The Ageing Foot

As our feet grow older, they naturally develop more problems. But painful and uncomfortable feet are not something you should have to put up with. A lot can be done to improve comfort, relieve pain and keep you on your feet for life. Below are listed some specific foot health problems that affect an ageing population:

Skin changes As the skin ages, it loses some of its former qualities of elasticity, moisture balance and fatty padding. The skin becomes vulnerable to tears and, therefore, ongoing slower wound healing and infection. The foot is an area particularly vulnerable to skin break-down complications; being at the most distal part of a limb it has susceptibility to peripheral neurological and circulatory loss. A Podiatrist is often the first health professional to thoroughly examine the foot and can be the first to detect skin changes, such as skin cancers, which are more prevalent in the aged foot.

Pressure areas With the average person aiming for 10,000 steps per day, an 80-year-old foot could have tread over 290 million steps in a lifetime. It should therefore come as no surprise to learn that the fatty padding in the foot, either under the heel or the ball of the foot, can be considerably reduced in the ageing patient. The combination of pressure and reduced protection produces pressure-related problems unique to the foot; callouses and corns over bony prominences and metatarsal heads, heel pain from standing and walking, inter-digital neuromas and bursas or capsulitis.

Nail changes Difficulties with bending down, eyesight or focal length and hand grip strength often are the initiating factors for a person to directly contact a Podiatrist for assistance with foot care. Podiatrists regularly treat nails in the aged population and offer professional care of nail pathology such as ingrown nails, fungal nail infections, and wounds related to excessively long or thickened nails.

Changing capability As well as physical changes, there are often cognitive impairments related to chronic disease and complex medical presentations in the aged. Impairment in memory, loss of concentration, impairment in focus and judgment can affect personal care. These mental capacity deficits produce a higher risk profile for the aged foot, which often requires professional input of a Podiatrist as a regular provider of foot care.

Orthopaedic changes The foot shape and appearance can change with ageing due to changes in bony structure and weakness or loss of elasticity in the connective tissues, such as ligaments and tendons. Muscle strains and tendon pathology are common consequences of an active older person who is demanding a lot from an ageing body. Bunions and clawing toes are common presentations in the ageing foot. Other underlying chronic diseases such as arthritis and diabetes often exacerbate foot orthopaedic problems.

Gait changes Falls in the elderly are a concern to people who have experienced falls, their families and the health system at a community level. It has been shown that people at higher risk of falls have a more variable pattern of minimum foot clearance, which could lead to trips and falls. Podiatrists have a role in footwear advice and maintaining the foot to be as pain-free and functional as possible.

Foot pain Foot pain affects up to 24% of people over 65 years of age (4). Pain is associated with altered activities of daily living, balance and gait. Some of the risk factors for pain are gender (with women reporting more foot pain), obesity and chronic health problems.

Podiatrists form an integral part of the health care team for ageing Australians. Podiatrists play a key role in assisting ageing Australians with general foot care, which would otherwise be left unattended and could lead to more serious problems, including infection, hospitalisation and, in worst-case scenario, even amputation.

Pregnancy and Foot Problems

Pregnancy triggers many different changes in a woman’s body, and can lead to problems that affect your feet and legs. Foot pain is one of these complaints that can often be overlooked. Due to the natural weight gain during pregnancy, a woman’s centre of gravity is completely altered. This causes a new weight-bearing stance and added pressure to the knees and feet. Furthermore, the naturally released hormones that prepare the body for child birth also cause relaxation of the ligaments in the feet.

Flat Feet

Hormones increase during pregnancy. Some of these hormones help relax ligaments and other structures to allow a vaginal birth. These same hormones can also relax the ligaments in your feet, leading to flat feet (fallen arches) and over-pronation. This loosening of ligaments can also increase your shoe size during pregnancy. Therefore, you may have to wear a half or whole size larger after you give birth. Your growing womb, baby and breasts contribute to weight gain that causes extra stress on your already compromised feet, especially your arches. It is not uncommon for pregnant women to develop heel pain (plantar fasciitis) because of the extra weight and stress on the arches.


  • Try to avoid standing for long periods of time and walking barefoot. Take a break when you can, and sit down and elevate your feet.
  • Supportive, properly fitted shoes and arch supports will help; see a Podiatrist to discuss custom orthotics.


Oedema (swelling) is an increase in fluid in the tissues of your body. Swelling in your feet and ankles during pregnancy is very common. It is usually caused by an increase in blood volume that occurs to help you carry extra oxygen and nutrients to your baby. Pregnancy hormones can also cause changes in the blood vessels, which may lead to swelling. You may notice that your shoes become too tight. An increase in foot size due to swelling are common and temporary.


  • Do not stand still for long periods of time. Walking gets your calf muscles working, which helps pump some of the extra fluid out of your legs and feet.
  • Rest several times a day, elevating your feet as much as possible when sitting down.
  • Wear compression stockings to help decrease the swelling.
  • Drink plenty of water throughout the day. Try to avoid foods that contain large amounts of salt, as they will increase your fluid retention.
  • Rest on your left side. This decreases the pressure on blood vessels and allows more fluid
    to move from your legs to your upper body.
  • Wear the correct shoe size for your feet.

Toenail Changes

Your toenails tend to grow faster during pregnancy. This is usually due to increased blood volume and circulation of hormones. Because you are providing nutrients for your baby, the cells in your toenails can sometimes be deprived of an adequate amount of nutrients. This can cause the development of nail brittleness, ridges or grooves that go across your nail, and dark or discoloured lines in the nail bed. A nail might even become loose and fall off. These nail changes will usually go away after your pregnancy.


