usually feel symptoms, including:

— A burning or tingly sensation under their toes

— Pain radiating into the tips of the toes

— Cramping

— The sensation that a sock is rolled up in the front of the shoe

Neuromas are often brought on by long periods of wearing poorly fitting shoes that are too narrow and constricting. Another cause of neuromas is obesity. The uneven weight distribution of carrying excess weight can cause more pressure to be applied to the nerves in the foot, resulting in the enlargement and the formation of a bursa sac around the nerve.

4. Bunions

Bunions — also known as hallux valgus — are very common in all active age groups. They are painful, bony bumps that develop on the outside of the big toe joint. They tend to develop slowly over time, as pressure on the big toe joint pushes the toe inward, toward the second toe.

Bunions are caused by abnormal biomechanics forces in the big toe, ill-fitting and tight shoes and arthritis in the joint. Bunions are especially common in women due to wearing ill-fitting footwear such as high heels or pointy-toed shoes. The bunion becomes enlarged and sometimes painful when the tissue covering the big toe joint becomes stressed, irritated and inflamed.

The area directly below the big toe, called the sesamoid apparatus, endures a large amount of stress and force. It acts as a pulley system composed of bones, muscles, tendons and ligaments that propels the foot forward for walking and running. This area can be the site for a fair amount of pain and discomfort, making walking and exercise extremely difficult and painful.

5. Fat pad atrophy

The fat pad is one of few places in the body where fat is a welcome addition. The foot relies on the fat pad in both the front of the foot and in the heel area to better absorb the tremendous forces the foot is subjected to during the day. Over time, the fat pad degenerates and can lead to inflammation of the heel bone, the plantar fascia and bones in the front of the foot, known as metatarsals.

6. Hammertoes

Hammertoes are very common foot deformities that can be painful, especially if a hard area of skin, known as a corn, develops over the hammertoe. Every step can be painful, especially when there is contact with the top of the shoe. The term “hammertoe” refers to a toe that points upward, rather than lying flat.

This constant friction and irritation can cause the development and inflammation of a bursa, which is a fluid-filled sac that protects a bony prominence. Hammertoes are sometimes the result of neurological disorders such as neuropathy and stroke. Hammertoes may also affect balance and posture.

7. Gout

The big toe is a favorite spot for the development of gout, a metabolic inflammation of the joint that causes extreme pain. Diets rich in certain proteins and substances known as purines, dehydration, overindulgence in alcohol and coffee, red meat, shellfish, legumes and certain systemic diseases can precipitate a very painful gout attack.

[READ: Tips for Swollen Ankles and Feet.]

How to Avoid Common Foot Problems

Obesity can increase your risk of suffering from foot pain. As people’s body mass index, or BMI, increases from the normal range to obesity, so do the odds that they will have foot pain as they get older; this is true for men and women.

Compromised blood flow to the feet can cause or worsen foot pain. Various factors can affect the quality of blood flow to the feet, including whether you smoke or have diabetes, peripheral neuropathy or blood clots.


Shoe fit is always an important consideration. One study showed that almost 90% of the population is wearing the wrong shoe size. A person’s shoe size at age 20 isn’t necessarily going to be the same at age 50.

As our bodies shrink with age, our feet often seem to get bigger. Feet do not literally grow, orthopedists agree. Rather, over the years, tissue in our feet degenerates and ligaments become looser, which causes strain on joints and can lead to arthritis. The degeneration of ligaments can cause feet to flatten and become wider. In addition, pregnancy has also been shown to cause increases in shoe size.

It is always best to have your new shoe fit in the afternoon when the swelling is greatest, not in the morning. If shoes are not comfortable when you try them on, don’t buy them in the hopes you will break them in. Poor shoe fit causes many overuse injuries in the muscles, tendons, ligaments and bones. The best shoe should have a slightly wider toe box to allow for afternoon swelling and a small to medium heel height that will protect against knee problems as well as plantar fasciitis and Achilles tendonitis.

Orthotic devices

Orthotic devices are very useful to support areas of the foot that have structural (high arches/low arches) and functional deficits. Patients commonly use either over-the-counter or prescription orthotics. OTC inserts are best suited for comfort and cushion in a shoe. They provide little to no orthopedic support, are accommodative in nature and do not change the mechanics of the foot.

Prescription orthotics, prescribed by a doctor, are designed to improve the shock absorbing capability and make the motion relationship between the front, middle and back of the foot more ideal. They have been shown to improve function and decrease pain in the knee, hip and lower back.

Compression socks

Compression socks are useful to wear in the presence of venous congestion and varicose veins. Prior to wearing these devices check with your doctor to make sure they’re right for you.

Foot surgery should always be the last resort. Most foot and ankle problems can be managed successfully without surgery. Don’t self-diagnose. If an issue persists for more than one week, you should seek medical attention by a health care professional.

[SEE: Best Running Shoes.]

Importance of Healthy Feet for Health

Walking has many benefits that lead to a healthier lifestyle. It can promote better circulation, leading to lower incidence of cardiovascular disease, arterial sclerosis and high blood pressure.

In addition, walking also promotes better regulation of glucose, the primary type of sugar found in your blood and your body’s primary source of energy. Proper glucose control is important especially for people with Type 2 diabetes, a disease that has increased over the last two decades. Walking has been prescribed by endocrinologists in diabetic cases, where they’ve seen helpful results, especially with the geriatric population.

Bottom Line

Ultimately, the importance of healthy foot and ankle function can never be underestimated.

It has been shown in numerous studies how a painful and compromised foot can lead to musculoskeletal problems elsewhere in the body, including the knee, hip, spine and even the TMJ joint in the jaw.

More and more clinicians are appreciating and recognizing the role of the foot in preventing these issues. And if there’s one thing we can agree on, it’s that foot and ankle problems may not be life-threatening, but they certainly are lifestyle-threatening and affect our overall health, especially when it comes to older adults.

If you experience any of these common feet problems or experience other issues with your feet, talk to your primary care physician or podiatrist.

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