Taking the right steps to prevent or treat foot problems

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Anyone’s feet can hurt after a long period of walking or standing, especially if their shoes aren’t supportive or comfortable. But older adults are more likely to have conditions such as arthri­tis and diabetes that can lead to foot discomfort.

Then there’s the wear and tear that comes with age. “When we’re younger, our feet are more flexible and our skin is more resilient, both of which protect us from conditions such as hammertoes, bunions and calluses,” says orthopedic surgeon Sean Peden, a foot and ankle specialist at Yale Medicine in New Haven, Conn.

Foot issues should be dealt with promptly, he says, because they not only hurt but also can affect mobility and ­increase your risk of falling. For foot care tasks such as cutting toenails, you may want to have a professional pedicure or — especially if you have diabetic nerve damage or an abnormal gait — see a podiatrist for help. Here are steps for preventing and treating foot problems.

If you’re experiencing pain on the bottom of one or both feet near the heel — especially after a period of rest, such as a night’s sleep — you probably have plantar fasciitis. This occurs when the plantar fascia, tissue that runs along the bottom of the feet from heel to toe, becomes inflamed.

Wearing the right shoes to keep your feet pain free

Plantar fasciitis is caused by stress on the fascia, which can come from overly tight muscles in the calves and feet. The trigger may be overuse or leaping back into activity after a sedentary period (playing tennis after a break of several months, for example). While this can happen to anyone, “over the last 25 years we have seen it in more older adults, as they’re staying active into their 60s, 70s or even 80s,” says Bryan Markinson, a podiatrist and associate professor of orthopedic surgery at the Icahn School of Medicine at Mount Sinai in New York.

Another cause for foot pain in older adults — especially if it generally flares up with activity and is accompanied by swelling — could be osteoarthritis (OA). The cause: a wearing away of the protective cartilage between joints in the foot.

Prevent it: Choose shoes with thick, stiff soles and extra cushioning to reduce stress on joints or fascia. For ­instance, if your shoe “easily bends in half, it can cause or worsen plantar fasciitis,” says Alex Kor, DPM, a spokesperson for the American Podiatric Medical Association. Regular calf stretches may also head off plantar fasciitis.

Treat it: When pain strikes after rest, a couple of minutes of walking usually helps (though the ache might worsen again after activity). Also useful in the moment are calf stretches or a plantar fascia stretch. Do the latter while sitting: Grasp the toes of the affected foot and gently pull the foot toward you.

For ongoing pain, you may need a hiatus from activities such as aerobics where your feet pound on hard surfaces. ­Icing the area several times a day is also wise. These sorts of moves help about 90 percent of people within 10 months, according to the American Academy of Orthopaedic Surgeons. With OA, your doctor will probably recommend weight loss if it’s appropriate; low-­impact activities, such as cycling and swimming; and, possibly, physical therapy. In some cases, an ankle-foot brace or a custom in-shoe orthotic may help relieve pain.

Bunions (a bony outcropping at the big toe joint) and hammertoes (which hump up at the middle joint) are more likely to develop with age. That’s typically due to years of pressure on feet from ill-fitting shoes, says Said Atway, a podiatrist at Ohio State University Wexner Medical Center in Columbus. In addition to causing pain, especially when you’re wearing shoes, the area may be swollen and red, and it could develop calluses and corns. You might also find it hard to straighten hammertoes.

Prevent it: Footwear is key. Shoes should be about a half-inch longer than your longest toe, with a roomy toe box, Peden says. Sandals are fine if they have a somewhat stiff bottom and don’t pinch or rub other parts of the foot.

Treat it: See your doctor or podiatrist, who will probably suggest the footwear strategies above. For hammertoes, your doctor might also give you exercises to help you stretch and strengthen foot muscles. One good option is “towel curls,” where you try to pick up a towel with your toes.

If you have bunions, you can place drugstore “bunion shield” pads over the areas to help cushion the sore spots. (Test pads before wearing them for an extended time, to make sure they don’t increase pressure on the bunion and worsen pain.)

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If the above steps don’t relieve pain sufficiently, your doctor might recommend surgery to remove a bunion or straighten a hammertoe. Recovery from hammertoe surgery usually takes about four to six weeks, and it can take up to six months to bounce back from bunion surgery.

Calluses and corns are thickened areas of skin that form on toes or the soles of feet as a result of pressure, often from poorly fitting shoes. “They are your feet’s natural way to help protect the skin underneath them,” Atway says. Calluses are usually painless, while corns tend to be painful or tender — and are sometimes accompanied by a fluid-filled sac underneath.

Prevent it: Proper shoe fit is essential, Peden says. Have your feet measured ­every time you buy a new pair of shoes because foot size may increase with age, and shop for shoes at the end of the day, when feet may be slightly swollen. And keep your toenails trimmed. “If they are too long, they can force your toes up against your shoe, creating pressure,” Peden says. He also recommends wearing supportive shoes at home, to protect your feet.

Treat it: Hillary Brenner, a po­di­a­trist in New York City and New Jersey, recommends soaking a callus or corn for 10 minutes daily in warm water, then gently filing it down with a pumice stone. Finish with an over-the-counter moisturizer that contains salicylic acid or urea, to help soften the lump. If wearing shoes is painful, apply a small piece of moleskin (find it at the drugstore) to the area.

Pins-and-needles sensations

Nerve damage (neuropathy), which can cause feet to tingle or feel numb, is a frequent complication of diabetes — and one that’s more common with age. “This needs to be taken seriously because you may not notice if something has irritated or punctured your feet,” Kor says. “This means something as minor as a blister can turn into a serious infection in just days.”

Prevent it: The most effective measure is keeping your diabetes under control.

Treat it: You cannot cure nerve damage, but managing your blood sugar carefully if you have diabetes can help keep it from worsening. And taking steps to keep your feet healthy can reduce infection risks. So never walk barefoot — you could step on a sharp object without realizing it.

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It’s important to check your feet daily for scratches and sores, and to let your doctor know whether anything is amiss. Use a moisturizer that contains urea on your feet daily, too; dryness can lead to infection, Brenner says. Trim toenails straight across, and use a nail file on corners, instead of cutting them. If you have an ingrown toenail, see a dermatologist or podiatrist right away.

If one or more of your toenails are discolored, thick or cracked, chances are you have a fungal nail infection. Research suggests that about 20 percent of people over age 60, and 50 percent of those over age 70, might have toenail fungus.

“The fungus itself is harmless and can’t hurt you,” Brenner says. “It may spread to other toenails, but it won’t spread into your bloodstream.”

If the appearance of infected nails bothers you, see a dermatologist or podiatrist. They can often diagnose the infection with a visual exam, but it’s best for them to send a small nail clipping off for a culture to make sure. Nail fungi are challenging to treat. The over-the-counter and prescription topical products that you might see in advertisements aren’t effective for everyone. And prescription oral antifungal medications aren’t always recommended for older adults because they can cause liver damage.

It’s helpful, however, to keep the nail clean, trim it frequently and use a nail file to thin the nail if it’s thickened. A daily application of a moisturizer with urea also thins the nail.

To help prevent nail fungal infections — as well as foot fungal infections, such as athlete’s foot — don’t go barefoot around pools or in gym locker rooms. Also, change to fresh socks if your feet become sweaty — and after a bath or swim, dry your feet well.

Copyright 2022, Consumer Reports Inc.

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