What happens to our feet as we age and get older? What are the common foot issues we might experience? David Gordon aka The Bunion Doctor explains how to keep your feet healthy. 

Our complex feet

There are 52 bones in your feet, 26 in each foot. Considering an adult has 206 bones in total, that’s a lot for such a small part of the body!

Our feet are more complex than many of us imagine and we need all these bones, along with joints and tendons to do many of the activities we take for granted including standing, walking, running, swimming…the list goes on.

As we get older, our feet, like everything else, change, and along with this comes a range of different conditions. I’ll be covering some of the most common foot issues I treat patients for below.

 

Feet: The early years

When you are born, the main makeup of your foot and ankle is cartilage and over time, the cartilage converts into bone.

In the first years of life, the foot and ankle is remarkably flexible compared to adulthood.

The arches of the feet are flat, and the tendons and ligaments very stretchy. As the arches develop, around the age of 4 or 5 years, the foot gradually becomes more rigid but still remains much more flexible than in adulthood.

It’s common for parents to be concerned regarding their children’s, so called, ‘flat feet’ but in general, there is nothing wrong with having flat feet, so long as the child has no pain nor loss of function or the ability to participate in activities.

Flat feet, like high arches, are a normal variant, just like being short or tall. There is generally no need, and only weak evidence to support the use of insoles in children who have no symptoms, to prevent or reverse flat feet. Foot shape tends to stabilise around the age of 7 or 8 years, after which the feet stop growing, in girls around the age of 13 years and boys around the age of 14 years. The growth plates fuse around the age of 16 years.

In general, the feet and ankles enjoy the benefits of youth through the teens and 20s, during which it is unusual to get pain or dysfunction unless there has been a specific injury.

Unfortunately, once you hit your 40s things can then start to decline.

 

After 40 years old – common conditions and treatments for feet

The common parts of the feet which start to degenerate with age are the joints and tendons.

The Achilles tendon

The Achilles tendon is the most common tendon to be involved in terms of pain and loss of function as one gets older. It is the largest tendon in the body and is susceptible to pain and stiffness first thing in the morning and during or after activities.

Achilles Tendinopathy is best treated as soon as possible by removing exacerbating factors and using physiotherapy and shockwave therapy.

Plantar Fasciitis

Another common condition is Plantar Fasciitis.  While the plantar fascia is not technically a true tendon, but rather a ‘fascia’ (a thick band of tissue), it does behave and function in a similar way to a tendon.

Around 8% of the population will get Plantar Fasciitis in their lifetime. It is thought to be a degenerate condition on the under surface of the heel, and can cause plantar heel pain, especially first thing in the morning and after periods of rest.

Plantar Fasciitis can be an incredibly debilitating condition, lasting from several months to even several years. It is best to seek treatment as soon as you have symptoms as the earlier treatment is instigated, the better chance of resolving symptoms sooner.

As with Achilles Tendinopathy, treatment includes physiotherapy and shockwave therapy as well as silicone heel cups, night splints and comfortable trainers.

Osteoarthritis

As age increases so does the incidence of Osteoarthritis occurring at the top of the big toe joint and surprisingly, I see patients presenting with pain in this area as early as the mid-30s.

‘Hallux Rigidus’ is the alternative name for Big Toe Joint Osteoarthritis with patients complaining of pain in ‘dorsiflexion’, when the toe is bent upward particularly in a lunge activity or doing the downward dog in yoga or a plank at the gym.

High heels can also increase pain. Over time these activities become uncomfortable and are avoided, and sufferers may walk on the outer part of the foot to protect the painful joint.

Bone Spurs can grow and be felt as lumps on the top of the big toe joint as the joint becomes stiff and less flexible.

Initial treatment for Hallux Rigidus includes avoiding exacerbating factors, stiff soled shoes or stiff insoles, painkillers and injections such as steroid or hyaluronic acid.

If these measures don’t work, then a minimally-invasive (keyhole) procedure to remove the Bone Spurs at the top of toe can improve any pain associated with impingement and increase flexibility.

