How Aging Affects Your Feet

8 Common Problems and Why They Occur

 

Aging takes its toll on your feet as it does with the rest of your body. Given the amount of stress we place on our feet over a lifetime, it's easy to see why these problems occur. In addition to general wear-and-tear, there are physiological changes that will affect how your joints, bones, and tendons function.

 

Feet dangling from dock with sun shining in background

These changes tend to develop gradually as cell turnover and collagen production begin to slow. As the skin starts to thin, so, too, will the fatty layer cushion the soles and heels.

 

These changes can give rise to stability problems affecting the knees, hips, and lower back. The gradual wearing down of cartilage in the joint space, along with inflammation of bursa and tendons, only adds to the burden.

 

The most common aging-associated foot problems are those that affect the skin, connective tissues, joints, nails, and blood circulation.

 

Dry Skin

Dry skin, especially on the soles of the feet, is a problem that may require a daily application of moisturizer to prevent cracking and infection. The gradual depletion of collagen, exacerbated by the lack of consistent foot care, can lead to the formation of cracked heels and calluses.

 

If left untreated, cracked skin around the heel can make it painful to walk or even stand.

 

If cracks in the skin are deep enough, bacteria can infiltrate the exposed tissue and cause a foot infection. In older people or people with diabetes, this can lead to a potentially serious infection known as cellulitis.

 

Flat Feet

As your feet age, connective tissues called ligaments can begin to stretch, reducing the height of your arch and leading to a condition commonly known as flat feet (pes planus).

 

The pain caused by pes planus, which typically develops in the midfoot, tends to increase with activity and is often accompanied by swelling along the inner ankle and arch. Hip, knee, and lower back pain are also common.

 

Flat feet can also alter the angle of your foot, causing overpronation, the loss of stability, and an increased risk of ankle and foot sprains.

 

Shortened Achilles Tendon

Another type of connective tissue, known as a tendon, can begin to lose water as you age. Tendons connect muscle to bone, and, if these are shortened due to water loss, you may end up with a more flat-footed gait since you will be less able to flex your ankle, midfoot, and toes.

 

This is especially true of the Achilles tendon which connects the calf muscle to the heel bone (calcaneus).

 

Unless steps are taken to routinely stretch your Achilles tendon, you may be at greater risk of a tear or rupture if you overexert the tissues (such as by forceful jumping or running up the stairs).

 

Hammertoe

Hammertoe is the abnormal bend in the joint of one or more of toes, typically caused by the wearing of narrow shoes or high heels that forces the toes deeper into the toe box. Hammertoes are prone to calluses and corns. Joint stiffness, discomfort, swelling, and pain are also common.

 

Once they develop, hammertoes are essentially permanent unless surgery (such as arthrodesis or arthroplasty) can realign the toe joints. Stretching may help restore some of the mobility but doesn't necessarily reverse the condition. Toe pads, splints, and well-fitted shoes can help relieve some of the discomfort and pain.

 

Toenail Changes

Toenails usually become thicker and more brittle as you age, making them more difficult to cut and maintain.4? One reason for this is that nail growth tends to slow in tandem with the decrease in hormone production in older adults.

 

Estrogen and testosterone both stimulate the production of keratin and contribute to the smooth, firm appearance of toenails and fingernails. When these hormones decline, the reduced supply can cause our nails to discolor, crack, and form uneven ridges and layers.

 

Although proper nail care can significantly improve your nail's appearance, it may not be enough to entirely avoid aging-related changes. Other common causes of toenail changes include:

 

·         Hypothyroidism

·         Peripheral artery disease (PAD)

·         Onychomycosis, a fungal infection of the toenails

·         Seborrheic Keratosis

 

A common skin condition affecting older adults is called seborrheic keratosis. These raised, flesh-toned lesions are often mistaken for warts and typically affect the top of the feet, toes, and ankles. (They are never seen on the soles of the feet.)

 

Though the seborrheic lesions are not painful, they can sometimes be itchy or cause irritation when wearing shoes.

 

See your doctor if you notice any changes in the color, texture, or shape of the lesions. These may be an early sign of skin cancer, including pigmented basal cell carcinoma and cutaneous melanoma.

