Oh, your aching feet! “Most of the time, it’s not just one, but a combination of causes,” says Roderick C. Hunter, Jr., DPM, AACFAS, a podiatric physician in Harker Heights, Texas and spokesperson for American Podiatric Medical Association.

The No. 1 reason for most foot problems: ill-fitting shoes. Those adorable little high heels you couldn’t resist? The unsupportive sandals or clogs that are so easy to get into? They could be doing major damage to your feet.

There can be a zillion reasons why your feet may hurt you, but if you are over 50, these are the top culprits.

Problem #1: Osteoarthritis

Symptoms:

  • Pain in your toe or other joints, especially when you push off during walking
  • Toe joint stiffness
  • Swelling or permanent enlargement around the toe joint

Often referred to as the “wear and tear” arthritis, osteoarthritis is caused by the wearing down of the protective cartilage that covers the ends of your bones. On your foot, it is most likely to strike at the joints where your toes meet your foot (metatarso-phalangeal or inter-phalangeal).

“Your feet really take a beating because they are weight bearing. You are flexing your toes all day to push off to walk, so there is over time a slow degradation of cartilage between the two points. You end up with bone-on-bone contact, which is extremely painful,” says Dr. Hunter. Although the pain can come and go, over time, it tends to become more constant.

Shoe disaster: Shoes that are too tight, or don’t have proper arch, sole or heel support.

Osteoarthritis: Solution

For daily pain management, try a three-pronged strategy:

  • Start by getting supportive, well-fitting shoes.
  • You can also take pain relievers (like aspirin or ibuprofen) as directed, but be careful: Long-term use can lead to stomach ulcerations or worse.
  • Ice your feet at the end of the day for 15 to 20 minutes.

If these at-home remedies don’t do the trick — you have constant pain or limits on your foot’s function — see a podiatrist or rheumatologist. They can provide steroid shots to provide relief of the inflammatory symptom or create a special shoe or orthotic insert for you. (A pedorthist can also create orthotics.) In severe cases, surgery can relieve the pain and improve motion.

Problem #2: Hammer toes

Symptoms:

  • Abnormal bend in a toe due to arthritic changes or muscle imbalance
  • Moving affected toe is difficult and painful
  • Corns and calluses from the constant friction of the toes rubbing against shoes.

As adorable and kicky as they are, heels force your toes into a tightened position in the toe box. Ditto with shoes that just fit too close to your toes. This creates imbalances between the muscle groups that control the toes, which in turn deforms the small toe bones. Hammer toe can be extremely painful due to abnormal motion in the toe joints, or difficulty fitting into shoes. They can also result in painful corns and calluses.

Shoe disaster: High heels, shoes that are too short

Hammer toes: Solution

Wear shoes with a half-inch of space between your longest toe and the inside of the shoe. Any heel higher than an inch is too much. “Spike or chunky heel doesn’t make a difference. It is all about height,” says Dr. Hunter. An orthopedist or podiatrist can recommend stretching exercises to stretch and strengthen the toes. In severe cases, surgery may be necessary to release the toe.

If corns are a problem, see a doctor to remove them — you can cause increased pain or infection if you try cutting corns out yourself.

Problem #3: Plantar fasciitis

Symptoms:

  • Stabbing pain when you put weight on your heel. It will feel like you’ve stepped on a tack. The pain is usually worse first thing in the morning or after you’ve rested for a while.

Your plantar fascia is a thick ligament that runs along the bottom of your foot, connecting the heel to the toes. Plantar fasciitis is an inflammation at the point where the ligament inserts at the heel bone. The cause of the heel pain can be a combination of several factors: obesity, flat feet or high-arched feet, overuse, or a tendency to roll your feet inwards when you walk.

Shoe disaster: No support, open back, worn-down heels

Plantar Fasciitis: Solution

Ditch the flat sandals, mules, and backless clogs in favor of shoes with good shock absorption. Dr. Hunter recommends replacing shoes that you use regularly every six months. Other therapies include: maintaining a healthy weight, icing your heels for 15 minutes three to four times a day, and if you are an athlete, try to find a lower-impact sport.

The symptoms of plantar fasciitis may lessen during the day with some activity, but they typically do not resolve without some type of care. If you can’t find relief, see a doctor about physical therapy, splints, orthotics, steroid shots, or in severe cases, surgery to detach a portion or all of the plantar fascia from the heel bone.

Problem #4: Bunions

Symptoms:

  • Bulging bump on the outside of your big or pinky toe joint that may also be red and swollen
  • Pain at the site of the bunion
  • Trouble moving your big or pinky toe
  • Corns and calluses from overlapping toes

Bunions can be caused by wearing tight shoes, genetic predisposition, or arthritis. Bunion deformities cause a painful range of motion at the metatarsophalangeal joints, possible overlapping of the first and second toes, and because it can be difficult to find shoes that fit right without rubbing or pressing.

Shoe disaster: High heels, shoes that are too narrow or too tight

Bunions: Solution

  • Make sure your shoes have a wide toe box and don’t wear heels higher than one inch.
  • Orthotic inserts can relieve pressure on the bunion or apply a bunion pad to cushion the bump when wearing shoes.
  • Bunion surgery can return your foot to its normal shape.

Surgery is really the only way to remove a bunion, but there is always a chance of recurrence.

Problem #5: Osteoporosis

Symptoms:

  • There are no symptoms in the early stages. Over time, you might feel generalized foot pain.
  • Suspect a fracture if you have a lot of pain when you put weight on your foot or the foot swells, bruises and is painful to the touch. 

Osteoporosis occurs when existing bone starts to break down faster than the body can create new bone. The result is thin, brittle bones that break easily. Postmenopausal women are at highest risk due to the lack of estrogen production. This can lead to all types of foot fractures.

Shoe disaster: While bad-fitting shoes can’t cause osteoporosis, you do want to wear supportive, well-fitting shoes to minimize the chance of a fracture due to pressure, bumps, or tripping.

Osteoporosis: Solution

Osteoporosis and its milder precursor osteopenia are usually treated with vitamin D, calcium supplements, and bisphosphonates like Boniva and Fosamax, which help build bone. “You can also sit in the sun to promote the manufacture of vitamin D. Wearing sunblock will not diminish the effect,” he says.

Shoe Shopping

When shopping for new shoes, Dr. Hunter recommends you know your foot type and look accordingly. Are your feet flat or highly arched? Wide or narrow? Flexible or rigid? Do your feet tend to roll inward or outward? This can be determined by a podiatrist, physical therapist, or athletic trainer; many athletic shoe stores offer computerized foot type analysis as well. Then ask a clerk for help in accommodating your particular issues.

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