Foot health often declines with age, a consequence of decades of wear and tear, subtle changes in gait, and reduced circulation. Foot pain is a widespread issue for older adults, with approximately one in three people over the age of 65 experiencing aching or stiffness. While this discomfort is sometimes dismissed as a normal part of aging, most foot problems are treatable and should not be ignored, as they can significantly affect mobility and increase the risk of falls.
Structural Changes and Deformities
The physical architecture of the foot gradually changes over a lifetime due to the weakening of tendons and ligaments, which can lead to alterations in foot shape and function. One of the most prevalent changes is the development of bunions (Hallux Valgus), where the joint at the base of the big toe enlarges and the toe drifts inward. This structural shift creates a bony bump that causes friction and pain, often worsened by narrow footwear.
Another common deformity is hammertoes, where the lesser toes develop a permanent, bent shape at the middle joint. This contraction results from muscle and ligament imbalance and can lead to painful corns forming on the prominent knuckle. Furthermore, the foot’s natural shock absorption capacity diminishes due to the weakening of the arch, leading to acquired flatfoot (Pes Planus). The protective cushioning on the sole also experiences fat pad atrophy, a thinning of the fatty tissue under the heel and ball of the foot, which reduces natural padding and increases pressure on the underlying bones.
Pain Caused by Inflammation and Degeneration
Chronic pain localized to the joints and soft tissues is a frequent complaint among older adults. Osteoarthritis, the most common form of arthritis, is a degenerative joint disease resulting from the progressive breakdown of cartilage in the foot and ankle joints due to mechanical stress. This condition causes stiffness and pain that may be worse in the morning or after periods of rest, increasing with activity throughout the day.
A distinct, painful inflammatory condition is gout, which arises from an excess of uric acid in the bloodstream. This excess acid forms sharp crystals that accumulate in a joint, most commonly the big toe, causing sudden, severe episodes of swelling and redness. Another frequent source of chronic heel pain is Plantar Fasciitis, the inflammation of the thick band of tissue running along the bottom of the foot. This pain is most pronounced with the first steps taken after waking or after long periods of sitting, typically easing after a few minutes of walking.
Conditions Linked to Underlying Systemic Health
Some of the most serious foot problems in older adults are direct manifestations of chronic, body-wide health issues. Peripheral Neuropathy, frequently associated with long-term diabetes, involves damage to the nerves that transmit signals between the brain and the feet. This nerve damage initially causes tingling or burning sensations, but eventually leads to a dangerous loss of protective sensation, meaning an individual may not feel a blister, cut, or pressure injury.
The inability to detect injury is compounded by Peripheral Artery Disease (PAD), where plaque buildup narrows the arteries, restricting blood flow to the feet. This poor circulation (ischemia) impairs the delivery of oxygen and nutrients needed for healing, leading to cold feet, changes in skin color, and a high risk for slow-healing wounds. When both neuropathy and PAD are present, unnoticed injuries cannot heal properly due to the lack of adequate blood supply. This significantly increases the likelihood of chronic foot ulcers, severe infection, and potential amputation. Regular foot checks are extremely important for individuals with diabetes or cardiovascular risk factors to catch these complications early.
Age-Related Skin and Nail Problems
The skin and nails of the feet undergo changes with age, making them more vulnerable to dermatological issues. Onychomycosis, a fungal infection of the nail, becomes more prevalent, causing the toenails to become thickened, brittle, and discolored. This thickening makes the nails challenging to trim and can increase pressure within footwear.
The skin tends to become thinner, less elastic, and drier (xerosis), due to a reduction in oil and moisture production. This dryness often leads to cracked heels, or fissures, which can progress to a painful break in the skin that allows for bacterial infection. Fungal infections of the skin, such as Athlete’s Foot (Tinea Pedis), cause scaly, itchy, or red skin and can easily spread to the toenails if left untreated. Additionally, thickened or improperly trimmed nails frequently contribute to the development of painful ingrown toenails.