Do our feet change in middle age?

Have you noticed, as you’ve entered middle age, that you’ve gone up a shoe size? Experienced more foot pain? Or can’t comfortably wear certain types of shoes anymore?

Your feet do change as you age, said University of Chicago Medicine Orthopedic Foot and Ankle Surgeon Kelly Hynes, MD. We asked Hynes to explain what’s going on with middle-aged feet, whether there’s something you can do to stave off foot problems and pain, and if you need to ditch your flip-flops.

Do people’s feet change as they get older?

They don’t change in size, necessarily. But feet may get wider, not longer, as we age. They change in their elasticity the same way other body parts do – tissue becomes less tight, causing the increased width and sagging of the arches.

So your feet don’t get bigger?

No. It’s more of a change in positioning. It might seem like you need a bigger shoe, but it’s because the feet have widened and you’re trying to make them fit more comfortably in a bigger sized shoe. Your feet stop growing longer when you stop growing in height.

Does that changing elasticity make foot injuries more likely?

It’s different for everyone, based on how much you’ve used your feet in your life. As the tissues start to collapse a little bit, you can actually get arthritis and pain in the foot. So your foot needs more support, which usually means a change in footwear.

Does that mean older people shouldn’t be wearing flip-flops, high heels or unsupportive shoes?

I wouldn’t say everybody has to give up flip flops, high heels and unsupportive shoes. But people who notice that they’re getting foot pain, or their foot is not stable, or there’s a lot of pain in the bottom of their foot? They need to look at something more supportive.

What kind of footwear is best to wear as you get older?

Something with a more solid sole, and something with a little bit stiffer arch support. Buy shoes that are comfortable. For many foot conditions, you want a shoe that doesn’t bend. If you try to bend it, it shouldn’t be easy to fold in half. You also want to look at thickness of the sole. If it’s only a few millimeters thick, then it’s probably not thick enough to give you support.

Should people just get orthotics?

Not everyone needs an orthotic. That is a requirement for very specific foot and ankle conditions, and not everyone needs it as they age. It’s more about overall support in the shoe.

As you get older, what are some of the most common foot problems?

Plantar Fasciitis is number one. That’s pain underneath the heel, especially first thing in the morning. Then there’s Achilles Tendinitis, which is a very similar wear-and-tear condition that causes pain at the back of the heel. It doesn’t happen to only athletes and runners. The other thing that’s really common is Adult Acquired Flat Foot, where the foot starts turning out as the tendons become weaker over time. It’s common in a middle-aged population. The tendons that are meant to hold up the arch stop working, causing a foot that wasn’t flat to become flat.

So, even though you’ve never had flat feet before, all of a sudden you do?

Yes. And that can cause pain. Those are the people who typically benefit from orthotics and other treatments, such as physical therapy.

What about arthritis in feet?

There’s arthritis of the middle of the foot, when the arch starts to sag and collapse and arthritis sets in. There’s also big toe arthritis (Hallux rigidus), which is a very common problem. A lot of people will get it in their 30s or early 40s. Their big toe hurts with activity. Some people think it’s a bunion, but it’s actually arthritis. It gets like a bone spur or a bump on top of the big toe joint.

Are bunions an age-related problem?

Most people who have bunions have them, at least to some degree, in early adulthood. They can gradually get worse with age, as part of the change of elasticity problem. As the tissues relax, the bunion can get bigger.

When is foot surgery necessary?

Occasionally we need to do surgery if arthritis in the foot hasn’t improved, after stretching, shoe changes, and maybe injections. If Adult Acquired Flat Foot gets very bad, where the foot’s position has changed quite a lot and the therapy and orthotics haven’t worked, then sometimes we operate on that problem. Plantar Fasciitis is not an operative problem and gets better with time and therapy. And for big toe arthritis, about 50% of the time, people will at some point have surgery.

What can middle aged people to do prevent foot problems from happening?

It’s hard to know if you can truly prevent it. Some people are more prone to foot problems than others. In theory, if you always wear reasonable shoes, especially when you’re being active or if you’re on your feet a lot, that should help. You want people to enjoy their activities, and not avoid doing things because it could lead to foot problems when they’re older. Just always make sure your feet are comfortable in the shoes you’re wearing.

Can stretching help?

Yes. Stretch your calf muscles. A lot of foot problems happen because the calf muscles are very tight. It sends more force through the joints of the foot and ankle, and that’s why things start to hurt and get painful over time. If you do 2-3 minutes of calf stretching in the morning, and again before bed, my theory is that might help stave off these issues. The more ankle motion you have, the less stress you have through the small joints of the foot.

So, the bottom line is, don’t alter what you’re doing, just try to be comfortable.

That’s the most reasonable approach. Most of these middle-aged foot problems are not surgical problems. There’s usually a tweak you can make to the shoes you’re wearing that will take care of it. Most foot changes are normal, age-related changes that are going to happen. As long as you recognize it, and when you feel pain, make the needed adjustments to the support in your shoes. You should be able to control it in most scenarios.