As feet get older they lose some of their strength and springiness due to changes in the skin and joints. Feet tend to spread and lose the fatty pads that cushion them. This does not mean that feet should necessarily become painful as they get older. However, it does mean that they are not able to sustain the same levels of activity that they could when you were younger. You need to look after your feet.
What natural changes happen to feet with ageing?
Every part of the body ages. However, the feet are subjected to particularly heavy treatment throughout our lives. They experience repeated impact, weight bearing, pressure, friction and often minor trauma.
The natural changes that happen to the feet over time include:
- Thinning of the skin.
- Wear and tear to the joints.
- Reduced muscle strength.
In addition to this, feet will be more at risk of injury and pain if you have conditions which:
- Affect the nerve supply or blood supply to the feet.
- Affect the bones, muscles and joints themselves.
- Cause the feet to swell.
- Peripheral arterial disease
- Varicose veins
- Heart failure
- Rheumatoid arthritis
- Kidney disease
What are the effects of ageing on the way the foot works?
The young foot is springy, strong and resilient. It has arches bound together by elastic tendons which allow for springiness and shock absorbtion. Joints are flexible and bones are strong and resilient. Skin is tough, the blood supply is efficient, and healing is fast. However, time takes its toll as all of the parts of the foot become less resilient with age. Eventually the foot becomes less able to resist repeated stresses such as impact, pressure and extremes of temperature.
Loss of springiness
The older foot becomes less springy as the tendons which hold the arches together lose their stretch. This reduces the ability of the foot to absorb impact so that, for example, your feet will be less tolerant of jumping off a chair.
Additionally, areas of wear and tear may develop in the joints between the bones. As the joint faces wear and becomes rougher over time, the small movements between the bones of the foot will become less flexible. This also reduces the springiness of the foot. Arthritis and wear and tear of the foot are more likely if you have had:
- Severe foot trauma.
- Foot overuse injuries from sporting or dancing activities - for example, running or ballet.
- Inflammatory arthropathy, such as rheumatoid arthritis or systemic lupus erythematosus, affecting the feet.
The lack of flexibility in the joints, combined with the tendency of the arches to drop, can lead to a change in the shape of the feet. The ankle joint, subtalar joint and the big toe joint frequently develop arthritis.
Loss of strength
With age the muscles lose some of their strength. This is a gradual effect, with muscle strength and power peaking in the 20s and early 30s.
The bones of the foot also thin with age. This is extreme in conditions such as 'thinning' of the bones (osteoporosis) when the bones may become fragile. However, all bones thin with age. This natural thinning is made worse by smoking and by a lack of exercise. It's also worse in those who have:
- Poor vitamin D intake.
- High or regular doses of steroids.
- Bodybuilding steroid drugs ('anabolic steroids').
- Thyroid overactivity.
- Long periods of their life without periods due to:
- Pregnancy and breastfeeding.
- Contraceptives which suppress periods, such as Depo-Provera®.
- Conditions such as early menopause and anorexia nervosa in women, which affect the periods.
- Testicular failure (sometimes called andropause).
Loss of resilience
- With increasing age the skin becomes less elastic and has less fat in its structure. This reduces the cushioning and also increases vulnerability to damage.
- The padding under the balls of the feet tends to slip over time. This is particularly so in those who have worn high heels a lot and in those with rheumatoid arthritis, leading to pain (metatarsalgia) and callus formation. (A callus is a hard and thickened area of skin.) Use of padding in the shoe can help with this.
- Decreased skin cell turnover with ageing means decreased injury repair.
- Dry skin can result from the decreased fatty layer and can contribute to cracked heels and calluses.
- Decrease of the fat pad on the sole reduces cushioning and can increase sensitivity to pain.
A tendency of the lower legs and feet to swell increases with age. Swelling puts additional pressure on the structures in the foot. There are many reasons for this, including:
- Loss of elasticity in the leg veins.
- Loss of muscle tone in the calves (the muscles in the calves are a part of the mechanism for pumping blood back upwards to the heart).
- Heart disease.
- Some medications.
