So... You Want to Know More about Podiatry?

Back in September I did an interview with Jessica Silver at ElWell; an Oxfordshire-based wellbeing company offering tailored support to individuals, and their relatives, as they age, in order to continue to live with vitality and remain independent.


First things first, what is the difference between a podiatrist and a chiropodist?

There isn’t actually a difference – a podiatrist and a chiropodist are the same thing!

They are inter-changeable terms, although if a person refers to themselves as a ‘podiatrist’ and can be found on the HCPC register, this confirms that the individual has attained a university degree in the subject and can help you with minor or more severe foot problems. If you’re worried about elderly foot care, get in touch with a podiatrist. You can find one near you on the College of Podiatry or Institute of Chiropodists and Podiatrist's website.

Why is elderly foot care so important?

As we get older our feet can change and we can experience foot pain. This could be from minor changes such as our toenails getting longer and thicker, fungal nail infections or bunions becoming more pronounced, or could be due to conditions such as diabetes and obesity. The good news is that at-home remedies and seeing a podiatrist can help with elderly foot care.

It’s so important for seniors to take proper care of their feet because our feet are key to staying independent and mobile as we age. We know that our risk of falls increases as we get older, and making foot health a priority can help to prevent this.

For example, keeping toenails short and ensuring painful corns are regularly removed (and/or the cause of the corn identified and addressed) can help people feel more confident, comfortable and mobile.

Ill-fitting footwear is a problem I see time and again and this undoubtedly contributes to falls in the elderly. Reduce the risk of foot instability and pain and help your parent choose comfortable, well-fitted and non-slip shoes – always with a fastening, such as velcro, and never backless!

ElWell is run by experienced physiotherapist Nancy Farmer – and she also hates backless shoes as they can cause so many avoidable falls in the elderly. You can find out more about Nancy and ElWell here.

When talking about geriatric foot care it’s also important to mention tingling or numbness. Don’t instantly be inclined to put this down to ‘old age’ – it could represent some early peripheral neuropathy (damage to the nerves and is a risk factor for ulcers and pressure sores) and it’s important to determine the cause of this (for example it could be diabetes, a B12 deficiency or pernicious anaemia). If you’re worried about this, go and see a podiatrist!

How can I encourage my older parent to care for their feet?

Regular and often is the mantra here – if you can encourage your parent to make their foot care and health a priority then that really helps. Here are my top tips for encouraging them to care for their feet on a regular basis:

1. Give their feet a check regularly. This doesn’t need to take much time but look for signs of very dry skin, long toenails in need of a cut, blisters, infection or cracked skin etc. If they are unable to bend down to look at their feet then either a carer or family member can check their feet for them. Or they can use a long-handled mirror to do it themselves.

2. Washing their feet daily is sensible. Use a bowl of warm water and add some table salt (it is antimicrobial and it is my firm belief that saltwater is the cure for most things!). Or, you can also dissolve Epsom salts in the water to ease pain related to inflammation. These are not antibacterial but are great to soothe aching feet.

3. While the feet are wet, gently brush between the toes using an old soft toothbrush to clear any dead skin and debris.

4. If there is any sign of a fungal skin infection (a red pinprick rash that may be itchy, or dry flaky skin that hasn’t responded to moisturiser), then surgical spirit is the answer! Dry the feet well and then use a spray bottle to spritz some surgical spirit across the feet.

5. Moisturise the feet after washing to prevent dry, cracked skin and irritation. Try and use a non aqueous moisturiser such as E45, but really any moisturiser – as long as it is used consistently – will work well. Again, if bending down is a problem and your parent is looking after their own feet then my tip is to squeeze some moisturiser onto the top of the opposing foot and then rub the other foot with it. Alternatively, spray emollients are also available such as Aveeno’s Daily Moisturising Mist.

6. Keep toenails short to help maintain good foot health. Toenails thicken as we get older, so you may want a professional to cut your parents’ nails. You may only require one appointment, just to ‘return the feet to zero’, so that you can better manage them for your parent. A podiatrist or chiropodist can do this or, if the nails only require minimal care, a toenail cutting service could visit at home. If your parent is diabetic, has poor circulation, is immunocompromised and/or is on anti-coagulants then I would advise you seeing a professional to cut their toenails.

