What's in store for those aging feet? Bigger shoes

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SPECIAL FITNESS ISSUE: THE FOOT

What's in store for those aging feet? Bigger shoes

Tendons, ligaments lose elasticity over time, flattening the feet.

Good footwear — the right fit, ample cushioning — can help.

By Beckman, Special to The Times

http://www.latimes.com/features/health/la-he-

agingfoot1jan01,1,762566.story?coll=la-headlines-health

ONE thing that doesn't shrink when people get older are feet: They

enlarge. More specifically, they flatten.

The feet's tendons and ligaments lose some of their elasticity and

don't hold the bones and joints together as tidily. When combined

with other aging-related changes, the feet can encounter limits to

how much use — or abuse — they can take.

Dr. Pribut, a podiatrist at Washington University

Medical Center in Washington, D.C., estimates that some people over

the age of 40 can gain half a shoe size every 10 years.

" The changes that take place in the foot are like those that take

place in the rest of our body as we age, " adds Dr. Jim ,

director of scientific affairs at the American Podiatric Medical

Assn. in Bethesda, Md.

With time, tissues weaken and muscle mass declines and our bodies

lose that youthful bounce and vigor. " But putting weight on our feet

makes them unique, " he says.

Gravity gradually overwhelms the older, less resilient ligaments in

the weight-bearing feet but not in the free-floating hands. It also

squeezes fluid from leaky veins in the lower extremities,

contributing to swelling.

Looser tendons and ligaments mean more than the need for bigger

shoes. As the front of the foot widens and the arch lowers, the foot

becomes not only longer but more flexible and flatter, letting the

ankle roll inward and increasing the chance for sprains, says Dr.

Kendrick Whitney, an assistant professor at Temple University School

of Medicine in Philadelphia.

Then there's the constant force of bearing weight that causes the

fat pads cushioning the bottom of the feet to thin out.

" Even if you get fatter and heavier, the fat pads still get

thinner, " says Dr. Mark Caselli, an adjunct professor at the New

York College of Podiatric Medicine in New York City. When this

happens, they can absorb less shock, which can make feet sore and

painful after time.

The loss of padding can also cause corns and calluses on your balls

and heels, Caselli says, " which for athletes can cause problems when

performing activities. "

Whitney adds: " It feels like you're walking directly on your bones. "

As the foot becomes wider, longer and less padded, the plantar

fascia tendon that runs along the length of the sole and forms the

arch becomes stretched, contributing to the lowering of the arch. A

lower arch contributes to bunions, sometimes painful, bony

prominences sticking out from the big toe.

Foot flattening has the added disadvantage of pulling the big toe

up. This can cause pain in its own right, but if a big toe is

sticking up and in a too-tight shoe, it can rub against the top of

the shoe, thickening the toenail and possibly damaging it.

" When the toenails turn black a few times, people start paying

attention, " Pribut says.

Osteoarthritis, rheumatoid arthritis and osteoporosis can pester

joints and bones of the feet as well, especially in the big toe,

already hampered by tendons and ligaments pulling it up. These

conditions can cause damage to bones and joints, and thin bones are

more prone to stress fractures.

These changes in foot structure affect balance and gait. In a study

soon to be published in the journal Gait and Posture, a group of

researchers, including Hylton Menz of La Trobe University in

Bundoora, Australia, found that healthy people in their 80s put less

force under parts of the foot that are important for balance than

did people in their 20s. They also found, in two other studies in

2006, that these and other changes are associated with an increased

risk of falls.

For example, older people who had weaker, less flexible ankles as

well as other problems such as bunions or reduced sensation on the

bottoms of their feet were more likely to fall during the course of

the study than less problem-ridden volunteers.

The most obvious age-related change, however, can be overlooked by

many people. A 2006 study looked at the footwear choices of 440

patients at a U.S. veterans' affairs hospital — most of whom were

men, averaging about 67 years — and found that only 25% of them were

wearing the right size shoe.

" Over the years, people tend to remember their Social Security

number and their shoe size, but they're remembering their shoe size

from when they were 25 years old, " Caselli says.

When too-tight shoes are combined with declining circulation — which

means less sensitive feet — the skin of the feet can suffer undue

friction. This friction causes hard bumps of skin — calluses and

corns — that can also be painful. There's plenty of help for aging

feet, though. The right size shoes — properly fitted, with good

support and cushioning — are key. Even so, experts say older feet

won't have the same stamina that they did in their youth.

Shoes should have good cushioning in the heel to make up for the

loss of natural padding, and the widest part of the foot — usually

the front — should fit the widest part of the shoe. " Some people

think, 'Just get a bigger shoe size,' " Caselli says, " but if the

shoes are too long, they will pinch the toes. "

Many experts recommend keeping the leg muscles in good shape. Out-of-

shape calf muscles can torment the plantar fascia and Achilles

tendons. Basic stretching and weight-bearing exercises help prevent

muscle and bone loss and improve circulation.

Dr. Arthur Helfand, a podiatrist, retired researcher and author in

Narberth, Penn., says to take your feet into your own hands in the

doctor's office, where feet are often neglected.

" Don't wait to be asked when you go in for your checkup. Take your

shoes and socks off, " he says. Often, physicians will observe a

person's gait but not look at the overall shape and fitness of the

feet, such as areas of increased friction.

Caselli says there's no need for people to retire from an athletic

life. " You shouldn't cut activities out. Just decrease how much you

do, to compensate for the wear and tear on your body, " he says.

Pribut agrees that the older athlete needs to slow down a tad. He

recently told a 70-year-old sprinter who needed to qualify for a big

race what many athletes don't want to hear: Just do well enough to

qualify. " I convinced him it's important to get to the big game and

not hurt himself in the process. "