June 13, 2020
Nothing like Googling “cute shoes for bunions” to make a gal feel ancient. Truth: By the time you enter your 40s and 50s, your feet have likely sustained considerable damage. Add in menopause, and the issues compound. Foot pain affects women more than men, and ranks among the top 20 reasons for doctor visits among those over age 65, per a 2018 study in the Journal of Foot and Ankle Research. Learn the most common culprits behind midlife foot discomfort—and how to keep the ouch from defeating you.
The Problem: Dry, Calloused Skin: Does the skin on your heels look like a cracked earth landscape? Welcome to menopause, where plummeting estrogen levels impact the body’s ability to retain moisture…resulting in parched skin, including on the feet. This dryness can have two effects: 1) Thickening skin around the heels “can lead to fissures, painful cracks that can bleed or get infected,” says Marlene Reid, DPM, a podiatric surgeon at Family Podiatry Center in Naperville, Illinois. And 2) Existing calluses—areas of hard, built-up skin—worsen. Per a recent study, calluses are one of the most frequent causes of foot pain in older adults.
The Fix for Dry, Calloused Skin (Part 1): Moisturize your feet twice daily with a heavy cream or lotion containing cocoa butter or urea, says Dr. Reid. Reduce callouses by soaking your feet once a week in soapy lukewarm water for 10 to 15 minutes, then using a foot file to gently slough away built-up tissue (resist the urge to perform bathroom surgery with any sort of blade!). If you are diabetic or have circulation problems, you’ll need to see a podiatrist, who can safely reduce your calluses. Once the bulk of the callus has been removed, creams will be able to penetrate more deeply.
The Fix for Dry, Callused Skin (Part 2): Your podiatrist may also recommend orthotics, inserts worn in your shoes that provide additional cushioning and support. Orthotics can be custom-made to offer strategic areas of support in order to alleviate existing calluses and discourage new ones from developing. Over-the-counter orthotics are widely available, but they aren’t tailored enough to significantly help with calluses, Dr. Reid says.
The Problem: Arch Pain: The average woman gains one and a half pounds per year in her 50s and 60s. Even a modest amount of added weight can affect the arches in your feet, as extra weight on top equals increased pressure below. Arches can weaken, start to flatten, or even collapse. Specifically, the tendon that holds up the arch, the posterior tibial tendon, can strain or tear. The technical term for this achy discomfort: plantar fasciitis.
The Fix for Arch Pain: Lifestyle changes that minimize weight gain will lighten your feet’s load, but you also want to address any arch pain immediately. “It’s way easier to solve before a tear happens and scar tissue develops,” Dr. Reid cautions. Orthotics are a go-to for controlling the forces that contribute to heel pain. Wearing shoes with a stiff heel when standing or walking can also take pressure off of the arch. Other options include physical therapy (with at-home foot exercises) and even stem cell injections. There’s surgery, too. But fortunately, “90% of plantar fascia issues can be resolved without it,” Dr. Reid says.
The Problem: Pain in the Balls of Your Feet: Middle age and weight gain often go hand-in-hand, but we also tend to lose fat in certain areas, including the face and the bottom of the feet. (Menopausal weight gain usually settles in the abdomen. Thanks for nothing.) This new lack of shock absorption causes pain known as metatarsalgia, often felt in the balls of the feet—especially for those who’ve spent years wearing high heels. “Anything higher than three inches puts at least seven times the pressure on the balls of the feet, and that pressure displaces the fat pad,” Dr. Reid explains. Some patients say the pain feels like they’re walking on rocks or tiny, sharp stones.
The Fix for Pain in the Balls of Your Feet: Orthotics to the rescue, again! They help redistribute weight so you’re not putting as much pressure on the ball of your foot. Another option is to have a doctor inject dermal fillers—the type used to plump out facial wrinkles—into your feet to replace the padding. Because fillers are absorbed by the body over time, they’ll last only about three to six months before you’ll need another round. In a small study, 15 patients with metatarsalgia due to chronic high heel wearing received injections of a filler called hyaluronic acid in the balls of their feet. Six months later, 33.3% reported no metatarsalgia pain.
The Problem: Hallux Rigidus: It may sound like a side effect of too much Viagra, but hallux rigidus is actually arthritis of the big toe joint. Symptoms include pain at the joint that joins the big toe to the foot (the pain intensifies as you take a step and push off); loss of flexibility in the joint; and inflammation. You can thank Father Time for this constellation of symptoms—the trouble tends to start between ages 30 and 60, as years of wear and tear cause the foot's protective cartilage to break down—although genetics and congenital deformities can hasten the process.
The Fix for Hallux Rigidus: Conservative treatments include ice, rest, orthotics, and OTC anti-inflammatories. If caught early enough (at a stage known as hallux limitus), surgery called a cheilectomy may improve motion, reduce pain, and save the joint. Wait too long, though, and severe arthritis could set in. (How long is too long varies from patient to patient and can be determined by x-rays and symptoms.) Should this happen, you may end up needing a joint replacement or a fusion of the joint, which almost always provides relief but also means you’ll never be able to bend your toe at that joint again.