"Exercise, exercise, exercise" has become the battle cry of many older Americans. If they are not hearing it from their doctors, they are imposing an exercise regime on themselves. Exercise is a good thing, but for many older people, their spirit is willing but their feet are weak. An estimated 10 million Americans suffer from osteoporosis and another 18 million have low bone mass, putting them at risk for stress fracture, particularly when they begin exercising.
According to the U.S. National Center for Health Statistics, impairment of the lower extremities is a leading cause of activity limitation in older people. Foot problems can also lead to knee, hip, and lower back pain that undermine mobility just as effectively.
Older people are much more active than they've been in the past. As a result, they place a higher demand on their feet and lower extremities, and if they haven't been taking care of them, their feet are subject to overuse problems. Many of the foot problems facing older people stem from the cumulative effect of years of neglect and abuse. The good news is that many of the foot problems experienced by older people can be treated successfully.
One condition limiting the lifestyles of many older people is arthritis. Arthritis, which is estimated to affect one in seven people, is often the most frequent source of debilitating pain and joint destruction. Although there are many forms of arthritis, osteoarthritis, traumatic arthritis, and rheumatoid arthritis can cause the most damage to joints, including the ankle joint. Traditional treatment of an arthritic ankle includes anti-inflammatories, pain medication, shoe inserts called orthoses that help with foot mobility, and physical therapy and exercise. When these measures of treatment fail to provide relief, surgery, such as ankle arthroscopy and ankle arthroplasty, is considered.
Regardless of how one stays active, foot care should be a part of everyone's routine. Healthy feet means limitless exercise, within a doctor's recommended guidelines, which can lead to a longer, more healthy life.
The following are tips for overall foot and ankle health:
- Always contact a family physician before starting an exercise program.
- Wear proper fitting shoes. For more strenuous walking and running, an athletic shoe with gel soles, rubber bottoms, arch supports, and a size larger are recommended. If mall walking or street walking is preferred, a supportive walking or running shoe will suffice. Wear thicker socks for more cushion.
- Stretch daily and remain active. As a body ages, circulation suffers. Daily stretching will help warm up muscles to begin exercise and help cool down tired muscles after activity.
Stress fractures
Stress fractures have become "the great masquerader" to the sports enthusiast and physician. The stress fracture appears to be most often associated with maltraining. A stress fracture is most likely caused by recurrent microtrauma, resulting in cortical bone fatigue, which is often imperceptible on plain radiographs until 6 to 8 weeks after the onset of pain.
The stress fracture is most often seen in the tibia, fibula or metatarsal, but any persistent, activity-related pain of the foot or ankle should arouse suspicion. Stress fractures involve the bones ranging from the tarsal navicular to the metatarsals. Anatomic malalignments and muscle-tendon imbalance, as well as maltraining, may be contributing factors.
Often the diagnosis of stress fracture can be made clinically. Technitium-99m bone scans are useful when there is some diagnostic uncertainty; for example, for a runner with lower leg pain in which a compartment syndrome is suspected, a stress fracture must be ruled out. Individualized treatment of the stress fracture is the rule. Often, minor technique changes or decreasing the frequency of an activity will allow healing. There are, however, some stress fractures that require immobilization. Even while immobilized, the athlete is encouraged to exercise within the limitations of no pain. Weight-bearing is allowed in all but the most unusual situations. Encouraging activity prevents disuse atrophy and bone demineralization. Stretching, strengthening, and analyzing techniques are mandatory to prevent recurrence of stress fracture.
Foot health: Selecting the right athletic shoe
Summer offers a variety of sports and activities. From running to aerobics, the feet bear much of the burden for carrying out these summertime activities, and selecting the right footwear is critical to foot health and performance.
Feet are made to bear tremendous pressure. An average day of walking brings a force equal to several hundred tons to bear on the feet. Weight-bearing sports like running and aerobics put even more pressure on the feet and ankles.
Selecting the right athletic footgear is important to the overall health of the feet. Depending on your sport of choice, there is a shoe to meet your foot care needs.
Use the correct shoe for each sport. For example, a running shoe is built to accommodate the impact that concentrates on the forefoot, while a tennis shoe is made to give relatively more support to the ankles, and permit sudden stops and turns.
The following identifies the proper style of footwear for a particular sport:
Tennis:
Proper tennis shoes "give" enough to allow for side-to-side sliding. In addition, tennis shoes need to have padded toe boxes to prevent injuries.
