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Taking good care of ourselves is a lifelong process, and the best way to ensure good health into our senior years. But when it come to health, we usually don’t think of our feet until something goes wrong. Given the amount of stress we put on our feet in a lifetime, it’s easy to see why certain foot problems seem unavoidable. In addition to wear and tear, there are natural changes that occur with the aging process that affect foot health, making problems like swelling and certain skin conditions more prevalent.
Common Skin Problems
Skin changes, which gradually occur with aging, include: decreased skin cell turnover, decreased collagen production, and thinning of skin, with a decrease of the fatty layer beneath. These changes bring about several typical problems, specifically for the feet, which deal with extra stress from weight-bearing. Dry skin, especially on the soles of the feet, is a problem that may require daily application of a moisturizer to prevent cracking or an itchy rash. The decreased fatty layer beneath the skin means reduced cushioning on the sole of the foot, which also contributes to cracked heels and calluses due to extra stress on the skin. In addition, the decreased fat pad on the sole of the foot may contribute to an increased sensitivity to pain due to that loss of cushioning.
•To learn more, including treatment options, see: Coping with Dry, Cracked Feet
One common skin condition that affects older adults is called seborrheic keratosis. Seborrheic keratoses are lesions that are darker than the surrounding skin and are slightly raised, appearing as if they could easily be scratched-off.
Seborrheic keratosis is a benign skin lesion that usually does not warrant medical care, although the lesions can become itchy. However, the skin cancer melanoma can also have a similar presentation—specifically, the brown-to-black coloration. Melanoma can and does affect the feet, even though this area of the body is not usually thought of as a high sun-exposure area. Any time a skin lesion appears to change in color, size, or shape, it’s always best to have it evaluated by a physician.
Another common skin lesion of aging that frequently affects feet is the stucco keratosis. These also have a bumpy, stuck-on appearance, but are skin-colored or lighter. The name stucco keratosis comes from their texture, which resembles a stucco surface. Stucco keratoses are common on elderly skin, particularly on the tops of the feet and ankle areas. They can be treated with OTC exfoliation products and creams, but tend to come back.
Toenails usually become thicker and more brittle with age, making them more difficult to cut. One reason that nails become thicker is because their growth slows over time, mostly due to hormonal changes in the body. Other causes of toenail thickening include hypothyroidism, and inadequate circulation to the limbs from peripheral artery disease (PAD). Onychomycosis, which is a fungal infection of the toenails, is another common cause of toenail thickening.
Many people notice that, as the years go by, their shoe size or foot shape changes. It’s not uncommon for someone to experience an increase in shoe size by a half-size or more as they age—this happens because of the changes that occur in the body’s ligaments and tendons through the aging process. Tendons and ligaments gradually lose strength and their ability to “spring back,” which can amount to a decrease in arch height of the feet, increasing foot length slightly and requiring an increase in shoe size. Age-related tendon and ligament changes may also increase the risk of injury such as tendonitis, tendon tears, or muscle strains.
Arthritis is another reality of aging. Osteoarthritis is what we think of as wear-and-tear arthritis: that inevitable consequence of years of stress on the joints. The ankle joint, subtalar joint, and the big toe joint (first MTPJ) are three joints that frequently develop arthritis. Symptoms associated with bunions and hammer toes may worsen over the time due to the progression of arthritis within those toe joints. Another joint problem that can develop in older adults is gouty arthritis. Gout is a metabolic disease that often manifests as intense arthritis symptoms at the big toe joint.
When observing an X-ray of an elderly patient, we sometimes see signs of decreased bone mineral density, indicating the possibility of osteoporosis. This is especially true for female patients, who may be unaware that they are at risk for a fracture due to this change in bone health. Often, it’s the long bones of the foot (metatarsals) that will show signs of decreased bone mineral density on a foot X-ray.
One of the most common foot and ankle problems of aging is swelling. The cause of the swelling can be elusive, especially if it’s not associated with an injury. Leg vein problems are a common cause of swelling and usually occur in a single limb at a time. Cardiovascular disease, certain medications, and hormonal changes are possible causes of swelling that occur in both limbs.
•To learn more about vein disease and other causes of swelling, see: Common Causes of Foot and Ankle Swelling.