 

Arthritis

Osteoarthritis, also referred to as wear-and-tear arthritis, affects roughly 10% of men and 13% of women over 60. The ankle joint, subtalar joint, and the first metatarsophalangeal joint (big toe) are three joints commonly affected in the foot and ankle.

 

Common risk factors for foot osteoarthritis include.

 

·         Obesity

·         Hammertoe

·         Bunions

 

A past foot or ankle injury7

Another foot condition commonly affecting older adults is gouty arthritis. Gout is an inflammatory disorder in which the accumulation of uric acid crystals around a joint causes acute and often debilitating pain, mainly in the big toe.

 

Circulatory Problems

One of the most common foot and ankle symptoms in older people is edema, the medical term for the swelling of tissues. Edema is often caused by poor circulation, leading the build-up of fluid in the lower extremities (especially the ankles and feet).

 

Edema is typically associated with conditions seen in older adults, such as:

 

·         Congestive heart failure

·         Chronic kidney disease

·         Cirrhosis and other liver diseases?

 

The obstruction of a blood vessel can lead to venous edema, typically affecting one leg. Cardiovascular disease, certain medications, and hormonal changes may cause swelling in both legs, referred to as bilateral peripheral edema.

 

Diabetes can also affect blood circulation, particularly as you get older. If this happens, infections of the foot can be far more difficult to treat, leading to the formation of ulcers that just won't heal.

 

Diabetic neuropathy, a pins-and-needles sensation mostly affecting the legs and feet, is another common consequence of long-term diabetes.

SEPSIS IS A KILLER

Testing for Sepsis

Unlike diseases or conditions like diabetes or kidney stones, there is a test for sepsis, called a SEPSIS PANEL However, your doctor may make the diagnosis by evaluating your symptoms, your history, and other tests. This can then lead your doctor to suspect you have sepsis. The signs and symptoms of sepsis can include a combination of any of the following:

- confusion or disorientation,

- shortness of breath,

- high heart rate,

- fever, or shivering, or feeling very cold,

- extreme pain or discomfort, and.

- clammy or sweaty skin.

Should you notice 2 or more of the above, 

head to the emergency room.

Always remember ... a doctor's job is to 

"rule out the worst possible scenario."

Testing for Sepsis

Unlike diseases or conditions like diabetes or kidney stones, there is no one test for sepsis testing. However, your doctor makes the diagnosis by evaluating your symptoms, your history, and other tests. This can then lead your doctor to suspect you have sepsis.

Here are some of the tests that help determine if you do have sepsis.

Blood tests

Blood tests show healthcare providers many things about your body, from the possibility of an infection to how well your body’s organs work. These are some of the more common blood tests for patients who present with possible signs and symptoms of sepsis. None of these tests can diagnose sepsis, but when the test results are combined with information about your illness and a physical examination, they can help your doctor determine if you have sepsis:

Complete blood count (CBC): A CBC is a common blood test. It measures how many white blood cells are circulating in your blood, among other things. White blood cells (also called leukocytes) fight bacteria, viruses, and other organisms your body identifies as a danger. A higher than normal amount of WBCs in your blood could mean that you have an infection. But too few WBCs can indicate you’re at risk of developing an infection.

Lactate: Your organs may produce lactic acid when they don’t receive enough oxygen. Intense exercise, heart failure, or serious infection, among other conditions can cause this. A high level of lactic acid caused by infection can be an important clue that you have sepsis.

C-reactive protein (CRP): Your body produces C-reactive protein is produced when there is inflammation. Several conditions can cause inflammation, including infections.

Blood culture: A blood culture test tries to identify what type of bacteria or fungi caused infection in the blood. Blood cultures are collected separately from other blood tests. They are usually taken more than once from different veins. It can take several days to get the results of a blood culture.

