Age-Related Changes in Feet and Legs: A Podiatrist’s Guide

An Article Written By Cecilia Brennan
Podiatrist – New Step Podiatry.

 

When someone claims they’re “old,” I love to reply “you’re not old, you’re chronologically experienced!” Ageing isn’t exactly a walk in the park, though.

Think of it like puberty, but instead of being over a few years, it’s over a few decades and instead of acne and new hair growth, you get wisdom and less hair growth, although, sometimes you do get new hair growth in new places.

The feet and lower limbs aren’t immune from the passage of time. This blog article will help you understand the changes your feet are going through or are about to…

 

Toenail Changes as we Age

Not only do toenails grow slower in old age, but they are also prone to becoming thicker and more brittle, making them more difficult to trim. Several factors contribute to these changes, including:

  • Reduced and disrupted nail cell creation: as we age, cell regeneration slows down, and new cells may not be as neatly organised. This results in slower nail growth and changes in nail structure.
  • Reduced circulation: toenails require nutrients to grow, which are delivered through the bloodstream. Reduced blood flow means fewer nutrients reach the nails, leading to slower growth and less structurally sound nails.
  • Microtrauma: years of microtrauma from poorly fitted shoes or physical activity can cause toenails to thicken in response to repeated stress.

When toenails get thicker, they can develop a slight yellow discoloration, making it difficult to distinguish between age-related changes and fungal infections. Older individuals are more susceptible to fungal infections, like many infectious diseases. If you suspect your toenails might be fungal, consult a podiatrist for an assessment and management plan.

At our podiatry clinic, we use specialised equipment, such as a podiatry dremel/drill, to thin down thickened toenails. Our expert podiatrists ensure a quick and tidy trim with our professional clippers.

We also frequently treat involuted toenails in older patients, where the edges of the toenail curve inward more than usual, causing discomfort and increasing the risk of infected, ingrown toenails. Regular and proper trimming is essential for managing involuted toenails.

 

Skin Changes on the Feet and Legs

As we age, the skin on our feet and legs undergoes changes that make it more thin, dry, and fragile. Similar to the effects seen on the face, these changes occur due to various factors:

  • Decreased collagen and elastin production: these proteins provide structure and elasticity to the skin.
  • Reduced sebum production: sebum acts as the skin’s natural moisturiser.
  • Slower skin cell turnover: the rate at which skin cells regenerate and shed decreases with age, leading to a buildup of dead skin cells and a rougher texture.
  • Hormonal changes: menopause in women, for example, can decrease skin hydration and elasticity.
  • Exposure to environmental factors: sunlight, pollution and harsh weather conditions can damage the skin’s protective barrier, disrupting its ability to retain moisture.
  • Medications: older individuals often take more medications, some of which can increase skin dryness as a side effect.

As we age, sweating decreases because sweat glands become less active, which can worsen dryness. Reduced sweating is one reason why older people can struggle during heat waves.

Ensuring our feet remain adequately moisturised with products like sorbelene or similar can effectively prevent painful cracking caused by dry skin, while also enhancing our skin’s resilience against blisters, cuts, grazes, and calluses. It’s far simpler to prevent severe skin injuries with moisturisers than to treat breaks to the skin or ‘skin tears.’

These tears can vary in severity, and too often, our podiatrists assess skin tears on the front of the legs due to activities like gardening or interactions with pets. These injuries could have been less severe had the skin been properly moisturised. Some skin tears can take months to heal and necessitate numerous visits to wound care nurses. Consistently using sorbelene or a similar product daily is a much easier solution than dealing with the consequences of untreated skin tears.

The International Skin Tear Advisory Panel (ISTAP) Classification of skin tears. Picture derived from https://www.vitalmedicalonline.com.au/skin-tears/

Musculoskeletal Changes in Aging Feet: Insights from Podiatrists

The musculoskeletal system is a complex network of muscles, bones, joints, tendons, ligaments, cartilage, and other connective tissues that support the body, allow movement, and protect vital organs. Together, these components enable the body to perform a wide range of activities, from walking and running to lifting objects and fine motor tasks. The musculoskeletal system also plays a critical role in maintaining posture and balance. Musculoskeletal changes in ageing include the following.