7. Toenails should be filed once a week. Whilst carers cannot trim toenails, it is absolutely fine for them to file them.


Do we need to see a podiatrist for ingrown toenails?

Ingrown toenails can lead to infection so it’s important to treat them quickly. If the toe is hot, swollen and inflamed then give it a warm salt water bath. Once dry, use antibacterial cream such as Germolene (this contains a local anaesthetic and softens the nail to ease the pain).

If the ingrown toenail worsens, then you should see a podiatrist. They can resect it (which just means trimming it out). They can do this in one quick appointment, providing instant relief! Though you may need to continue to saltwater bathe the toe and wear a dressing for up to a week or so if there is an infection present.

The best way to avoid ingrown toenails is to keep nails short and never try to cut away or poke down the sides of your own nails.



What happens to toenails as we get older?

Toenails change as we get older – one of the reasons why elderly foot care is so important. You may have noticed that your elderly parents’ toenails become thicker or turn discoloured and yellow. This is typically completely normal and can be easy to deal with – either at-home or with a podiatrist near you. Here are some age-related nail changes to watch out for, and how to treat the toenails!

Fungal toenail infections (onychomycosis)

Anyone can get a fungal toenail infection – it’s just bad luck really. It can be caused by a fungus, mould, bacteria or yeast. For example, if your elderly parent has a thick dry nail, this can crack and allow a fungus to penetrate the nail.

50% of fungal nail infections are misdiagnosed, so it is important to see a podiatrist for accurate diagnosis of an infection; but treating it is relatively straightforward – although patience is required!

It takes a year for a big toenail to grow from bottom to top, so you must commit to applying a treatment to the nail for that time, otherwise as soon as you stop treatment any remaining fungal spores will re-infect the nail and the cycle continues.

My go-to first-line treatment is white vinegar; it changes the pH of the nail so that the fungal spores can’t thrive. Put some into a spray bottle (you can always mix it with an essential oil such as tea tree or lavender to make it smell a bit nicer!). Wash and dry the feet and then spray the vinegar onto the nail once a day.

Take a ‘before’ photograph and apply this treatment for a minimum of 6-8 weeks. If you do not notice a difference, either try an alternative remedy (such as an over-the-counter anti fungal treatment), or it may not be a fungal nail at all – in which case, speak to a podiatrist to discuss your options.

What causes yellow toenails in the elderly?

Yellow toenails don’t look very pretty, but it’s most often nothing to worry about.

Seniors may get yellow nails when their fungal toenails are misdiagnosed and not treated. Or, friction on the nail bed second to poorly fitting footwear can cause the nail to lift from the nail bed – this will also give the nail a yellow or white-ish appearance.

A damaged toenail will often grow thicker over time (you’ll notice this if your second toe is longer than your first toe), and this will also give a yellow appearance to the nail.

Treatment here is aesthetic; a podiatrist can reduce the thickness of the nail using an electric drill (sounds more dramatic than it is!) and offer advice on how to manage the thickness of your nails at home, from regular filing and application of ointments to addressing footwear that may have contributed to the problem.


How can you improve bunions on the feet?

A bunion can be a bony lump that forms on your big toe joint (an osteophyte, caused by a reduction in range of motion of joint) or displacement of the first metatarsophalangeal (big toe) joint second to laxity of the tendons within the foot. The main culprit of bunions is genetics unfortunately, although they can be exacerbated by poor footwear (such as squeezing your feet into ill-fitting high heels). This is often the case for other toe deformities, such as hammer (curled) toes.

If the bunions are painless, I advise you wear footwear that accommodates them and is comfortable.

A great brand is Cosyfeet. Look for shoes with a wide toe-box, so as not to cramp your toes. Gel bunion protectors can also be helpful, as can certain anti-friction creams such as Gehwol Footcream.

If your bunion hurts, or becomes red and swollen, I would recommend you consult a podiatrist for further advice.

Are seniors able to get bunion surgery?

Bunion surgery, like any surgery, is a big decision and not to be taken lightly. It can improve independence and mobility, but there are a number of health factors to consider. If your elderly parent is considering corrective surgery, I would encourage them to speak with their podiatrist and GP to discuss the options that are available.

What are the best shoes for seniors?

