Foot, Nail and Skin Problems That Affect Walking

Why feet change with age

• Skin thins and dries, and the fat pad under the heel and ball of the foot wears down, so impact is felt more.
• Nails thicken and curve, growing slowly and becoming brittle; fungal infection is very common.
• Joints stiffen, toes may curl (hammer toes), bunions develop, arches flatten.
• Reduced circulation and sensation from diabetes, arterial disease and neuropathy mask pain and slow healing; see peripheral neuropathy and balance.
• Swelling from heart, kidney or vein problems alters the fit; see swollen legs in older adults.
• Reduced vision and flexibility make it hard to see or reach the feet.
• Weight and posture changes alter pressure.

Common problems and what to do

### Thick, long or ingrown nails

Thick nails are hard to cut and press on the shoe; ingrown nails dig into skin, causing pain, redness and infection. - Do: after a lukewarm soak, cut straight across and file smooth corners; do not cut into the corners or too short; if thick or hard, ask a podiatrist or nurse. - Don't: use blades, tear or dig at nails. - See a doctor for redness, swelling, pus or pain, especially in diabetes or poor circulation. - See nail, hair and foot care for the dependent elderly.

### Fungal nails and athlete's foot

Yellow, white or brown, thick, crumbly nails; itchy, peeling skin between the toes or on the soles. Common in the monsoon and with diabetes. - Wash and dry feet well, especially between toes; wear clean cotton socks; change damp socks and shoes; do not share towels; wear slippers in shared bathrooms; see monsoon illnesses and older adults: prevention. - See a doctor for treatment; nail fungus needs prolonged, doctor-directed therapy, and some tablets interact with other medicines. Do not use leftover creams.

### Corns and calluses

Hard thickened skin where shoes or bones press. A corn has a hard core that hurts. - Do: relieve pressure with properly fitting shoes, cushioned insoles or padding; soak and gently smooth with a pumice as advised; moisturise. - Don't: cut with blades or use medicated corn plasters, which can burn the skin, particularly in diabetes or poor circulation; see insoles for foot pain. - See a podiatrist if painful, bleeding or recurring.

### Bunions and hammer toes

A bony lump at the base of the big toe, toes bent upward at the middle joint. Bunions cause pain, rubbing and difficulty with shoes. - Do: wear wide, soft, deep-toed shoes; protective pads or spacers may help; see bunion corrector guide. - Don't expect a corrector to straighten a long-standing bunion; it may only give comfort. - See an orthopaedic doctor if pain limits walking; surgery is possible in selected cases.

### Cracked heels and dry skin

Deep cracks can bleed and become infected. - Moisturise the heels twice daily with a thick cream; wear closed-heel footwear or cotton socks at night; avoid hot water soaks and harsh scrubbing; see itchy, dry and fragile skin in older adults. - See a doctor for deep, painful cracks, bleeding, redness or in diabetes.

### Heel pain and plantar fasciitis

Pain under the heel, worst with the first steps in the morning; see plantar fasciitis and heel pain.

### Flat feet and arch pain

Supportive shoes and insoles may help; a physiotherapist can advise on stretches and strengthening.

### Swollen feet

Swelling needs a cause; see swollen legs in older adults. Raise the legs when sitting if the doctor agrees, avoid tight socks, and do not ignore sudden one-sided swelling.

### Foot ulcers and wounds

Any break in the skin, blister or sore needs attention the same day, particularly with diabetes or poor circulation; see diabetic foot care at home, diabetic foot ulcers: prevention and wound care at home for older adults.

### Arthritis and gout in the foot

Pain and swelling in joints; sudden hot, red big toe may be gout; see gout home care and supports and arthritis at home: a complete guide for older adults and families.

Daily foot care routine

1. Look at both feet every day, including soles, heels and between the toes, in good light, with a mirror or a helper if needed. Check for redness, swelling, blisters, cuts, cracks, colour change, nail problems, and hard skin. 2. Wash in lukewarm water, with a mild cleanser; test the water with the elbow or a thermometer; do not soak for long. 3. Dry carefully, especially between the toes. 4. Moisturise the tops, soles and heels, but not between the toes. 5. Cut and file nails safely, or ask a professional. 6. Wear clean, dry, seamless socks (cotton or a moisture-wicking blend), without tight elastic. 7. Check inside shoes for stones, rough seams or folds before putting them on. 8. Never walk barefoot, even at home, in bathrooms, or on hot floors, beaches and temple grounds; carry or wear light protective footwear where allowed, and choose shade or mats. 9. Move your feet: ankle circles, toe curls and calf stretches several times a day; see chair exercises for seniors and balance exercises for seniors. 10. Keep legs elevated when resting if swelling is present and the doctor agrees.

Choosing footwear

Good shoes protect feet and prevent falls; see choosing shoes for older feet and walking aids and footwear.

• Fit: shop in the afternoon when feet are largest; measure both feet standing; leave a thumb's width in front of the longest toe; the heel should not slip.
• Width and depth: a wide, deep toe box for bunions and hammer toes; adjustable fastenings such as Velcro or laces for swelling and poor grip.
• Sole: firm but cushioned, non-slip, not too thick or too thin; flat or a low, wide heel.
• Material: soft, breathable leather or fabric, without hard seams.
• Insoles: cushioned or supportive insoles as advised; custom pieces for diabetes or deformity should be made by a professional.
• At home: supportive, non-slip indoor shoes or slippers with a back, not loose floppy chappals or socks on smooth floors.
• Break in new shoes gradually.
• Avoid: high heels, pointed toes, flip-flops, worn-out soles and very tight shoes.
• Replace shoes when worn.

For people who are dependent or bedridden

• Check and wash feet daily, and dry between toes.
• Protect heels from pressure with correct positioning and, if advised, heel supports; see positioning a bedridden parent and preventing bedsores at home.
• Keep toes free of tight bedding and avoid foot drop with advice from the physiotherapist.
• Do range-of-motion exercises as taught.
• Cut nails safely, and report changes; see personal hygiene for bedridden patients.

High-risk feet: diabetes and poor circulation

If your parent has diabetes, poor circulation, kidney disease or numbness, feet need extra protection: daily checks, professional nail and callus care, proper shoes, prompt care for any sore, and regular foot examinations at least once a year by a clinician; see diabetes after 60: a home care guide and neuropathy foot care.

Red flags

Call 112 or go to hospital for: - A hot, red, swollen foot or leg with fever, severe pain, blackened skin or foul-smelling discharge, particularly in diabetes. - A sudden cold, pale, blue or painful foot or leg. - A swollen, painful calf with breathlessness or chest pain. - A deep wound with heavy bleeding.

See a doctor the same day or within days for: any blister, cut or sore that does not improve in a few days; redness around a nail; new numbness or tingling; colour change; persistent pain; swelling; or a corn or callus that bleeds or becomes infected.

When to ask a professional

Ask a podiatrist, orthopaedic doctor, dermatologist or trained nurse for nail and callus care, foot examination, footwear and insole advice. Ask the doctor for diabetes and circulation checks. A physiotherapist can teach exercises. Seek urgent help for red flags.