Prothrombin time and partial thromboplastin time (PT and PTT), platelet count, and d-dimer: Sepsis can have serious effects on blood clotting inside your body. If the PT and PTT are too high, it can indicate your blood is not clotting well. Platelets are tiny cells in your blood that help to form blood clots. If your platelet count is too low, it can mean your body is forming many unseen clots in tiny vessels all over your body. This can be an important sign of sepsis. The d-dimer test also indicates that blood clotting is happening in your body. The level of d-dimer can be high if you have one large clot, or it can be high if your body is making many tiny clots, as happens in sepsis.

Confirmatory/Diagnostic Tests

The following tests are what doctors call confirmatory or diagnostic tests. The test results give the medical team more information when they suspect sepsis. Patients and their doctors need to first recognize the clinical signs and symptoms for the tests to be ordered, however. If your doctor suspects sepsis, treatment (with fluids and antibiotics) should begin right away, while waiting for these confirmatory test results.

Endotoxin is a component of certain bacteria, released when the bacteria cell disintegrates. It should not be in your blood, so its presence confirms there are gram negative bacteria in your bloodstream, although this test cannot identify which type. This test is not a replacement for blood cultures.

Procalcitonin (PCT): Procalcitonin is a protein in your blood that rises if you have a bacterial infection. It cannot tell what type of bacterial infection you may have. If you have low levels of PCT, your doctor may rule out a bacterial infection. The infection may be caused by a viral infection or an illness not related to an infection.

Monocyte distribution width (MDW): Monocytes are a type of white blood cell that increases in number when an infection is present. MDW can be measured as part of the CBC.

More testing: urine tests

Urinalysis: Like the CBC, this simple urine test can tell your doctor a lot about your health, including if you have a urinary tract infection (UTI) or problems with your kidneys, such as a kidney stones. There is no special preparation to provide a urine sample for a urinalysis.

Urine culture: A urine culture can determine what bacteria or fungi causes a UTI. Urine for a culture must be obtained midstream. You need a special cleanser to wipe your genitals before you start urinating. Once the area is cleaned as instructed, urinate for a few seconds into the toilet and then place the container under the flow and collect the sample.

Testing for specific infections

In addition to blood and urine tests, your doctor may want you to undergo other tests to identify where the infection may be. Here are some examples:

Pneumonia

Chest x-ray: A chest x-ray may show if you have pneumonia or damage around the lungs. A chest x-ray can’t tell your doctor what type of infection you have.

Pulse oximetry. A pulse oximeter measures the oxygen saturation level of your blood. This tells your doctor how well your lungs are taking oxygen from the air and putting it into your bloodstream. The device is clipped on your finger or ear lobe. A light measure sthe oxygen levels as your blood flows past.

Sputum test. A sputum (phlegm) sample can show if there is an infection in your throat or lungs.

Meningitis

Computerized tomography (CT) scan: A CT scan of your head may show swelling or inflammation .

Magnetic resonance imaging (MRI): MRIs of your head check for swelling or inflammation.

Lumbar puncture: A lumbar puncture is also called a spinal tap. Your doctor uses a lumbar puncture for a sample of cerebral spinal fluid (CSF), fluid that circulates around your spine and brain. Your doctor inserts a needle into your spinal cord, in your lower back, to remove a small amount of fluid to send for testing.

Strep throat

There are two tests for strep throat, the rapid antigen test and the throat culture. For the rapid antigen test, your doctor or nurse uses a swab to get a sample from the back of your throat. This test takes only minutes. A throat culture is done the same way, but with a special swab. This goes to a lab, similar to a blood culture or urine culture.

Influenza

Doctors usually diagnose influenza by your symptoms. Rapid influenza diagnostic tests may indicate what type of influenza you have, but they are not always accurate. A cotton swab takes a sample from inside your nose or the back of your throat.

Skin infections

If your doctor suspects you have an infection on your skin, such as cellulitis or MRSA, a culture will help determine what type of infection is present. A small amount of saline solution is injected under your skin, then withdrawn.

The symptoms of early sepsis are vague and often easily dismissed. Any invasive procedures (such as a surgery) or an invasive devices (such as an IV), or any type of break in your skin (such as a bug bite or cut), should be mentioned if you experience any of the symptoms,. Testing can be frustrating when nothing specific turns up, but it’s the only way your team can decide how best to treat you.