En español | In an average lifetime, your feet help you walk 110,000 miles — more than four times around the Earth. To do so, they're a true anatomical feat, with a whopping 28 bones, 33 joints and more than 100 tendons, muscles and ligaments.
And, yes, how all those joints and muscles wear, or tear, can significantly impact your lifestyle. “Foot problems impact the quality of your life, whether it's going out for the evening or playing a round of golf,” says Alan Bass, a New Jersey–based podiatrist and a spokesperson for the American Podiatric Medical Association (APMA).
It's no wonder they sometimes hurt — and even more so as we age. A 2016 study published in the European journal Maturitas found that 1 in 4 people aged 45 or over experiences foot pain, especially in the forefoot and toes, which can impair mobility and balance, and even be a risk factor for falls. So what exactly causes these aches, and when should you see a doctor about them?
"The most common foot problems, regardless of age, are generated by overuse and caused by the shape of the foot, the structure of the foot, the surface it's on, the activity level, the weight the feet carry and the shoes we wear,” says Alex Kor, an Indiana-based podiatrist who is also an APMA spokesperson.
If you go to a podiatrist with foot pain, says Bass, “We first take a look at the foot structure and the way you walk and stand, and then we might do X-rays. But any treatment we do is tailored to the individual.” With that in mind, these ailments are the most likely to be diagnosed as the root of your problem:
This inflammation of the plantar fascia ligament, running from the heel to the ball of the foot, can cause pain in both the heel and the arch and is sometimes associated with heel spurs (calcium deposits under the heel bone). “Talk to 10 podiatrists, and they'll all say that plantar fasciitis is the most common problem they see walking into their office every day,” says Kor. “I've seen it in everyone from athletes who are teenagers to 95-year-olds.” One common cause, he says, is wearing the wrong shoes, no matter what you're doing. “Your foot doesn't know the difference between walking on the track, running on a treadmill or standing in your home eight to 10 hours a day.”
Most plantar fasciitis goes away over eight to 12 months, says Pedro Cosculluela, an orthopedic surgeon at Houston Methodist Hospital who specializes in foot and ankle problems. Some doctors, he says, treat the condition with shots of cortisone or platelet-rich plasma. Short of that, Kor recommends never buying shoes without seeing and feeling them first. “You need to pick a shoe up — whether it's a gym shoe, a running shoe or a dress shoe — and bend it. If it bends at the arch, it's usually a bad shoe and you will be more prone to overuse conditions like plantar fasciitis.” And good supportive shoes don't need to be expensive, adds Kor, who recalls a recent patient who bought the right $14 pair of shoes and got a significant reduction in pain in a month.
“With the aging process comes breakdowns with joints,” says Bass, “because we don't walk on sand, we walk on concrete and asphalt.” That often means osteoarthritis, a painful degenerative disease of joint cartilage and the adjacent bone. “We see arthritis of the ankle, the joint underneath the ankle, the middle of the foot, the big toe — plenty of places,” Cosculluela says.
What can you do? Restrict activity that involves the foot, lose weight, wear appropriate shoes, add padded shoe inserts, get physical therapy, take anti-inflammatories, get steroid injections and limit yourself to nonimpact exercises. “I tell people all the time, if you've had foot pain for a year, running, walking or jumping are probably the wrong exercises for you,” says Kor. “Instead, do an exercise like a stationary bicycle, swimming, water aerobics, elliptical machine, rowing machine, things that will not bother your foot,” says Kor. “If you're heavy, then losing 20 pounds might make walking less painful in the future."
The technical name is hallux valgus and it's a painfully common condition that involves a bony buildup on the big toe joint, with that toe sometimes bending in toward the smaller toes. The causes? Heredity, for one, which may be aggravated by years of wearing shoes that are too narrow or high-heeled. “And people who have a lower arch or a flatter foot are more prone to bunions,” says Bass. “There's not much to do for a bunion short of surgery,” says Cosculluela. “But unless it's causing pain and limiting activity, we don't do surgery.” No matter whether you have surgery or not, you have to deal with the biomechanics, which means wearing orthotics. A podiatrist can take a mold of your foot to fit custom ones, which can be pricey; Bass also recommends the widely available Powerstep brand of orthotics.
These happen when any of your smaller toes curl up, sometimes because of — you guessed it — wearing shoes that are too tight in the toe box, and sometimes when someone with a very flat foot does not get proper support over time. “If the tendinous and soft tissue structures don't get enough support,” Kor says, “the tendons going to the toes start to pull, which can lead to a hammer toe.” What can you do? Wear shoes with wider toe boxes as often as you can. “Like bunions, hammer toes are foot deformities, and there is no device that will definitely cure them,” he says, though small toe shields worn on top of the toes can reduce friction against shoes.
That collagen you're losing in your face? It may be slowly disappearing in your feet, too. “There are fat pads on the ball of the foot, as well as on the heel, and as we age, they sometimes atrophy,” says Kor, who particularly sees this problem in smokers. As with other ailments, wear orthotics, over-the-counter insoles and/or shoes with lots of support. Bass likes New Balance, Brooks and Clarks.
Morton's neuroma, an uncomfortable condition caused by a swollen, inflamed nerve, affects the ball of the foot, usually between the smaller toes. It can feel like you've got a small rock in your shoe and most often affects women who have worn high heels or too-narrow shoes. The solution: Wear shoes with wider toe boxes, or add shoe inserts designed specifically for this condition, either over-the-counter or doctor-prescribed.
Very dry skin
The skin on our feet, like all our skin, gets drier with age and can develop cracks. “These fissures can be dangerous,” says Kor, “particularly in somebody who's neuropathic, meaning without sensation in the foot. If you have a crack, it's an open invitation to bacterial infection. People often soak their feet, but that will dehydrate the skin and make the crack worse.” Instead, he says, moisturize with Eucerin, Aquaphor or prescription Lac-Hydrin right after showering.
Swelling of the feet and ankles can be caused by many things, including poorer circulation, diabetes and a more sedentary lifestyle. “A condition called venous insufficiency, in which our veins stop working properly, can lead to fluid accumulating in the feet at the end of the day,” says Kor. “That can lead to a condition called venous stasis, in which the blood stagnates and bursts through the skin to form an open wound, which we call a venous stasis ulcer.” His advice: Elevate the feet above the waist for 20 to 30 minutes at least twice a day, wear compression socks and ask your doctor if you also need medication.