Bone density loss:
Bone density peaks in early adulthood and gradually declines with age. This process, known as bone loss or osteoporosis, is due to an imbalance between bone resorption (breakdown) and bone formation. The bones become thinner and more fragile, making them more susceptible to fractures. These changes can increase the risk of fractures and other bone-related conditions.

Joint changes:
As we age, joint changes can lead to discomfort, pain, and conditions such as osteoarthritis. The changes that occur include:

  • Cartilage degeneration: cartilage is the smooth, rubbery tissue that covers the ends of bones in joints. With age, cartilage becomes thinner and less resilient due to wear and tear, reduced ability to repair itself, and decreased production of proteoglycans, which help maintain cartilage structure. This leads to reduced shock absorption and increased friction in the joints.
  • Synovial fluid changes: synovial fluid lubricates the joints and provides nutrients to the cartilage. As we age, the production of synovial fluid decreases, leading to less effective lubrication and increased joint stiffness and discomfort.
  • Loss of joint space: the spaces between joints can narrow over time due to cartilage loss and bone changes. This can result in bones rubbing against each other, causing pain, inflammation, and decreased range of motion.
  • Bone spurs: also known as osteophytes, these are bony growths that can develop on the edges of bones in the joints due to cartilage loss and joint degeneration. These spurs can cause pain, restrict movement, and contribute to conditions like osteoarthritis.

Overall, when these changes become pronounced and are visible on imaging tests like X-rays, the joint is diagnosed with ‘osteoarthritis’.

 

Decreased muscle mass and strength:
Muscles around the joints help support and stabilise them. With age, there is a natural decline in muscle mass and strength (sarcopenia), which can reduce joint stability and increase the risk of joint injuries and pain.

Decreased flexibility:
Decreased flexibility in the tendons and ligaments occurs due to decreased collagen production. Collagen provides strength and elasticity to ligaments and tendons. Ageing also reduces the water-holding ability of our tendons and ligaments. When there is less water content in these tissues, they become stiffer and more prone to injury. Decreased flexibility also occurs due to reduced blood flow, hormonal changes, microtrauma accumulation and lifestyle factors.

Reduced physical activity:
Older adults often engage in less physical activity, which can lead to joint stiffness and reduced flexibility. Regular movement is essential for maintaining joint health and mobility.

Overall, these combined factors result in ligaments and tendons that are less pliable, increasing the risk of strains, sprains, and other injuries, and potentially contributing to falls.

 

Foot Shape Changes with Age: What Podiatrists Observe

Have you noticed that your feet have changed shape as you’ve gotten older? In additional to increased swelling (see circulation below), common changes to foot shape during ageing include:

  • Less padding: as we age, the fatty padding under our feet, which acts as natural cushioning, becomes thinner. This reduction in padding results in less shock absorption, making older adults more susceptible to corns and calluses under the foot and joint pain in the ball of the foot and heel. In shoe cushioning either built into the shoe or in the innersole is important to improve foot comfort in those who have lost a lot of their foot padding.
  • Longer feet; as we age, our arches can flatten/lower, making our feet appear longer. This flattening occurs due to changes in the muscles, ligaments, and joints. Sometimes podiatrists see higher arches as people age, this can occur when the arch joints have osteoarthritis or when a patient has certain neurological conditions.
  • Toe changes: such as claw toes, hammer toes, and bunions become more common due to muscle and joint changes. These deformities increase the risk of developing calluses, corns, and blisters on the toes. To prevent these issues, it’s important to wear shoes that are deep and wide enough to accommodate the changes.
    Podiatrists have various techniques to help prevent and manage calluses and corns on toes. While there are methods to improve toe shape changes, rigid deformities that are concerning a patient may require surgery. However, many people prefer to avoid surgical options and continue with conservative options provided our podiatry clinic.
Corns and calluses can form on these pressure points on top of the toes as seen in different toe deformities

Circulation Changes in Ageing Feet and Legs: Signs and Symptoms

Arteries, veins, and lymphatics are all crucial components of the circulatory system, the following explains what they each do, what can occur in the ageing process and how this presents.

