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There is a common misperception that growing older means having to cope with sore feet all the time. The nation’s foot and ankle surgeons disagree and believe seniors shouldn’t be resigned to accepting foot pain as a consequence of aging. Pain from common foot and ankle conditions can be treated successfully. Non-surgical and surgical treatments, therefore, can help seniors stay active, exercise regularly and maintain a healthy lifestyle.
Years of wear and tear on the foot and ankle can promote joint deterioration and eventual onset of painful arthritis. The big toe, for example, is vulnerable. It is the most complex joint of the foot, where bones, tendons and ligaments work together to transmit and distribute the body’s weight. Each day, with every step, it bears a force equal to about twice your body weight.
A common arthritic problem in the big toe is called hallux rigidus, a form of degenerative arthritis that causes pain and stiffness. As the condition advances, range of motion decreases until the big toe becomes stiff. Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot.
Early signs and symptoms include pain and stiffness in the big toe while walking, standing, or bending, and swelling and inflammation around the joint. Cold, damp weather can induce discomfort, too. Over time the symptoms can worsen, as evidenced by constant pain, difficulty wearing shoes and dull pain in the hip, knee or lower back caused by gait changes to compensate for foot pain.
Treatment for mild or moderate cases of hallux rigidus may include wearing shoes that have a large toe box and exert less pressure on the toe, custom orthotic devices, nonsteroidal anti-inflammatory drugs (such as ibuprofen), injections of corticosteroids to help reduce the inflammation and pain and ultrasound treatments or physical therapy to provide temporary relief.
In some cases, surgery is the only way to eliminate or reduce arthritis pain in the big toe, and several types of procedures can be performed. In some, the surgeon removes arthritic damage from the joint, as well as any accompanying bone spurs, and alters the position of one or more bones in the toe. More aggressive procedures are used when the joint can’t be preserved. They include fusion of the joint, removal of part or all of it and replacement with an implant.
The ankle also is prone to arthritis, especially in those with a history of sprains or other ankle injuries. An improperly rehabilitated ankle sprain, for example, can leave residual ligament damage and weakness or instability in the joint that can lead to osteoarthritis.
For some with end-stage ankle arthritis, surgery is the last resort to relieve persistent and debilitating pain. Previously, it was necessary to cut through bone to surgically repair diseased ankle joints. But today’s minimally invasive arthroscopic techniques enable foot and ankle surgeons to reduce surgical trauma and cost. With arthroscopy, surgery to treat an arthritic ankle takes far less time and has a high percentage of favorable, pain-free outcomes.
A patient survey conducted by the American College of Foot and Ankle Surgeons reported that two in three patients who had surgery to treat arthritis in the foot or ankle had significant pain relief, and more than half increased their physical activity as a result.
Brittle bones are vulnerable to tiny, hairline breaks, called stress fractures. In addition to osteoporosis, stress fractures are caused by an abnormal foot structure, deformities, and repetitive stress on the feet and ankles, such as running and jumping in recreational activities and sports.
Symptoms include pain, especially pinpoint pain at the site when touched, and swelling without bruising. Left untreated, stress fractures can lead to bony deformities that inhibit movement and cause arthritis, chronic pain and disability.
Treatment of stress fractures includes rest and avoidance of physical activity, immobilization or sometimes surgery. Badly displaced stress fractures normally require surgery to achieve proper union.
Do arches really fall? Though many believe this is a myth, the terms “fallen arches” and “flatfoot” do refer to a clinical condition in which the arch really does collapse and the foot flattens. The two most common types are:
- Adult-acquired flatfoot caused by inflammation of the tendon (posterior tibial tendon) that supports the arch and eventually causes it to lengthen or stretch.
- Flexible flatfoot which begins in childhood or adolescence, usually affects both feet and gets progressively worse through the years. The foot flattens when standing but the arch returns to normal when there is no weight-bearing pressure.
Adult-acquired flatfoot is a common overuse condition that can lead to severe foot pain and degenerative arthritis if left untreated. Those at greatest risk are older men and women who have been active throughout their lives, primarily in occupations that require standing or walking most of the time.
The first symptom is pain. It’s usually worse while walking, especially when rising up on the toes. Going up and down stairs, for example, can be very painful.
Early-stage cases can be treated with non-steroidal anti-inflammatory drugs, custom orthotic devices or casting. A foot and ankle surgeon will compare the arch of the normal foot with the other to check for discrepancies. Muscle and tendon strength also are evaluated during the exam, and an x-ray may be needed to spot bony irregularities along the tendon. An MRI also could be used to identify the extent and specific location of tendon damage.
If the condition worsens, surgery might be necessary. Procedures for this condition repair the torn or damaged tendon to restore normal function. In all cases, the goal of treatment is to stop progression of the deformity and prevent or delay the onset of arthritis.
As flexible flatfoot progresses, tendons and ligaments in the arch can stretch, tear and become inflamed. Symptoms include pain in the heel, arch, ankle or on the side of the foot, weakness in the foot or leg, and a noticeable “turning in” of the ankle.
Non-surgical treatments are similar to those for adult-acquired flatfoot. If surgery is necessary, a foot and ankle surgeon has several options based on the extent of the deformity and other factors. Procedures can involve lengthening tendons, realigning bones or inserting implant devices.
Though many older Americans have foot pain, aging by itself isn’t responsible. Pain usually is caused by treatable foot conditions that can result from years of stress and pounding. Foot and ankle surgeons are employing advanced techniques to correct foot disorders and alleviate activity-limiting discomfort. With proper diagnosis, treatment and rehabilitation, foot and ankle pain can be eliminated from the proverbial list of health consequences associated with aging. |