Estimates suggest that, on average, if you live to the age of 80 years old you will have taken enough steps to walk the Trans-Canada Highway between Victoria, British Columbia and St. John’s, Newfoundland over 20 times! That is a lot of ground covered on a pair of feet that must get us through a lifetime.
If you knew how many steps you would be taking in your life, would you care for your feet a little better than you are now? Maybe you already have a concern about your feet? While issues with our feet do not discriminate against age, there are a few conditions that become more common among older adults. Read on to learn more about them and how Canadian Certified Pedorthists – C. Ped (C)- can help.
Fat Pad Atrophy
We are all born with large fat pads in our feet. It is why babies’ feet are so cute and plump. When we learn to walk, these fat pads serve the purpose of cushion and shock absorption, reducing the amount of stress on the other soft tissues and bones of the feet. Unfortunately, as we get older, the fat pads begin to break down, thin out, and stop doing their job so well, otherwise known as atrophy. When this atrophy occurs, clients will often describe it as the sensation like they are walking directly on the bones of their feet, most commonly at the heel or ball of the foot. Not only is the sensation unnerving, it can also lead to other complications such as ulceration.
Treatment: To treat fat pad atrophy, a Canadian Certified Pedorthist may recommend supportive footwear with cushion in the areas where thinning has occurred. They may also design custom foot orthotics with extra padding applied to the areas that feel most like they are lacking natural cushion. The foot orthotic may also include features such as a deep heel cup to contain the fat pad under the heel or a metatarsal pad to take some pressure away from the ball of the foot.
Corns & Calluses
Corns and calluses are regularly grouped together; however, they are two unique changes that can happen to the skin of our feet. A corn is a dry thickening on the outer layers of skin with a hard, central core, about 1cm or less in diameter, and commonly found on the side of the 5th (baby) toe, on top of or between the other small toes, and on the bottom of the foot. The most common cause of corns is ill-fitting footwear. Similarly, calluses are formed by a thickening of the skin. However, calluses often appear in areas of high friction and pressure. They can range in size, even covering the entire bottom of the ball of the foot.
Treatment: To treat corns or calluses, a Canadian Certified Pedorthist may recommend better fitting footwear and can help you to choose shoes with a toe box that matches the shape (including depth and width) of the foot. If footwear isn’t the cause they may introduce pre-made or custom spacers to keep the areas separated. Custom foot orthotics can help to positively alter the mechanics of the feet such that pressure and friction can be reduced. Your C. Ped (C) can excavate or dig material out of the shoe or foot orthotic to accommodate a corn or thick callus.
Hammer, Claw & Mallet Toes
Hammer, claw, and mallet toe deformities each refer to a different orientation of the small joints in the lesser toes (toes two through five). They are often the result of an imbalance between the muscles that point the toes down and those that pull the toes up. They are exacerbated by footwear that is too tight and there is a higher occurrence of lesser toe deformities in women than men. Our small toes are meant to help stabilize the foot, and when this function is compromised it increases the risk of falling. This is especially the case among older adults, who have other risk factors for falls as well. Toe deformities are best treated early on when range of motion is still available in the joint.
Treatment: Because ill-fitting footwear is associated with toe deformities, a Canadian Certified Pedorthist will first make recommendations on features and fit to look for. In most cases, extra depth will be required in the toe box of the shoe. Neoprene or mesh can allow for more stretch over the toes compared to a leather or vinyl. Something as simple as having your shoes stretched can also be a big help. If you have a hammer, claw or mallet toe that is due to another problem with your foot your C. Ped (C) may modify an off-the-shelf device or make custom foot orthotics for you. An off-the-shelf or custom toe prop or crest can also be used to offload the tips of the toes in question; this is particularly useful if a painful callus has formed. (For more on conditions of the toes read https://www.pedorthic.ca/foot-health/toe-conditions/)
While changes to the surfaces of our joints, also known as osteoarthritis (OA), can occur as naturally as getting wrinkles on our skin, people over the age of 55 are four times more likely to experience the effects of OA than those in younger age groups. OA can also be brought on by a history of injury and generally poor alignment of the joint. The most common areas of OA in the feet occur at the big toe joint, the ankle, subtalar joint, and midfoot. (For arthritis myths debunked read https://www.pedorthic.ca/pedorthics-arthritis-debunking-common-myths/)
Treatment: Those who are living with OA in their feet or other joints are encouraged to remain active with low impact activities. Depending on the affected joint, your Certified Canadian Pedorthist may recommend footwear features such as a stiff rocker to help reduce painful range of motion and quickly propel the foot during the gait cycle. Custom or off-the-shelf foot orthotics are a conservative treatment that can be used to alter motion and loading of the joints. Selection of the materials a C. Ped (C) might use for someone experience pain due to OA in the foot or ankle will be dependent on what is found during the assessment and could be anything from soft foams to rigid plastics.
To learn more about foot conditions that could be affecting you and your mobility, visit our website to find a Canadian Certified Pedorthist near you visit https://www.pedorthic.ca/find-a-pedorthist/
By Jaime Nickerson, C. Ped (C)