They danced in muddy fields at Woodstock and slogged through Vietnamese jungles. They pushed strollers and climbed corporate ladders by day and danced away evenings of Macarena and electric slide. They endured deadly stilettos, saddle shoes, go-go boots, plastic platforms, Earth shoes, jellies and joggers and, perversely, stilettos again.
But as baby boomers stride into the senior years, the feet that stood by them so long are wearing out.
Toes, straight and true for generations, start to curl. Tendons tear after years of stairs. Arches that stood a hundred million steps fall.
“We’ve got a baby boomer population aging here, and we’re seeing the breakdown of the foot,” said Dr. John Mozena, a Portland podiatrist.
Two great demographic shifts have the nation limping and wincing into an era of bad feet: The average American is now older and fatter than at any time in history.
Age and weight are hard on joints and arteries and many other body parts. But the feet take a special beating.
“The foot, more than any other structure in the body, is very mechanical,” said Dr. Matthew Bookwalter, a podiatrist with The Portland Clinic. “It’s a lever. And it has load limits.”
And the foot’s parts can fail over time with the incredible stress of thousands of steps a day. “If you have biomechanical, structural problems in your foot, the effects of those are going to show up as you age,” said Dr. James Christina, director of scientific affairs for the American Podiatric Medical Association. A survey by that group showed that foot pain limits the daily activity of nearly 19 percent of U.S. residents, and almost 29 percent of people ages 51 to 60.
High-stress practices, from running to wearing fashionable but uncomfortable shoes, also take a toll over time.
In a 2001 survey by the American Academy of Orthopaedic Surgeons, four in 10 women who wore heels reported wearing the wrong size and eight in 10 reported foot pain. Most cited style as their reason for wearing painful shoes Water Park.
Heavier people amplify the hobbling effects of age by putting more pressure and stress on each foot with every step. “Obesity causes the same issues as aging, only accelerated,” Mozena said. And the obese are far more prone to diabetes, the nation’s No. 1 cause of amputated feet.
The foot’s arch is a good milestone of the twin burdens of time and weight. The arch is supported by the posterior tibial tendon, which runs from the calf past the inside ankle. Over time, stress can stretch the tendon so the arch sags, making the foot longer and wider. “When people say their foot doesn’t grow, that’s wrong,” Mozena said. “It does grow, by the arch dropping.” If you don’t change shoe size to accommodate that middle-aged spread, he said, you risk pinched nerves, hammer toes or bunions from the shoe rubbing and squeezing the foot.
If the tendon tears or stretches, the arch can collapse, causing flatfoot, a more serious problem where the foot aches and the ankle rolls inwards. Bookwalter said the alignment of women’s hips and legs especially stresses the tendon, as does excess weight. “When I was a resident, we had a saying about The Three F’s: fifty, fat and female,” he said. “It’s crude. But it’s accurate.”
Fallen arches are just one of many age-related foot problems. Time can also twist lesser toes, said Dr. Michael Kennedy, an Oregon Health & Science University orthopedist. Opposing muscles usually balance to hold the toes in place, Kennedy said. But over the years, the bigger, outer muscles can overpower the weaker, inner muscles, causing toes to bend up at the first joint (hammertoe) or last (mallet toe), or even curl into a claw toe.
Age can also bring arthritis, especially in ankles and big toes, and thin the padding of the sole, worsening corns, Kennedy said. Years of wearing too-tight shoes can also worsen the common foot woe called bunions — genetically inherited flaws that make bony bumps that misalign the big toe.
Extra weight courts a few serious foot problems. One is plantar fasciitis, a leading cause of heel pain commonly seen in people just 20 or 30 pounds overweight, Bookwalter said. In that ailment, a heel-to-toe band of tissue called the plantar fascia gets inflamed, causing pain, especially in the morning. Women, runners and people who stand for work are at extra risk.
Diabetes poses the most menacing weight-related foot risks. The condition can damage small blood vessels and nerve fibers in the feet, which may tingle, hurt or grow numb, making it hard to balance or even feel a foot injury. The disease also makes it hard to heal even small cuts, which often grow infected and fester into limb-threatening ulcers.
Portland’s Connie Morrell knows the pain well. She developed diabetes during pregnancy 30 years ago. A decade ago, her feet started to tingle, as if asleep, then feel numb. Morrell, 57, later lost her sense of balance, then her ability to walk long distances. Now she has to wear big “diabetic shoes” and limit how far she walks, or else risk a serious injury.
“It is painful,” Morrell said. “You can’t feel how you’re walking. But your feet sting and burn if you walk on them too much.”
Three times, she’s bumped her right big toe and lost the whole nail. So far she’s had no wounds that won’t heal. But her podiatrist, Mozena, “says he will be taking my big toe off sooner or later,” she said.
Bookwalter said diabetic patients who develop ulcers often need serial amputations, first losing a toe, then the foot, then the leg. As much as 70 percent of foot and leg amputations are forced by diabetic ulcers — an amputation every 30 seconds worldwide, according to the International Diabetes Federation.
Something as small-seeming as an ingrown toenail can threaten a diabetic’s leg, doctors said. Mozena recalled one older woman who neglected her feet, letting a toenail grow around and bite into the bottom of her foot. The cut got infected, and when he removed the nail Mozena said he found maggots underneath.
Ulcers are so serious for diabetics, Mozena said, that “We recommend looking at the bottom of your foot at least on a daily basis” to check for problems. Doctors urge diabetics to prevent cuts by keeping nails trim, washing feet regularly and feeling for sharp objects inside shoes before donning them.
Vigilance and early care are good ideas for all foot woes. When caught early, many foot problems can be treated with modest measures including supportive shoe inserts called orthotics, weight loss or painkillers. Just switching to comfortable, well-fitting shoes eases many ailments. But if problems linger, more serious steps are needed, from steroid injections to weeks in foot-immobilizing boots, even surgery.
Untreated foot problems can wreck a life. The foot is the body’s shock absorber, Mozena said. If it’s working wrong, people change their gait and can shift stress to their other foot, hips or back, injuring them. The constant punishment we give our feet means they seldom heal without some care.
A good rule of thumb is to see a doctor for any foot pain that doesn’t ease in a month or two, Bookwalter said. Unfortunately, many people suffer secretly for years before hotfooting it to a doctor.
“The beauty of the foot is it can be hidden,” Mozena said. “If you had anything like you have on your foot on your face, people would be in here in two hours.”
(Copyright (c) 2006, The Oregonian, Portland, Ore. Distributed by McClatchy-Tribune Business News.)
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