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“Feet, don’t fail me now: Common foot problems to avoid and treat as you get older” (2)

There are many common foot problems experienced by the age 50+ population. Some of the most common include the following: 

Bunions:  

Patient often believe that a bunion is a “bump” or calcium deposit on the side of their big toe joint. Unfortunately, many are told that it can just be “shaved” off.  A bunion is not just a bump on the side of the big toe joint, it is actually a structural deformity and the “bump” is the first metatarsal (long bone behind the big toe joint) move out (away from the center of the foot) and the big toe moving in (toward the center of the foot or toward the 2nd toe).  The “bump” cannot just be shaved as this is actually a normal part of the bone. To “fix” a bunion with a good long lasting result so the bunion does not come back, the bunion should be fixed at the root of the deformity, with a Lapiplasty® 3D bunion correction. This can actually be done if the big toe joint is healthy, or if there is arthritis, they are just done slightly different in each case. 

Symptoms with a bunion include:

      1. Pain along the side of the big toe joint
      2. Pain in the big toe joint
      3. Callous along the side of the big toe joint or big toe
      4. Pain under the 2nd toe joint on the ball of the foot. 

Bunions are hereditary. They ARE NOT caused by shoes. Shoes can make a bunion hurt more, but they do not cause them. Non-surgical ways to decrease pain include wearing wider shoes. There are no straps or gadgets that can fix a bunion. Surgery with an evidence-based procedure such as Lapiplasty® 3D bunion correction is the only way to correct a bunion permanently and completely. Candidates for surgery are those that have good blood flow and feeling to the feet. This is a reason why fixing a deformity earlier may be a good idea. Once there is problems with blood flow, or circulation, and feeling surgery may no longer be an option, or if it is an option, it may be more difficult to heal.

Hammertoes:

Hammertoes are hereditary like bunions and result from imbalance between large muscles and small muscles, and are often worsened by bunions. Hammertoes are also very similar to bunions with respect to symptoms, surgery candidates, and reasons they occur. Hammertoes can result in rubbing in shoes that cause callouses to the top of the toes, or at the tip of the toes. These callouses can be trimmed down to alleviate some discomfort but that WILL NOT solve the problem.  If the deformity remains and there is rubbing and friction from the shoe the callous will continue to return. Hammertoes can also result in pain and callous on the ball of the foot because if the toes is contracted it pushes the foot “knuckle” down. This increases the pressure on the soft tissues and the bone and can cause pain and callouses.

Wearing shoes that are tall and wide enough and, in some cases, also using an orthotic, can take pressure off of the toes and the “knuckles” to decrease pain. Hammertoes are hereditary like bunions and result from imbalance because large muscles and small muscles, as are often worsened by bunions.

Plantar Fasciitis:

This is actually common in all ages of adults. This is typically due to the foot rolling in or “pronating” more than it should. This is often due to tightness of the muscles that form the Achilles tendon. It can be aggravated by poor shoe gear and increased activity.

Typical symptoms include pain on the bottom of the heel that is worse in the morning and after rest, though for some, it may progress as the day goes on. For some, they may have pain in the arch region as well. This pain may result in people not wanting to walk and be active. In most cases, plantar fasciitis can be resolved with supportive, stability walking or running shoes and a medical grade prefabricated orthotic. With the right shoe and the right orthotic most patients do not need injections or custom orthotics.

Home stretching of the Achilles tendon and icing can help symptoms, but the key is wearing the right shoe and support with all walking. This is typically a clinical diagnosis based on symptoms and exam. Rarely do patients need x-ray, advanced imaging such as MRI or ultrasounds, or physical therapy. Patients may need to modify physical activity until symptoms decrease, but rarely do they need to stop physical activity.

Neuroma:

Neuromas are actually very uncommon, though they are commonly diagnosed. Most of the time when a neuroma is diagnosed it is actually pain due to either a bunion, a hammertoe, abnormal weightbearing (standing) foot position or a combination of these issues that lead to soft tissue irritation and increased pressure on the joints of the toes on the ball of the foot. These problems can lead to very similar symptoms. In many cases better shoes and medical grade prefabricated orthotics may resolve the symptoms, but if not, then fixing the problem leading to the symptoms, such as the hammertoe or bunion may be needed.

Diabetic Neuropathy:

Nerve damage from diabetes can lead to loss of feeling in the feet, known as neuropathy. This loss of feeling, or protective sensation, may result in a person getting a sore on the foot and not even knowing it. This can unfortunately then potentially lead to infection.  It is very important for diabetics to control their blood sugars, as this helps to decrease the negative effects of diabetes on the nerves. Diabetics should stay active to control their blood sugar and to help maintain circulation, or blood flow to the feet.

Diabetics should always wear shoes that fit their feet appropriately to protect from pressure sores from the feet and to protect their feet from injury from stepping on something. They also should check their feet daily.

Diabetics are often told they should “never” have surgery, but if they have good blood flow, good feeling, and good control of their blood sugar, then surgery is usually very safe. In many cases, it is better to be proactive in diabetics and correct deformities that may be present, such as hammertoes and bunions, otherwise they can turn into areas that more likely to form sores due to the combination of deformity, loss of feeling, and shoes rubbing on the deformity in later stages of their diabetes. 

Progressive flat feet:

If a patient notices their arch continuing to decrease and has pain in the ankle or foot region they should seek care immediately. This is often caused by an imbalance of muscles/tendons and can result in a tendon severely stretching or tearing. Once the tendon is torn, it can be much more difficult to resolve symptoms and as the arch collapses it can lead to arthritis and more pain throughout the foot and ankle.

Swelling in the legs and feet:

Swelling in the legs and feet, whether both sides or just one is not normal. This can be due to an injury, problems with veins, or problems with the heart. Any swelling that last for more than a couple of days should be evaluated by a podiatric physician to identify the cause and determine treatment so that it does not lead to further problems.

Author
Foot & Ankle Center of Iowa

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