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Feature Article

Foot problems in older people

Paul Dearden, Andrew Wines

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Abstract

Age-related fat pad atrophy, bony deformities such as hallux valgus (bunions) and hammer, claw and mallet toe, Morton’s neuroma, toe nail disorders and arthritis are common foot problems in older people. Resulting foot pain, deformity and loss of function can significantly compromise an older person’s mobility and independence.

Key Points

  • Most foot problems in older people can be improved by shoe modification and use of cushioned insoles.
  • The most useful investigation for patients presenting to their GP with foot problems is a weight-bearing anteroposterior and lateral x-ray series; cross-sectional imaging of the foot has limited value in general practice.
  • Neuritic or burning type pain radiating to the third and fourth toes is a classic symptom of Morton’s neuroma.
  • Generalised numbness or pain radiating down the leg to the foot suggests either peripheral neuropathy or nerve root compression.
  • Toe nails that are thick and crumbly raise the suspicion of fungal nail infection, and nail clippings should be sent for microscopy and culture.
  • Rapid progression of deformity in a person with known or suspected diabetes warrants urgent referral to an orthopaedic surgeon or at-risk foot clinic.

    Picture credit: info.Michaelheim-photographer.com/DepositPhotos
    Model used for illustrative purposes only

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