How Aging Affects Your Feet

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.
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 cushioning 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.1
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.2

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 mid-foot, 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.3

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.

Alhough 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.5 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 60.6 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 diseases8

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.