Arteries

Arteries carry oxygen-rich blood from the heart to tissues and organs throughout the body, ensuring they receive vital nutrients and oxygen. However, as we age, reduced blood flow becomes a common concern, particularly in the feet. Several factors contribute to this decline in circulation:

  • Arterial stiffness: with ageing, blood vessels lose their elasticity and become stiffer, hindering the smooth flow of blood to the feet.
  • Plaque buildup: over time, fatty deposits can accumulate on artery walls, leading to a condition known as atherosclerosis. This buildup narrows the arteries, restricting blood flow to the feet.
  • Lifestyle factors: sedentary lifestyles, smoking history, poor dietary choices, and obesity can exacerbate poor circulation in ageing individuals.

When circulation is significantly compromised, it may result in the diagnosis of Peripheral Arterial Disease (PAD). Recognising the signs and symptoms of PAD affecting the feet is crucial:

  • Persistent cold feet: feet that remain consistently cold, even in warm environments.
  • Skin discoloration: bluish or pale skin on the feet, indicating reduced blood flow.
  • Decreased hair and nail growth: noticeable reduction in hair and nail growth compared to typical ageing.
  • Slow healing skin injuries: cuts, grazes, or blisters that are slow to heal and may lead to complications.
  • Claudication: leg pain during exercise that resolves with rest.
  • Weak or absent pulses: difficulty detecting pulses in the feet, indicating compromised blood flow.

At our practice, our podiatrists utilise specialized equipment to assess for PAD and provide personalized guidance. It’s crucial to evaluate for PAD when symptoms are present, as reduced blood flow not only hampers the healing of injuries but also increases the risk of ulcers, wounds, and infections. By seeking timely intervention, our podiatrists can offer strategies to prevent complications and delay the progression of PAD.

Veins

Veins play a crucial role in returning deoxygenated blood from body tissues back to the heart, while also transporting waste products and metabolic byproducts like carbon dioxide. As people age, they become more susceptible to a condition called venous insufficiency. This condition is marked by impaired venous function, particularly in efficiently returning blood from the legs to the heart. Several factors contribute to its prevalence in older individuals:

  • Weakening of vein walls: with age, the walls of veins may lose their strength and resilience.
  • Dysfunction of vein valves: valves within the veins, which normally prevent backflow of blood, can become damaged or dysfunctional.
  • Age-related chronic health conditions: conditions such as hypertension, diabetes, and heart disease can further impair blood vessel health and circulation.

Signs of venous insufficiency encompass:

  • Swelling: oedema or swelling in the legs, ankles, or feet due to fluid buildup.
  • Spider veins: small, web-like clusters of veins that may emerge from fluid pressure on the small veins.
  • Varicose veins: twisted, bulging larger veins visible just beneath the skin’s surface, especially in the legs, often causing discomfort or heaviness.
  • Hemosiderin deposits: resulting from the breakdown of red blood cells, these deposits release iron-containing pigment (hemosiderin) into surrounding skin and tissues near venous congestion.
  • Venous eczema: Also known as stasis dermatitis, this type of skin inflammation may cause itching and often accompanies venous insufficiency and edema.
  • Skin changes: the skin may undergo discoloration, increased shininess, and feelings of tightness, itchiness, or irritation. In severe cases, venous ulcers may develop.

Understanding these signs and symptoms is crucial for timely diagnosis and management of venous insufficiency. Seeking medical evaluation and appropriate treatment can help alleviate discomfort and prevent complications associated with this condition. If you are suffering from oedema/swelling, seeing both a podiatrist and general practitioner is important to evaluate for all the other medical causes of swelling. Elevating legs more often, if sitting down for long period of time do try to get up and move around more and using compression stockings are some tips for managing swelling at home.

 

Lymphatic system

Lymphatics form part of the lymphatic system, which is responsible for draining excess fluid, proteins, and waste products from tissues back into the bloodstream. They also play a crucial role in immune function by transporting lymphocytes and other immune cells.