Cycling:
Select a cycling-specific shoe that is right for you among models designed for racing and mountain biking. The casual rider who doesn't have any known foot problems can use cross training shoes (i.e. combination cycling-hiking shoes), which provide the necessary support across the arch and instep as well as the heel lift that cycling shoes give.
Golf:
No longer driven by fashion, today's golf shoes are constructed using basic principles of athletic footwear. Advanced technological innovations keep golf shoes light and add strength.
Running:
A good pair of running shoes is the most important piece of equipment for a runner. Shoe choice should be determined by weight, foot structure, and running regimen. Keep in mind that all shoes have a different shape, and sizes are not uniform from shoe to shoe. It's a good idea for a beginning runner to see a foot care specialist before starting a running regimen.
Children's athletic shoes:
It's not the brand name or price tag of an athletic shoe that makes the difference in a child's foot health. Foot care specialists agree it's often better to buy a child two pairs of less expensive shoes than a single expensive pair, so the shoes can be rotated to avoid rapid wear deterioration. Excessive wearing of the out-sole, loss of shoe counter support, or wearing out in the mid-sole indicate it's time to replace the shoes. Proper fit is the key.
If you have a preexisting foot condition, your foot care specialist can make recommendations for appropriate shoes.
Comfort, fit, and support are the key drivers in selecting shoes. The following are general shoe buying tips:
- Have your feet measured while you're standing.
- Always try on both shoes, and walk in the shoes before buying them.
- Buy for the larger foot; feet are rarely the same size.
- Shoes should feel comfortable immediately, and should not need a break-in period.
- Shop for shoes later in the day; feet swell during the day.
- Be sure that the widest part of your foot corresponds to the widest part of the shoe.
- Try on shoes while you're wearing the same type of sock you'll be wearing with the shoe.
- Because children's feet are constantly growing, allow at least one finger's width from the end of the longest toe when buying shoes.
Shin splints
Definition
Inflammation of the tendons on the inside of the front of the lower leg (Sports medicine specialists don't like to use the term "shin splints" because it commonly refers to several lower leg injuries. We'll use it anyway but focus on the specific problem that is the most common: tendinitis of the lower leg.).
Symptoms
An aching, throbbing, or tenderness along the inside of the shin (though it can radiate to the outside also) about halfway down or all along the shin from the ankle to the knee. Also, pain when you press on the inflamed area. Pain is most severe at the start of a run, but can go away during a run once the muscles are loosened up (unlike a stress fracture of the shinbone, which hurts all the time). With tendinitis, pain resumes after the run.
Causes
Tired or inflexible calf muscles put too much stress on tendons, which become strained and torn. Overpronation aggravates this problem, as does running on hard surfaces such as concrete sidewalks.
Beginning runners are the most susceptible to shin splints for a variety of reasons, but the most common is that they're using leg muscles that haven't been stressed in the same way before. Another common cause of shin splints among beginners is poor choice of running shoes, or running in something other than running shoes. Runners who have started running after a long layoff are also susceptible to shin splints because they often increase their mileage too quickly.
Self-treatment
Many runners experience mild shin soreness which usually can be tolerated. "If shin splints hit you at the beginning of a season, a certain amount of running through it will help the body adapt," says David O'Brian, DPM, a podiatrist in Roselle, Illinois. "But, if it's a persistent problem, you shouldn't run through it."
If it does persist, ice the inflamed area for15 minutes three times a day and take aspirin or ibuprofen. Ice immediately after running. To hasten recovery, cut down on running or stop altogether. Recovery time: two to four weeks.
Medical treatment
If the injury doesn't respond to self-treatment and rest in 2 to 4 weeks, see a podiatrist, who may prescribe custom-made orthotics to control overpronation. Ultrasound and anti-inflammatories may also be prescribed. Surgery is rarely required.
Alternative exercises
Nonimpact exercises, such as swimming, pool running, walking, and cycling in low gear.
Preventive measures
To stretch and strengthen the tendons and muscles in the front of the leg, sit on a table or chair and loop an ankle weight around your foot. Without bending your knee, move your foot up and down from the ankle. Or have a partner grasp the foot to provide resistance.
You can also strengthen the lower leg with band exercises. Anchor one end of an exercise band to a heavy object, such as the leg of a sofa. Stretch the band, then loop it around the end of your foot. Move your foot up and down and side to side against the band's resistance to exercise different muscle groups. The band can be ordered from a doctor or bought at a sporting goods store. Ask for "tension tubing."
Finally, make sure to wear motion control shoes and orthotics if your doctor says you need them. Don't run in worn-out shoes. Warm up well and run on soft surfaces. Avoid overstriding, which puts more stress on shins.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/3/2000
