Why healthy feet can make all the difference as you grow older
Is it possible to write a witty and profound article about feet? Possibly not. But this is important stuff. It could save your life.
In his wonderful book ‘Being Mortal’, the surgeon Atul Gawande describes sitting-in with a chief geriatrician for some routine consultations. He noticed that the doctor spent a lot of time examining the feet of one patient who had several issues related to ageing although not directly related to her feet. When asked whether the foot exam was really necessary, the doctor answered: “yes, you must always examine the feet”. He concluded that this lady was remarkably mentally and physically well at 85 years old, but struggled to reach her feet and had poor balance. This meant, in his view, that the most serious danger she faced was from falling.
Falls are common and can cause serious health issues for older people. They are the main cause of loss of independence and often the reason for needing assisted living. This was very true for my mother. After several falls, she lost confidence and the fear of falling led to a loss of mobility and strength.
Falls can cause head injury, fractures and internal bleeding, and in the UK, they are the most common cause of injury-related death in people over 75.
The geriatrician found in this case that the patient’s feet were swollen, she hadn’t cut her toenails and she had calluses and sores. Following a referral to a podiatrist for regular care, a year later this lady was doing well and hadn’t had any falls. The natural ageing process means that older people have an increased risk of having a fall.
Reading this reminded me of several patients I had met during my nursing career who struggled with walking and balance as a result of problems with their feet. Often simply being unable to reach to cut their toenails had resulted in chronically thickened and overgrown nails and as a result pain.
Weight-bearing exercise, such as walking, is often recommended in falls prevention, as is resistance training to generally strengthen muscles. But clearly, poor foot health is a barrier to these strategies. Poor ankle and foot strength affects balance and foot pain reduces the length of stride and walking speed. Research has also found that older people with foot pain have a reduced quality of life.
Now, I do not have the prettiest feet! I have hallux valgus (bunions) on both feet, and these are occasionally painful. It’s a common deformity that is thought to be genetic. It can affect the flexibility of the toes and as a consequence, balance. And there’s more – I have a chronically thickened middle toenail following a fungal nail infection but hey ho, I still love my feet, they do a great job!
If you are able, visiting a foot health professional is a great idea but I know that’s not affordable for us all. Research shows that professional foot care for older people leads to improvements in circulation and walking ability. But studies have also shown that self-care of the feet also has benefits. It’s just that we don’t often think to do it.
So, daily foot care is a really important part of my self-care and I remind myself that a key requirement for this is keeping flexible enough to reach my feet!
As a regular part of my exercise, I do some yoga and Pilates so that I maintain flexibility and balance. It’s a good idea to include specific movements of your feet, ankles and toes too, to keep them flexible by just going through the normal range of movement.
Next up, checking your feet daily is something that, as a health professional, I stress for people with conditions such as diabetes and poor circulation but it makes sense for everyone, particularly as we get older.
It is beneficial and not difficult. Keeping your nails trimmed and filed correctly, and gently removing any hard skin or callouses is essential. It doesn’t take long and prevents any painful build-up, and I love, love, love massaging cream into my feet after a shower.
So, if you want to prolong your mobility and independence, it really is worth taking care of your feet.