There is unfortunately nothing one can do to halt the progression of Osteoarthritis, and, if very significant, a joint replacement such as a Cartiva or a Joint Fusion can be performed to eliminate pain.

Morton’s Neuroma

Another very common condition in the foot is a Morton’s Neuroma. A neuroma is a swollen nerve and it presents as pain on the sole of the foot under the balls of the toes and may feel like a burning pain radiating onto the toes, usually the 3rd and 4th.

The feeling of walking on a small stone and a click may also be felt.

This condition usually presents in the 40s onwards, and treatment includes insoles, injections and surgery.

New minimally-invasive surgery for Morton’s Neuroma has a much faster recovery than traditional surgery, with you being back on your feet after a week, with minimal or no pain.

Bunions

And finally, one of the most common foot and ankle conditions that presents to me in clinic are Bunions. A bunion is a prominence on the side of the foot, below the big toe.

1 in 4 four people have a bunion and for the majority, it is inherited. Family history and genetics play a large role in the likelihood of getting bunions.   Whilst your high heels certainly won’t help an existing bunion, they’re unlikely to have caused it initially. Flat feet and lax ligaments may also be a factor in bunion occurrence.

While bunions may develop in childhood or adolescence, most bunions first appear between 30 to 40 years of age.

Initial management of discomfort from a bump on the side of the foot are wider and softer footwear, or trying bunion pads or silicone spacers to protect from rubbing. Most people persevere with this route for even decades, but as the bunion progresses and the foot becomes wider and the bunion enlarges, shoe fitting can be a real struggle. Many patients then report significant pain and the inability to enjoy the activities they like to do, from walking and dancing to going to the gym or taking the dog out, causing a real impact on quality of life.

Unfortunately, surgery is the only way to permanently correct a bunion, and it is at this stage that patients might consider a minimally invasive (keyhole) procedure to straighten the toe and narrow the foot.

The minimally-invasive technique allows for minimal scarring, a faster return to work and normal activities, and possibly reduced recurrence rates, allowing you to wear the shoes you want and enjoy the activities you wish, pain-free. Minimally invasive bunion surgery is often the best option for long-standing symptomatic bunions and has excellent outcomes and high satisfaction rates.

Interestingly my patients’ age range is from 18 to 88 for the treatment of bunions. So, while age is a factor, it isn’t just older people who suffer from them. Moreover, from one of my recent research studies reviewing my database of 425 women with bunions, we have learned that it isn’t the older age group (greater than 65 years) that had the greatest loss of function or poorest quality of life. It was actually the younger group between 35 and 45 years where bunions had the biggest impact.

 

Vitamin D and your feet

Calcium, phosphate and magnesium are minerals important in bone health, as well as being essential to many of the body’s normal processes.

Vitamin D increases the absorption of these minerals in the gut.

Without adequate absorption from food, the body may turn to your internal stores to ensure you have enough for the essential processes it needs. Your bones are a great source of calcium, so a lack of Vitamin D may cause your body to source calcium from your bones. This can weaken them and increases the risk of bone stress fractures as many studies have proven. If blood levels of the circulating form of Vitamin D are less than 40 ng/mL, an increased risk of stress fractures in the foot and ankle occur.

So, Vitamin D does not directly make your bones stronger, but plays an important part in the bone health process, including that of your feet!

In addition to getting plenty of sunlight, which may be easier said than done, you can enjoy the following foods with sources of Vitamin D: Cod liver oil, oily fish (salmon, mackerel, sardines), egg yolk, meat, offal, milk, mushrooms. Fortified foods (such as fat spreads and some breakfast cereals and yoghurts) contain small amounts.

 

Happy feet are within reach

Thankfully, despite increasing age and the greater likelihood of having foot and ankle problems there are plenty of successful solutions to conditions, especially if treated early and these include both non-surgical as well as surgical treatments.

I will always try and treat patients using non-surgical techniques first if appropriate and the majority of conditions can be managed successfully this way.

About the author: David Gordon aka The Bunion Doctor is a practising orthopaedic surgeon practising in both London and Hertfordshire.