Posts for: February, 2015

February 26, 2015
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Here are some of the main problems as we age – and what we can do about them.
As we get older, our feet tend to elongate and widen – sometimes by as much one size every 10 years from our 40s – partly because of the arches of the feet lowering.
This can be the result of tibialis posterior tendinopathy, a condition where the tendon (fibrous tissue) that helps to support the arch degenerates.
Fallen arches are also a “passive consequence” of osteoarthritis, says Anthony Redmond, a professor in clinical biomechanics from the Leeds Institute for Rheumatic and Musculoskeletal Medicine. “If your arch falls, you should get checked for arthritis elsewhere.”
Flat feet – from birth or linked to ageing – can strain muscles and ligaments (which link bones), causing pain in the legs and feet when walking. They are also thought to raise the risk of osteoarthritis higher up as they cause ankles to roll in, which in turn affects the knees.
Action: If you have aches and pains because of flat feet, avoid going barefoot. Orthotics – inserts in shoes – can help to stabilise the foot and prevent the changes that cause arches to collapse.
The skin dries out with age, especially for women going through menopause.
Heels, where skin is less supple, may crack into deep, sore fissures which are at risk of infection.
Sajjad Rajpar, consultant dermatologist at the Queen Elizabeth Hospital, Birmingham, UK, says: “The density of the grease-producing glands is at its lowest in the lower limbs, and it gets worse with age.”
Action: When moisturising, don’t neglect your feet. A heel balm containing lactic acid can help to exfoliate the top layers, while the urea in the cream will help to replenish moisture.
We use receptors in the ankles to maintain balance – they send messages to the brain about where the feet are in space. As we get older, these switch off, making us more prone to falls, says physiotherapist Sammy Margo. “Women find it harder to wear high heels at around 50 to 55.”
Action: Exercises to re-educate balance receptors can help. Try standing on one foot when brushing your teeth, then do it with your eyes closed.
Years of bashing nails against shoes can make them thicker, says consultant podiatrist Michael O’Neill of the College of Podiatry.
This can make nails harder to cut. One person in 50 will develop onychogryphosis – a ram’s horn toenail that looks like a pork scratching, says O’Neill. “It’s not just unsightly; it’s painful when pressing against shoes.”
Action: Use a file and a good pair of nail clippers on thick nails, as these are sharper than scissors, says O’Neill. Have a bath first and, if you have a partner, cut each other’s toes. People with onychogryphosis may need to see a podiatrist to have the nail trimmed with an electronic file.
One person in six over 50 will develop osteoarthritis in the middle part of the foot, according to a recent study at Keele University’s Arthritis Research UK Primary Care Centre.
The condition is characterised by inflammation around the joints, damage to cartilage, and swelling, resulting in pain, stiffness and trouble moving, and sometimes bony bumps over the top of the foot.
It is possible to develop osteoarthritis in the feet alone, says Redmond.
Risk factors include genetic predisposition, injury to the area and overuse.
Action: Good training shoes will minimise stress to the feet and losing weight can ease pressure on joints.
Research found that people with pain that varies with activity had a higher prevalence of lesions in the bone marrow, thought to be a precursor to osteoarthritis.
“Judicious use of orthotic insoles” can help to reverse them, says Redmond.
Older feet may be more prone to ulcers and sores, which can become infected if neglected. One reason is the high prevalence of Type 2 diabetes, which is most common in the over-40s.
In diabetics, the body becomes resistant to the hormone insulin, which mops up sugar from the bloodstream. A consequence of this is damage to the tiny blood vessels in the nerves.
“These nerves instruct sweat glands to sweat – if they stop working, the skin on the soles of the feet may become dry and more prone to splitting, infection and ulceration,” says Neil Baker, principal diabetes specialist at Ipswich Hospital NHS Trust.
Loss of sensation caused by nerve damage also means you may not realise when you’ve injured yourself, so small cuts can deteriorate and lead to ulcers.
Another problem is that diabetes can lead to poor blood flow, which means the body is less able to fight infections. If not managed well, the condition can result in amputations.
Action: If you have lost sensation in the feet due to diabetes, be vigilant about avoiding injury – don’t cut your own toenails as you may injure flesh without realising it, and use emery boards rather than sharp implements to remove dead skin.
Wear correctly fitting footwear – don’t go barefoot.
Fat under the skin all over the body tends to disappear with age – this includes the protective fat pads on your soles, mainly under the balls of the feet, says O’Neill.
“If you’re on your feet for long periods, it can cause pain. Because there’s no protection over the bones and joints it can lead to calluses (hard skin).”
Most people will lose these fat pads by 65, but it can happen from the age of 50.
Years of pressure from footwear, combined with a loss of protective fat in the feet and arthritic changes to the joints, mean that as we age we are more prone to painful, toughened areas of skin known as calluses and corns.
Says O’Neill:
“Most people in their 40s and 50s will have them. These harbour dead skin in the holes, and bacteria can develop as they decompose.”
Better footwear will help to even out the pressure, and surgery can address the underlying toe deformity that led to corns.
Sufferers of verrucas (warts on the soles of the feet, triggered by a virus) will probably find they get fewer of these with age, says dermatologist Sajjad Rajpar.
“Your tendency to get viral infections decreases with age because you develop immunity once your body has seen a virus.”
However, fungal infections of the toenails and feet are more likely as you age.
Action: Ensure your feet are dry before you put on socks. Women using nail varnish should apply a base coat first to protect the nails from toxins, which can weaken them and let fungal infections take hold.

According to a published study custom orthotiocs signifiucantly reduce pressures on teh foot that lead to ulcerations, reulcerations and improves quality of life.
J Am Podiatr Med Assoc. 2013 Jul-Aug;103(4):281-90.

How effective is orthotic treatment in patients with recurrent diabetic foot ulcers?



We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear.


One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy.


Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%.


Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities.

New research suggests a link between sleeping late at the weekends and health risks such as obesity and type 2 diabetes.

The study conducted by researchers from the Mammalian Genetics Unit and Medical Research Council and published in the Journal of Obesity, found that having a significantly different sleep pattern at the weekend compared to during the week - known as "social jet lag" - could be harmful to the metabolism.

The researchers' hypothesised that frequent sleep pattern disturbance would negatively affect the body clock, which could disrupt the metabolism, increasing the risk of developing obesity and type 2 diabetes.

The hypothesis may have been correct: a correlation was observed between social jet lag and certain metabolic markers that indicate an increased risk of obesity-related disease, such as type 2 diabetes.

The research was conducted by analysing data from over 800 people. Researchers examined the height, weight, and waist circumference of participants, then asked them to answer questions about sleeping patterns.

Those who had as little as two hours extra sleep at the weekend generally had a higher body mass index, were more likely to be obese, and had an increased risk of type 2 diabetes.

The findings do not suggest that people deprive themselves of extra sleep at the weekend if they feel they need it. Sleep deprivation has been linked to depression, stress, and anxiety. It is more advisable to go to bed earlier during the week.

Moreover, the study does not prove that social jet lag causes obesity. Discovering links between the two is not the same as determining a cause-and-effect relationship.

Dr. Michael Parsons, lead author of the study, said: "Our research confirms findings from a previous study that connected people with more severe social jet lag to increases in self-reported body mass index, but this is the first study to suggest this difference in sleeping times can also increase the risk of obesity-related diseases."

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