Changes to toenails
- Toenails usually become thicker and more brittle with age because their growth slows over time. This thickening is worsened by conditions such as an underactive thyroid gland (hypothyroidism) and peripheral arterial disease.
- Fungal infection of the toenails can also cause toenail thickening.
Loss of blood supply
The blood supply to the distant (or peripheral) parts of the body is the most likely to be affected by poor circulation due to conditions such as hardening of the arteries (atherosclerosis). Blood vessels tend to stiffen and narrow a little with age. Varicose veins and other conditions which cause leg swelling will make this worse. This reduces the ability of the feet to repair minor injuries quickly.
Conditions of the feet
The following conditions can all result from mistreatment of the feet, combined with ageing:
- Bunions. Bony protrusions at the base of the big toe. The most common causes are:
- Wearing shoes with a pointed forefoot that squeezes the toes.
- Wearing high heels that force your toes too far forward in the shoes.
- Morton's neuroma. This enlarged nerve, more common in women than in men, causes pain, burning, tingling or numbness on the ball of the foot or between the toes. It, too, can result from wearing shoes that are too tight.
- Plantar fasciitis. This in an inflammation of tissue in the bottom of the foot. The usual symptom is heel pain. Arthritis and wearing shoes with inadequate heel cushioning are other causes.
How can I protect my feet from the effects of ageing?
- As you age it's important that your footwear is warm enough and not too stiff. Shoes should be comfortable. Avoid footwear that rubs, makes your feet sore or is too tight. (These may restrict the circulation or cause pressure damage to the skin.) Avoid high heels and choose shoes which support your feet and hold them firmly in place.
- Wear shoes that support the arches of your feet. Cushioned insoles are useful.
- If your feet have a tendency to swell, make sure that your shoes are big enough to accommodate this. Put them on first thing in the morning before your feet have a chance to swell up.
- Keep your feet warm, wear socks in cold weather and make sure your socks aren't wrinkled in your shoes.
- Socks, tights or stockings should be the right size for your feet.
- Avoid walking barefoot, even indoors. By the time we reach 65 the fatty protective foot pads have worn thinner through long use. Walking barefoot is no longer recommended as it tends to speed up this process. If the feet are given no extra cushioning - for example, shoes - to make up for what they have lost then painful feet, calluses and metatarsalgia can result.
Exercise feet regularly. "If you don't use it, you lose it." Exercise improves the circulation in your feet and legs, and helps to prevent swelling of the feet. Avoid sitting for long periods with your feet hanging down - if you are unable to move around much for health reasons then sit with your feet elevated.
- Look after the skin of your feet. Remove hard skin which can be a breeding ground for germs (bacteria) and which can tend to lead to callus formation. Moisturise the feet regularly, and get rid of any hard skin with a pumice stone.
- If you develop foot blisters, bunions or any deformity of your feet like clawing of the toes or dropping of the arches, consider seeing a person qualified to diagnose and treat foot disorders (a podiatrist - previously called a chiropodist).
- After washing, apply a foot cream. This should have skin-hydrating lubricants and emollients to help keep your feet soft and free from hard, thickened areas (calluses) and cracks. It should also gently exfoliate your skin and protect it from infection.
- Trim and file your toenails straight across instead of rounding them. This helps prevent ingrown toenails. Use a nail clipper, not scissors.
- Inspect your feet daily if possible. Give immediate attention to any breaks or cracks in the skin or to any other problems that you notice.
- If you have had regular problems with your feet consider taking pre-emptive action with regular visits to a podiatrist to help keep your feet healthy.
Look after any underlying health issues as best you can. Aim to keep your weight in normal range, as being overweight adds to the pressure on your feet.
In particular, if you have any of the following you should have your feet checked regularly:
- Peripheral arterial disease.
- Problems with the nerves in your feet.
- Foot deformity.
- Deformities of the toenails.
Further reading and references
; Recommendations for physical activity in older adults. BMJ. 2015 Jan 21350:h100.
; Biomechanics of the Ageing Foot and Ankle: A Mini-Review. Gerontology. 201561(4):381-8. doi: 10.1159/000368357. Epub 2014 Nov 11.
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