As we grow older, look for accommodative, cushioned footwear with a wide toe box. Although slip-ons are convenient, they cause SO many problems with the feet, not to mention knocks and falls with a misplaced heel here and a chair leg there… A fastening (velcro, laces or a buckle) is a MUST. Slip-on or backless shoes will contribute to instability and cause friction across the toes, which can lead to corns developing and/or pain across the top of your feet.

Fat pad atrophy (loss of the fatty padding under your feet) is common in the elderly. It can cause foot pain during walking, with a sensation of ‘walking on pebbles’. Look for shoes with shock absorbency (a thick cushioned insole and/or thick rubber sole), or those that have space for a nice squashy gel or memory foam insole to cushion the bottom of the foot.

My favourite brands to recommend for senior footwear are: DB Wide Fit, and Skechers (but only ones with a fastening!)

Why is elderly foot care so important for people living with diabetes?

Individuals with poorly controlled diabetes have raised blood sugar levels which damage the nerves (the sensation) in the feet (and elsewhere in the body) and affect the blood flow, impeding normal circulation.

People living with diabetes may not feel their shoes rubbing, for example, so they will not perceive the pain to indicate a new wound (such as a blister) on their feet.

Poor circulation means the wound will take longer to heal, and the ‘sweeter blood’ encourages infection. It’s a triad of discontent, and therefore it’s SO important for people with diabetes to (i) control their diabetes under guidance by their GP, (ii) check their feet daily and (iii) discuss their foot care needs with a podiatrist.

Keeping the feet moisturised to avoid cracked skin is paramount in diabetic foot care, as the sweat glands can stop working. Comfortable, accommodative footwear, or specialist footwear where indicated, for people living with diabetes is also essential.

The National Institute for Clinical Excellence (NICE) recommends that all people with diabetes are offered an annual foot assessment with a practice nurse (available on the NHS) or podiatrist to check the health of their feet.

What’s the difference between a podiatrist and a toenail cutting service?

It’s so important for elderly people to keep their toenails trimmed and filed. If your parent only needs this basic level of footcare then a nail cutting service or Foot Health Practitioner can help with elderly foot care.

It’s a bit confusing but a nail cutting service and foot health practitioner are two different things. A nail cutting service such as that run by Age UK is a group of volunteers whom have likely been trained by a podiatrist to trim and file the toenails. Foot health practitioners have done a short course in footcare and so are more qualified than the volunteers, but they are not trained to the same level as a podiatrist – think hygienist in comparison to the dentist.

A qualified podiatrist is a lower limb specialist and can help with any foot care concerns – from corns and calluses, running injuries and other musculoskeletal problems such as bunions, minor surgery such as removal of part or an entire toenail and diabetes foot care advice. There are podiatrists available on the NHS (ask your GP for a referral) or you can see one privately. It’s important that you find a podiatrist near you that you and your parents are comfortable with.

Are corns and calluses a problem as we age?

Calluses are thickened, hard skin, often on the soles of our feet. Whilst some people are more prone to developing calluses than others, typically elderly people acquire calluses secondary to poor footwear. Calluses and corns can be softened with an urea-containing emollient such as Flexitol, CCS or Dermatonics. This will help to ease discomfort, and can help to slow the rate at which the calluses form.

Choose footwear which properly accommodates the shape of your feet, with a cushioned sole or insole. Calluses that are very thick require professional attention by a podiatrist, whom can reduce the calluses using sharp debridement with a scalpel. Again, this sounds pretty terrifying (!) but as the callus does not contain blood vessels or nerves, this is entirely painless.

Corns are caused by a focal area of pressure or friction over bony areas on the feet. They can be quite painful, akin to a stone stuck in your shoe. Corn plasters often contain salicylic acid, which will damage the healthy skin around the corn as well as softening the corn itself. Podiatrists do not recommend corn plasters, and they must not be used on a person with diabetes under any circumstances – they will cause an ulcer to form. Corns can be painlessly removed by a podiatrist or foot health practitioner.

Conclusion

So there you have it, all of your elderly foot care questions answered. Our feet are so important for our mobility and independence, so it’s important to give them the love and attention they deserve and keep feet healthy as we age. If you’re worried about your parents’ feet (or even your own!) then go and see a lovely podiatrist. We know a great one in Oxford (thank you, Felicity!) but if you live further afield then we can help you easily find a podiatrist near you. For more information on ElWell's services, please see their website. Original article available here.


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