Podiatry: Importance of footcare in the elderly

Our feet can be deemed as unsung heroes of our body. Hardly do we ponder about the heavy lifting it does, holding up our body and taking us places. Footcare deserves as much importance as any other body part and its importance among the elderly cannot be ignored as they suffer more foot problems compared to others. Hence, the field of podiatry has gained importance over the years.

Manoharan, a 65-year-old from Kerala, was developing frequent foot infections. This was characterised by itching, redness, swelling and pain. Manoharan, who would engage in a lot of farming in his backyard, had a habit of walking barefoot around his house.

A podiatry specialist found this to be the culprit behind his foot infection. He was prescribed antifungal creams and advised to wear footwear every time he ventured out. He was also advised to wear cotton socks inside his home.

Realising the importance of footcare has now helped Manoharan to carry out his farming activities worry-free.

Footcare in elderly and podiatry

Dr Farah Ingale, director, internal medicine, Fortis Hiranandani Hospital, Mumbai, lists some common foot issues in the elderly and stresses the importance of footcare among them:

• Heel fat pad syndrome: This refers to thinning of the fatty tissues which cushion the heels due to wear and tear. The foot becomes longer and the shoe-size may increase. It causes pain in the heel and walking difficulties.
• Flat feet: In this case, the arches of the feet flatten out. Conditions like diabetes and obesity can put one at an increased risk of flat feet, leading to foot and lower back pain.
• Foot bunion: This is a bony bump formed at the joint that connects the big toe to the foot. It is caused by increased pressure on the big toe over many years and can cause pain in the big toe joint.
• Calluses: Callus refers to the thickening of the skin caused by increased friction and pressure. It results from wearing ill-fitting shoes and walking barefoot.
• Dry skin: The skin tends to get dryer as we age, making it rough and scaly. This makes it prone to dermatitis and cracks on the foot. As a result, bacteria can enter these cracks and cause infections. Repeatedly scratching the itchy skin can also lead to bleeding and infections.
• Fungal infections: A weakened immune system, health conditions (like diabetes) and side effects of medications can cause fungal infections in the elderly. Lack of foot hygiene and exposure to dampness increases the risk of such infections.
• Arthritis: The foot has 33 joints. With age, these joints undergo degeneration that affects mobility. Obesity and underlying conditions like diabetes pose an increased risk for arthritis.

Experts say that regular podiatry care can reduce the above vulnerabilities.

Diabetes and feet

“When people have diabetes, wounds do not heal easily and the chances of the wound getting infected are very high,” says Dr Harish Kumar, clinical professor and head, centre for endocrinology and diabetes, Amrita Hospital, Kochi. Diabetics must be under constant podiatry care, he adds.

Peripheral neuropathy (nerve damage) can be a consequence of uncontrolled diabetes. “The high level of glucose and fats in blood can damage the nerves and also restrict blood supply towards them, hampering nerve functioning,” says Dr Harish, stressing that for this reason, podiatry is gaining importance.

Dr Harish also points out that neuropathy can reduce sensation in the feet. This can lead to people being unaware of wounds and infections on the foot. In severe cases, it can lead to gangrene (tissue death due to lack of blood flow or infection) and may also warrant an amputation.

What is charcot foot?

“Charcot foot is a rare but serious complication which can affect people with peripheral neuropathy. If neglected, the bones become weak and can break. As it progresses, the joints in the foot or ankle can dislocate,” says Dr Krithika Jagadish, consultant, plastic & aesthetic surgery, Belenus Champion Hospital, Bengaluru.

“A deformed foot can cause pressure sores to develop in the foot. An open wound with foot deformity can lead to an infection and even amputation,” Dr Krithika adds.

In the early stages, the foot is red and is warm to the touch accompanied by significant swelling of the foot and ankle.

“If you’re suffering from blisters, callous, ulcers or charcot foot, home remedies are not recommended as they can infect the wound and lead to amputation of the digits or foot,” adds Dr Krithika

Footcare and podiatry tips

Dr Krithika lists the various podiatry and footcare tips for the elderly:

• Keeping the feet clean: Maintaining good foot hygiene is essential to prevent infections (fungal, viral and bacterial). Wash your feet routinely with soap and pat dry, especially the web space (space between the toes).
• Examining the feet daily: Keep an eye out for blisters, wounds, insect bites, web space infections, calluses and pressure sores daily.
• Moisturising the feet: Moisturising the feet will help keep the skin soft and supple, thereby preventing cracks and dermatitis.
• Nail care: Trimming the nails as well as filing and rounding the edges can help maintain hygiene, prevent fungal infection, and stop ingrown toenails.
• Stretching the feet: Seniors should stretch their feet daily to reduce tension on their joints and ligaments.
• Massaging the foot and leg: This is done to improve blood circulation to the feet and helps reduce foot swelling by improving the lymphatic drainage.
• Wearing well-fitting shoes: Calluses are usually caused by poor-fitting shoes, due to the space present for the foot to move around and rub against the inside of the shoe. Well cushioned and well-fitting shoes can help to evade this problem.

Takeaways

• Common foot issues affecting the elderly include fungal infections, flat feet and loss of moisture.
• Uncontrolled diabetes can slow down the healing of wounds and infections.
• Peripheral neuropathy, a complication of diabetes, is caused by poor blood supply to the nerves.
• Adequate footcare like wearing well-fitting footwear, cotton socks and moisturising the feet are important to prevent foot complications.