Harvard Health Letter

Good old-fashioned mobility insurance: Protecting your feet and ankles

Seeking treatment that allows early detection of problems can help save you from prolonged disability.

mobility insurance foot care
Image: Wavebreakmedia/ Thinkstock

One of the most important means of transportation and independence protection in older age is often overlooked: the health of your feet and ankles. Maybe you can't reach your feet anymore, or you chalk up foot and ankle pain to aging. But ignoring foot or ankle problems may lead to long periods of unnecessary disability, including the loss of activities you take for granted, such as driving a car, carrying groceries, or playing with your kids or grandkids outdoors. "Unfortunately, it remains common that people seek our care too late—long after we are able to have the substantive impact we are used to providing," says Dr. Christopher DiGiovanni, chief of foot and ankle surgery at Harvard-affiliated Massachusetts General Hospital.

Overlooked problems

Dr. DiGiovanni says people tend to ignore a number of ailments, such as the following:

Fallen arches. These are also known as flat feet. They are prone to progression, and when dismissed, can lead to ruptured tendons, torn ligaments, arthritis, and difficulty wearing shoes or walking.

Ankle sprains. Spraining an ankle means tearing one or more of its ligaments. "The more you tear these, the more unstable your ankle becomes. When you don't manage this problem properly, the odds of another, more significant sprain become higher, and you risk wearing out the ankle joint and getting arthritis," says Dr. DiGiovanni.

Achilles tendinitis. Inflammation of the tendon that attaches to the heel can result from lack of flexibility or overuse. "Untreated, this can linger for months to years," Dr. DiGiovanni warns. "Prompt management helps decrease the chances of chronic pain or even rupture."

Plantar fasciitis. This is inflammation of the band of tissue that helps support the arch. It can also be associated with flat feet, lack of flexibility, or overuse. "Without early diagnosis and management, this can unnecessarily nag someone for months," Dr. DiGiovanni says.

Bunions. Bunions are malalignments of the big toe. A large bump forms where the big toe meets the foot. When bunions progress, they often result in stiffness, arthritis, other toe deformities, or difficulty wearing even practical footwear.

Ingrown toenails. An ingrown toenail develops when one side of the nail digs into the skin. If ignored, this can lead to serious infections that require surgery.

Treatment

Available fixes depend on the problem and its severity. All of these early interventions can often spare you from difficulty walking in the future.

  • For plantar fasciitis, effective treatment may involve nighttime splinting, stretching exercises, anti-inflammatory medicine, or even a steroid injection.

  • For Achilles tendinitis, rest, ice, elevation, physical therapy, shoe modifications, and even topical creams or shock wave treatment can be helpful for avoiding surgery.

  • Flat feet typically benefit from good orthotics for the arch, switching from high-impact activities (such as running) to low-impact activities (such as swimming or yoga), supportive shoes, and sometimes reconstructive surgery.

  • Bunions that become progressively bothersome may need surgery.

  • Treatment for ingrown toenails ranges from warm soaks, shoe changes, and antibiotic creams to removal of the offending portion of the nail.

  • Most sprained ankles respond well to early rehabilitation and therapy.

Prevent problems now

Seek out your doctor when a problem progresses or persists for more than a few weeks. In addition, examine your feet at least once a week. "It should only take two minutes," says Dr. DiGiovanni. Inspect your toenails, toes, and the tops and bottoms of your feet. Scan for redness, swelling, blisters, punctures, and insect bites. If you can't reach your feet, use a mirror or ask a friend. If you can't see your feet well, consider a magnifying glass."

People with neuropathy (decreased sensation) should inspect their feet every day. Neuropathy is often a problem in people with diabetes or prediabetes. "When sensation is impaired, small cuts can develop without notice, and become infected without the person realizing it," Dr. DiGiovanni explains.

Dr. DiGiovanni also recommends that you see a foot specialist every one to two years if you have a foot or ankle problem, or more frequently if necessary; avoid walking barefoot; wear comfortable, properly fitted shoes; and keep toenails trimmed.