As individuals age, lymphatic fluid flow may gradually decrease due to changes in vessel function and lymph node activity. This slowed flow can lead to fluid accumulation in tissues, resulting in oedema or swelling, akin to the effects seen in venous insufficiency.

Moreover, ageing can bring about shifts in the production and functionality of immune cells within the lymphatic system. These alterations may influence immune response dynamics, potentially heightening susceptibility to infections and diseases over time.

Understanding these age-related changes in lymphatic function is vital for maintaining overall health and well-being. By prioritising strategies that support lymphatic health, such as regular exercise, hydration, and a balanced diet rich in nutrients, individuals can better optimize their immune function and mitigate potential health risks associated with ageing.

 

Nerve and Sensation Decline in Ageing Feet

Our feet, like our faces and hands, have numerous nerve endings that help us feel. As we age, the sensitivity of these nerves decreases due to nerve degeneration. This reduction in sensitivity is believed to result from oxidative stress, chronic low-grade inflammation, and exposure to environmental toxins and pollutants. Conditions such as diabetes can lead to neuropathy, which further reduces sensation.

When sensation is reduced, we may not notice a forming blister from a pair of shoes or a small splinter in the skin. Pressure sores or bedsores become more common as well. If these skin breaks go unnoticed for too long, they are more likely to become ulcerated and infected. Therefore, it’s crucial to check your feet daily for cuts, grazes, and foreign objects in the skin. Apply first aid and seek medical attention for skin that hasn’t healed in 2 weeks and to remove foreign objects.

At our clinic, our podiatrists can assess whether you have protective sensation and provide guidance to avoid complications from reduced sensation.

Nerve degeneration also affects balance and coordination, which is discussed below.

A monofilament pressure sensation test

 

Functional Decline in Feet: Assessments by Podiatrists

Experiencing difficulty doing activities you once found easy? That’s part of ageing. Common functional changes that occur with ageing include:

  • Reduced balance: reduced balance occurs due to nerve degeneration and loss of strength from reduced muscle mass, increasing the risk of falls. If you would like a falls risk assessment, mention this to our administrative team to direct you to our podiatrists who perform these assessments.
  • Reduced mobility: mobility issues such as arthritis or joint pain can make it challenging for older adults to care for their feet, including trimming toenails or inspecting for problems.
  • Decreased flexibility: if you used to be able to reach your feet but now you can’t, it’s partly due to less collagen production and water content in ligaments and tendons.
  • Reduced ability to self-manage this occurs due to reduced flexibility in the back, hips, and knees, making it harder to reach the feet. Arthritis in the hands makes it harder to manage toenail clippers. Cognitive impairments from conditions such as dementia or Alzheimer’s can affect someone’s ability to perform self-care tasks, including foot care. Poor vision means you are more likely to miss a corner when trimming your toenails. Filing after trimming can help you determine if you have left an edge.

 

Summary

Sorry if this article seems all doom and gloom. However, throughout the article, there are tips on managing and preventing complications due to changes in the feet and lower legs as we age.

Ultimately, it is a good idea for all older people (65 years and older) to consult a podiatrist for a foot and lower limb health check. For those at increased risk of complications, more regular visits will be recommended. These visits may include the management of corns and calluses, thickened toenails, joint and muscle pains, and providing advice on preventing complications at home. This advice might cover footwear recommendations, exercise prescriptions, orthotic therapy, moisturiser use, and other self-care strategies.

If you would like more podiatry specific advice, the Australia Podiatry Association has numerous factsheets here (https://www.podiatry.org.au/foot-health-resources/foot-health-fact-sheets/fact-sheets).

Lastly, I highly recommend older Australians check out the resources on this Australian Government website. It’s about positive ageing, and provides information on planning for your health, aged care and connection to community as you get older. Please check it out here (https://www.health.gov.au/topics/positive-ageing).

 

 

Book an Appointment at Our Canberra Podiatry Clinic for a Foot Health Check 

Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve. Easily book an appointment at our clinic online or give us a call on 02 6198 4818.

 

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