How to deal with painful foot problems

Source: By Consumer Reports, September 21, 2020 at 2:00 p.m. EDT

Foot pain regularly affects an estimated 21 percent of older adults, according to the 2017 Framingham Foot Study. Such discomfort may affect your quality of life and increase your fall risk. Plus, “the feet can show some of the earliest symptoms of systemic diseases,” says Rebecca Sundling, a spokeswoman for the American Podiatric Medical Association (APMA) and a podiatrist at the Northwood Foot and Ankle Center in Holland, Mich.So if your feet hurt, consider the following.

Achy heels A variety of factors can cause achy heels. For instance, over time, the fat pad on the bottom of your feet may thin, which can make walking hurt. Most often, it’s plantar fasciitis, an inflammation of the band of tissue that connects the front of your foot to the back. This can cause midfoot and heel pain, especially when you first wake up. “The most common scenario [in plantar fasciitis] is no shoes at home or the wrong shoes,” says Alex Kor, an APMA spokesman and fellow and past president of the American Academy of Podi­a­tric Sports Medicine. So choose comfortable, supportive shoes; keep heels and flip-flops in the back of your closet; and maintain a healthy weight to reduce pressure on your feet. If you suspect a thin foot pad is at fault, consider using an ­orthotic. Over-the-counter (OTC) orthotics may work just as well as custom products. For plantar fasciitis, the American College of Foot and Ankle Surgeons recommends initially limiting activity, apply­ing an ice pack to the area three times a day for 20 minutes and doing exercises that stretch the calf muscle. (Ask your doctor.) If activity brings significant pain, stop. If these strategies don’t help after a few weeks, call the doctor; you might need further treatment.

Bunions, calluses and more Problems such as bunions, calluses and hammertoes may be caused by years of constrictive or high-heeled shoes. Hammertoes (humped up in the middle) and bunions (a bump on the big toe’s first joint), also may have a genetic component. Having less cushy fat pads on the bottom of the feet makes older adults susceptible to calluses — patches of hardened, thickened skin. In all cases, wear comfortable, well-fitting shoes that are wide (for bunions) or stretchy or have a large toe box and laces (for hammertoes). Treatment depends on the particular problem, but small drugstore foot cushions, padding such as lamb's wool and orthotics may reduce pressure on painful spots while wearing shoes. OTC pain relievers can also ease pain. If bunions or hammertoes remain painful, ask your doctor whether you might benefit from surgery.

Burning, numbness, tingling Burning, tingling or numbness might signal nerve damage (neuropathy). Because this is a common complication of diabetes, ask your doctor whether you should be tested for the disease. If you have neuropathy, with or without diabetes, your doctor and podiatrist can guide you through at-home care strategies, such as checking your feet daily, says Priya Parthasarathy, a podiatric surgeon at Foot & Ankle Specialists of the Mid-Atlantic. Otherwise, you might not notice an injury or infection right away. It’s also important to wear shoes that fit well and to avoid going barefoot.

Toenail care Older adults are more susceptible to fungal infections that can leave toenails brittle, crumbly and discolored, says Cary M. Zinkin of APMA. And nails thicken with age, which can increase the likelihood of painful ingrown toenails, Zinkin says. If you suspect toenail fungus, have a podiatrist confirm it. For an ingrown toenail, soaking in warm water with soap or Epsom salts several times a day for a week or two can help. If redness or swelling worsens, or you see pus, call your doctor.

To cut your risk of ingrown toenails, “avoid having your nails cut down the side while having a pedicure,” Parthasarathy says. If you’re caring for toenails at home, soak your feet for a few minutes, then cut nails straight across. You can use clippers and make small snips across, cutting so that toenails don’t extend over your toe. You can also simply file them, Kor says. If you have diabetes, neuropathy or another major medical problem, or take blood thinners, you’re probably best off going to a podiatrist for toenail care, Kor says. For those who prefer not to go to the office, some podiatrists offer at-home nail care.