Foot Ailments and Footwear Suggestions for 50+
Patrick Healy SPT
The Foot
How many bones are in the human foot?
How many joints are in the human foot?
26 bones!
33 joints!
Foot Morphology
Extrinsic Foot Muscles
Intrinsic Foot Muscles
Foot conditions common with individuals over the age of 50
Metatarsalgia
Tightness in gastroc can result in overloading of the forefoot
Pain across the bottom of the foot just below the toes
Associated with movement/morphology changes due to improper footwear
stretching and soft tissue massage may be beneficial for these patients
Hallux Rigidus
Most common form of arthritis in the foot, affecting 1 in 40 people over the age of 50
Swelling, stiffness and pain associated with activities such as stairs, running or push-ups
PT may benefit patients through joint mobilization and improving ROM.
Hallux Valgus
Lateral drift of the big toe and associated with joint dislocation
Specific interventions include toe-spread-out to decrease the resting and active angle of the great toe
Hyperkeratosis and Nail disorders
REGULAR FOOT CHECKS ARE NECESSARY
Nail disorders
Overstimulation of keratin producing cells
Exercise Considerations for Foot Health
Intrinsic Muscle Exercise
4 weeks of training reduces arch collapse and improve balance ability.
GO BAREFOOT! FREE THE TOES!
Why?
This is only recommended for those with sensation in their feet as ulceration and wounds need to be avoided for those with neuropathy
Diabetic Peripheral Neuropathy
Rise in Diabetes and Diabetic Neuropathy
As age increased, so did the prevalence of PN
American Diabetes Association 2019:
11.3% of population had diabetes
29.2% of 65+ had diabetes
Prevalence of PN in individuals with DM: 28.5%
Prevalence of PN in individuals without DM: 11.8%
Risk for DPN patients
As we age, the skin becomes more susceptible to cuts and ulcerations, and if we have decreased sensation, these painful events could go unnoticed. Our circulation decreases as well, making it harder to heal these distal injuries.
The risk becomes infection of the affected area and altered gait patterns leading to fall risk.
Exercise considerations for DPN
Buerger Exercises
Aerobic Training (AT)
Impacts nerve function positively with minimal adverse effects.
It showed particularly effective for those with severe DPN
Examples: Biking, Elliptical, Fast walking
Resistive training (RT)
Improvements in pain and tingling measured by Michigan neuropathy screening instrument after 12 weeks of low intensity RT
Most promising strategy to counteract muscle dysfunction and alleviate neuropathic symptoms
Medicare and Footwear Coverage
Medicare Part B covers these services each calendar year for qualified individuals with diabetes and severe foot disease:
You must meet your Part B deductible, then you only pay 20% of the Medicare-Approved Amount.
Be sure that both doctor AND suppliers are participating and accept assignment. If not, there is no limit on the amount that the supplier may charge you
Podiatrist or other qualified doctor must prescribe the shoes or inserts
Regular Foot Checks and Footwear
From a study of 100 individuals over the age of 65:
19% checked their feet everyday
30% checked once a month
21% did not typically check their feet
Found that 83% of individuals were wearing inadequate shoes, which has been cited as a risk for falling.
Shoes that are too small can create shearing forces and skin irritation.
Individuals with decreased sensation may not recognize this and develop cuts or ulcers.
General Footwear Considerations
Individuals that are over 50 should consider two different sized shoes as well as wider and taller toe box shoes
More Specific Footwear Considerations
Heel-Toe Drop
“Offset in height between heel and front of shoe”
Normal: 8-10mm
0-6mm drop: require more mobility and strength from calf muscles
>10-12mm drop: require less mobility and strength from calves BUT require more shock absorption from hip and knee
Stack Height and Cushioning
Recommendation:
Go to local running store, get fitted, find what works best for you
Summary/Overarching Concepts
“While temporary support may be needed during the acute phase of an injury, it should be replaced as soon as possible with a strengthening program just as would be carried out for any other part of the body”
Questions?
References
Leikin JB. Foot disorders in the elderly: A mini-review. Disease-a-Month. 2018;64(3):63. doi:10.1016/j.disamonth.2017.08.002
Hidayati L, Pratiwi IN, Pawanis Z, McKenna L, Widyawati IY. Buerger exercise reduces the risk of neuropathy in people with diabetes mellitus. Open Access Macedonian Journal of Medical Sciences. 2021;9(G):94-99. doi:10.3889/oamjms.2021.6743
Hicks CW, Wang D, Windham BG, Matsushita K, Selvin E. Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts. Scientific Reports. 2021;11(1). doi:10.1038/s41598-021-98565-w
Orlando G, Balducci S, Boulton AJM, Degens H, Reeves ND. Neuromuscular dysfunction and exercise training in people with diabetic peripheral neuropathy: A narrative review. Diabetes Research and Clinical Practice. 2022;183:109183. doi:10.1016/j.diabres.2021.109183
McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: A new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine. 2014;49(5):290-290. doi:10.1136/bjsports-2013-092690
López López D, Losa Iglesias ME, Becerro de Bengoa Vallejo R, et al. Optimal choice of footwear in the elderly population. Geriatric Nursing. 2015;36(6):458-461. doi:10.1016/j.gerinurse.2015.07.003
photo references
https://appliedbiomechanics.com/orthotics-bracing-blog/metatarsalgia-symptoms-treatments/
https://www.choosept.com/guide/physical-therapy-guide-bunion-hallux-valgus
https://sportdoctorlondon.com/hallux-rigidus-treatment/
https://medical-dictionary.thefreedictionary.com/Buerger-Allen+exercises