  • Do not wear shoes or socks that are too tight. The extra pressure they put on the skin around the nails may cause ingrown toenails.
  • Eat healthy, well-balanced meals. This will help supply the nutrients needed for you and your baby.
  • Do not trim toenails too short. Swollen skin can overlap the corners of short toenails, causing ingrown toenails.
  • Have someone else trim your toenails or get a pedicure if you are not able to see/reach your feet.

Podiatrists are able to provide a complete assessment of your feet during pregnancy and provide advice and treatment, should it be required.

Lower Back Pain and the Feet

The foot being the base and foundation for our body, many back problems can be related to the way we stand and walk. Around 40 per cent of Australians will experience some form of foot problems in their lifetime. Low back pain is a very common complaint and not many people understand how movement and alignment of the pelvis, leg, ankle and foot is intricately connected to the development of acute and chronic low back pain. Yet it can easily happen to people young and old, male and female.

There can many causes of low back pain. These may be osseous (bony), neuropathic (nerve damage) or soft tissue. Common causes can include:

Excessive Pronation

Excess pronation, or ’flat feet’, causes various rotations throughout the legs during the walking cycle. The end result of these rotations is a forward tilt of the pelvis, which in turn increases the curvature of the spine and places strain on the muscles and ligaments of the lower back.

Asymmetrical Movement of the Feet

If one foot is rolling in or out significantly further than the other, not only is there an increased curvature through the lower back, but a pelvic tilt can result. This can lead to scoliosis (a curvature of the spine), and once again places strain on the associated muscles and ligaments.

Structural / Functional short leg

One leg shorter than the other can be either structural (the bones in one leg are actually shorter than in the other leg) or functional. A functional short leg can be due to over-pronation in one foot more than in the other which rotates or twists the pelvis which becomes misaligned. When this happens, the leg is pulled up higher into the hip socket, the joints in the pelvis may be impinged, causing pain and discomfort and the leg muscle to shorten.

Incorrect Gait / Posture

Posture and gait (walking/running style) are closely related and can heavily influence other areas of the body. Even the most minor abnormalities in posture and gait can result in increased stress on the lower back and other areas of the body.

Treatment of Lower Back Pain

Podiatrists are able to diagnose any lower limb problems causing lower back pains through Footwear Assessment and Biomechanical Analysis. Podiatrists assess the suitability of footwear for your individual situation and critically analyse your posture and movements while you stand, walk and run to identify the cause of your lower back pain. Through this analysis Podiatrists are able to accurately diagnose the lower limb cause and prescribe the right treatment to alleviate your back pain.

Custom-made orthotics are the best way to treat and prevent over-pronation. They are custom-made shoe inserts which will give controlled support to the arch and hence neutralise abnormal foot pronation. Orthotics maintain the normal biomechanics and posture of the foot and leg, limiting pelvic tilt and muscular tightening of the lower back area. Heel lifts can be used to raise a structural short leg.

Stretching Exercises may be prescribed to relieve the gradual shortening of the affected muscles.

Feet and knee pain

You may not immediately think of knee pain as being related to a problem with your feet, but poor foot function can be a factor that causes pain further up the body, in joints such as the knees, hips, and lower back.

There are commonly two types of injuries which can cause knee pain:

  • Acute injuries (eg. ligament tears)
  • Overuse injuries

The most common cause of knee pain related to the feet is excessive foot flattening or rotation, which can force the knee to roll inwards in an abnormal position.

Various factors can cause overuse injuries to the knee, including poor footwear, inappropriate training programs and inadequate training surfaces (eg. bitumen or soft sand).Another major cause is abnormal alignment of the foot and lower leg.

Flat Feet 

With flat or excessively pronated feet, the result is excessive internal rotation of the lower leg at the same time that the upper leg is rotating in the opposite direction due to forces produced during walking. The knee is the area that therefore must absorb these twisting forces, and thus injuries occur.  Also, pronated feet result in a valgus, or ‘knock-knee’ position, which results in various muscles exerting their pull in incorrect directions.

High-arched feet

High arched, or excessively supinated feet, do not allow the shock absorption needed during walking.  The knee must therefore take too much force to absorb this shock, and this is when overuse injuries will occur.

Patellofemoral syndrome

With pronated feet the knees move into the ‘knock-kneed’ position. This causes the patellar tendon (which connects the muscles of the thigh to the lower leg via the knee cap/patella which acts as a pulley) to pull in the wrong direction.  The patella thus runs over areas in the knee that it is not supposed to, and eventually this will result in injury and pain. The pain is often felt with bent-knee activity, like squatting and walking upstairs.

Iliotibial band syndrome

The muscle which runs down the outside of the thigh, and which crosses the knee, is the iliotibial band. With excessive pronation, this muscle shortens over time and is therefore subject to pain and injury. Pain is felt on the outer edge of the knee joint.

Osgood shlatters disease

This commonly affects teenagers, and is an inflammation of the growth plate of the tibia (lower leg bone), which is situated just below the kneecap.


  • Orthoses – these allow the foot, leg and knee to function in the correct position, and thus forces are distributed correctly throughout the leg.
  • Exercises – strengthening and stretching of muscles around the knee to help reduce your knee pai
  • Dry Needling
  • Rest, ice, compression
  • Taping of the knee
  • Wearing appropriate footwear

If you have knee pain that you can’t seem to get rid of, consider seeing a podiatrist.