Because good foot health is essential to quality of life, it is of paramount importance that foot problems be prevented as much as possible, and that when they do occur, they receive early and appropriate treatment.

Common foot disorders in the older adult include:

• Hallux valgus (the big toe drifts toward the other toes). A bunion may form on the outside edge of the knuckle of the big toe, and the big toe may overlap the other toes.

• Deformities of the lesser toes. In hammer toe, the middle joint of the toe sticks up to form a painful callus on top of the joint due to friction and pressure with the shoe.

• Degenerative joint diseases such as osteoarthritis. Joint pain, weight bearing, and joint tenderness with pressure may interfere with normal walking.

• Circulatory changes related to diabetes and vascular diseases such as arteriosclerosis.  Narrowing of the blood vessels can affect the integrity of the skin and underlying soft tissues and compromise healing of open wounds.

Foot problems are often related to footwear, but in our society, going barefoot is not a viable option. We wear shoes for foot protection, sanitation, and fashion. Even in good, supportive shoes, our feet suffer because the muscles weaken from lack of use. On the other hand, shoes that do not adequately support the foot contribute to foot deformities and pain by:

• causing muscle weakness from disuse, and

• allowing supportive ligaments of the foot to stretch, permanently affecting the foot's structure.

Fashion, especially for women, is a major culprit. Narrow, pointed toes of shoes squish the toes together, causing overlapping, pressure points, and decreased circulation. High heels further compromise the toes, decrease ankle stability, and force the ball of the foot to bear an excessive proportion of the body's weight. In addition, long term wearing of high heels can cause permanent shortening of the heel cord, the toe extensor muscles on the top of the foot, and supportive structures in the arch of the foot. Combined, these changes significantly alter the structure and functional capacity of the foot.

Proper conservative foot care is essential to prevent disuse and dysfunction that can eventually lead to debilitating foot problems. To maintain your healthy feet, follow these steps.  

• Check your feet. Look for changes and/or breaks in the skin. Use a hand mirror to check the bottoms of your feet. Persons with diabetes or other circulatory problems should do this daily, and see their doctor as soon as problems are identified.

• Keep your feet clean. Use soap and warm water (not hot) every day, and dry thoroughly, especially between the toes.

• Keep your skin soft. Use a moisturizer if the skin on your feet is dry or cracks easily.   

• Be careful with sharp instruments. Do not cut calluses off; this can cause infection. Cut your toenails straight across and keep them fairly short to avoid ingrown toenails. If you can't cut your toenails, get help. If you have diabetes or other circulatory problems, have a professional help you.

• Maintain proper weight. This relieves a lifetime of pressure on your feet.

• Wear well-fitting, appropriate shoes. Over a lifetime, shoe size usually changes. If you wore size 7 in your twenties, you may need size 8 in your forties, and a wider width in your seventies. It's okay to wear heels occasionally, but they are very hard on your feet, especially if the toe box is narrow and pointed. Unsupportive slippers contribute to problems if worn long term. For prevention and treatment of toe deformities, look for a shoe that has:
  • high, wide toe box
  • soft leather uppers
  • longer shoe to promote proper joint alignment of the toes during gait
  • soft cushioned outer sole
  • lower heel promotes greater ankle stability 

                         

1.  Exercise position: sitting in a chair, with feet flat on floor. Raise the toes off the floor several times. Keep the ball of the foot on floor. This helps maintain normal range of motion of the toe joints which is important in normal walking.  

2.  Exercise position: sitting in a chair, with feet flat on floor. Slide foot back under the chair. Raise the heel, keeping the ball of the foot and the toes on the floor. This stretches tight muscles under the foot and maintains normal range of motion of the toe joints.

3.  Exercise position: sitting in a chair, with feet flat on floor. Keeping the feet and toes flat on the floor, press the toes into the floor. Keep them straight as much as possible, not allowing them to curl. This strengthens the intrinsic muscles of the toes. (Intrinsic muscles--small muscles of the toes that arise in the foot and insert on the bones of the toes.)      

4.  Exercise position: sitting in a chair, with feet dangling. Spread the toes apart as far as possible, then squeeze together as tight as possible. After practice, some people can put a wide rubber band around their toes and spread them against resistance, further increasing strength of the intrinsic muscles.

5.  Exercise position: sitting in a chair, with feet flat on the floor on the end of a bath towel. Curl the toes and draw the towel under the foot. As strength improves, add a weight to the other end of the towel. Strengthens intrinsic muscles.

6.  Exercise position: sitting in a chair. Place a marble on the floor, and pick it up with your toes. Strengthens intrinsics.

7.  Exercise position: standing, holding lightly onto a counter top or sturdy chair for balance. Raise up onto your tip toes, then rock back to your heels, lifting your toes off the floor several times. If unable to stand, this may also be done sitting. This improves balance and leg strength when done standing, increases foot and ankle range of motion and strength of the anterior tibialis muscle in both positions. (The anterior tibialis muscle is on the front of your lower leg just to the outside of the shin bone. It is important to keep this muscle strong and your ankle flexible so you can pick up your toes when you walk, and avoid tripping.)

8.  Exercise position: sitting in chair. Straighten one knee and flex the ankle. Point the toes toward the knee and feel the calf muscle stretching. Repeat 4 times on each leg, alternating legs.  This exercise will help avoid cramping in the lower leg.