When we think about how our bodies change with age, we usually think of graying hair, sagging skin, or arthritis of the knees or back. We almost never think about our feet and the effects that time and age have on them.
Those workhorses at the end of our legs are actually remarkable structures of natural engineering. With every step, they absorb a tremendous amount of shock, sometimes up to three times our body weight in force. They also provide a stable base to support the rest of the body and propulse it forward. More than a hundred muscles, tendons and ligaments in the foot work in concert to keep us upright and moving forward, step after step. These steps add up over the years and can produce a fair amount of wear and tear on the feet. Your feet will change over time, in ways that you might not expect. Here are the five most common changes to your feet over the age of 50, with tips on how to mitigate each.
1. Your feet get bigger:
While feet do not literally grow after about the age of 22, they can become longer and wider over time. The greatest contributor to this “growth” is basically foot spreading in response to pressure on weakened foot ligaments. Ligaments are rope-like structures that hold bones together. They lose elasticity with age, and do not flex with activity like their more youthful counterparts. Pressure from slow weight gain over the years and/or pressure from standing and working on the feet all day can strain the inelastic ligaments. They become ever so slightly lengthened over time, resulting in a longer foot and larger shoe size. This phenomenon is the cause of many “fallen arches,” where feet become flatter and longer. Feet can become wider in much the same way. People who over-pronate when they walk (roll their feet inwards) exert more side to side forces on the foot ligaments, spreading the bones width-wise, resulting in bunions, and wider feet.
Some women will develop larger feet after having children. Towards the end of pregnancy, hormones are released to prepare the pelvis for childbirth. These hormones not only loosen the pelvic ligaments but also loosen ligaments in the feet. The result can be foot spreading and an increase in size.
Most everyone will experience some change in foot size as they get older. Old shoes become tight and uncomfortable. Occasionally nerve compression, bunion pain, neuromas and other avoidable issues ensue from simply wearing shoes that don’t fit. A simple fix is to have you r feet measured before buying new shoes and considering new shoe brands and styles that may better fit your new foot size and shape.
2. Your feet get skinny:
There’s an unfortunate phenomenon that can occur over the age of 50 called Fat Pad Atrophy (FPA). FPA describes localized fat loss which may sound like a good thing at first. However the fat that’s lost is in the last place on your body that you would want to get rid of it – the bottom of your feet.
We normally have a fat pad beneath the heel and ball of foot that serves a protective layer, to provide cushion and shock absorption. In FPA, this protective layer wears away. The bottoms of the feet become bony and tender to walk on. Callouses, bruising and ulceration may result if untreated. Fortunately, not everyone will be affected by this condition. Genetics plays a large role in determining who will develop fat pad atrophy. Other risk factors are:
• History of steroid injections in the feet
• Long term use of high heeled shoes
• Body mass index (BMI) — your weight in relation to your height can have an impact
• Hormonal shifts caused by pregnancy, menopause, hysterectomy and chemotherapy
• Trauma from landing heel-first after a fall or jump on a hard surface
You may suspect FPA if you are starting get callouses in your feet for the first time, over the age of fifty. Callouses should be removed to prevent pressure sores, ulceration, and pain when walking. Normally this will require a visit to your podiatrist, or other health professional who is trained to safely remove these to the appropriate depth. People with FPA need to wear well cushioned shoes. Sometimes a gel insole or diabetic insole is necessary to maintain comfort and prevent skin issues.
3. Your feet no longer grow hair:
Did you know that you have (or used to have) hair on your toes? One of the first things that every podiatrist checks during an exam is for the presence or absence of hair growth in the toes, top of foot and lower legs. Hairy toes are a hallmark of good circulation and healthy arterial perfusion to the skin on the feet. Lack of hair on the feet can occur secondary to one of two main causes. The first is a natural aging of the hair follicles. Just as the hair on our heads can thin or diminish with age, so too can the hair on our feet and legs. This is a normal part of aging. The other cause is a more serious condition called peripheral arterial disease (PAD). PAD involves fatty deposits and calcium build up within the arteries that carry blood to the extremities (atherosclerosis), resulting in decreased circulation to the feet. Early signs of PAD can include cold toes, slow growing toenails, slow to heal sores or ulcers, and thin shiny skin on the tops of the feet. Signs of advanced PAD include pain to the legs with walking (claudication) and pain upon elevating the feet. Since people with PAD are at higher risk for stroke and heart attack, early diagnosis and treatment are important. Anyone with symptoms or concerns should see their doctor for an evaluation.
4. You get hammertoes:
After years of standing and walking, your toes can become permanently contracted into what is called a “hammertoe”. From a side view the hammertoe rests in an inverted V or C shape instead of laying flat. While the risk of developing hammertoes is higher if you’ve spent years squishing your feet into high heels or narrow shoes, anyone who has done a good amount of standing and walking can develop this problem. People really grip the ground with their toes when they walk, and people with high arches tend to be more prone to developing hammertoes. Over time, the repeated toe flexing results in tight, contracted tendons that hold the toe in a permanently bent position. Early on, toe stretching and yoga-like toe exercises can help. Advanced hammertoes can lead to arthritis and occasionally skin lesions. People with hammertoes should look for shoes that have a deep toe box, with a soft flexible material on the upper shoe. This style of shoe accommodates the hammertoe shape, maintains comfort, and helps prevent the development of skin lesions.
5. Your Toenails Get Thick:
Toenails that were once thin and clear can become yellowed, thick, slow growing, and difficult to cut. Thick, discolored toenails can occur secondary to a number of causes including:
• Fungal infection
• Poor circulation
• Hormonal changes
• Nail trauma
Thick toenails can be very tender, even though the nail plate itself is made of dead tissue called keratin. The tenderness arises from the base of the nail that is attached to the nail bed and the nail matrix (the cells that grow new nail). These areas get irritated because of a thick nail placing a lot of pressure on them, when the nail is moved, bumped into, or pressed on. The first step in managing a thick nail is to determine the cause. A fungal infection can be easily evaluated with a microscope and scrapings from beneath the nail. There are more involved test where cultures and special stains are applied to nail specimens to look for signs of fungus. Fungal infections can be treated with in office procedures, and medication. A non-infected thickened toenail can be thinned with electrical debridement, a painless method trimming and reducing nail size. There are also nail softeners that are available over the counter to help make a thick nail easier to trim and file.
Our feet will change over time, but we can adapt with them. Have your feet checked by your doctor regularly so that any serious concerns can be addressed early. There are lots of new treatments, tools, shoes styles and other methods to give your feet the care they deserve.