Common in later life, but not just ageStrong evidence
Across 31 population studies, about 1 in 4 people aged 45 and over had frequent foot pain (24%, though that figure was pooled from only 3 studies that could be compared), more often women, and about two-thirds of them said it limited them at least moderately. In Adelaide, foot pain on most days rose from about 1 in 10 adults under 35 to about 1 in 4 at 75 and over. Unlike most pains, foot, knee and hip pain didn't fade with age in 7,878 people aged 50 and over in North Staffordshire.
In the same area, 16.9% of people aged 50 and over had disabling foot pain, and new cases became a little more common with age over 3 years (6.7% at 50 to 59, 9.5% at 70 and over); 7 in 10 still had it 3 years later. In English general practice, men's foot consultations doubled between the ages of 25 to 44 and 75 and over. Painful feet "aren't a natural part of growing old or something to put up with", the Royal College of Podiatry says.
Sources 1, 2, 3, 4, 5, 6
The usual causes: arthritis, heel pain, bunions and toes, and the ball of the footStrong evidence
Painful foot osteoarthritis that shows on an X-ray affects 16.7% of people over 50 in North Staffordshire: 7.8% at the big toe joint and 12.0% in the midfoot, more in women and with age. Pain under the heel affects 9.6% of people over 50, at much the same rate at every age after that.
Across 76 surveys, about 1 in 3 people over 65 had a bunion (35.7%); in 3,077 older adults, 44% of women and 22% of men had one, but only 11% and 3% had a painful one. In 784 US adults aged 65 and over, toenail problems (74.9%), bent smaller toes (60.0%) and corns and calluses (58.2%) were each found in more than half. Morton's neuroma, a thickened nerve under the ball of the foot, is most often first diagnosed at 55 to 64 in UK general practice.
Sources 7, 8, 9, 10, 11, 12, 13
Does the heel's fat pad wear away?Emerging evidence
In two small lab studies, older people's heel pads were less springy and absorbed less shock, but they weren't thinner. "Fat pad atrophy with age" is expert opinion more than measurement, and an ultrasound can support, not make, a diagnosis of heel fat pad pain. Cushioned shoes and heel pads are the usual first step.
Sources 14, 15, 16
Numb, tingling or burning feet: nerves, usually from diabetesStrong evidence
Almost 1 in 10 people aged 55 or over in the UK have peripheral neuropathy, damage to the nerves of the hands and feet, and diabetes is the commonest cause, the NHS says. The main symptoms are numbness and tingling in the feet or hands, burning, stabbing or shooting pain, loss of balance and co-ordination, and weakness, especially in the feet.
Numb feet affect balance: in one small study, 11 of 20 older people with neuropathy had fallen in the past year, against 2 of 20 without it, and a review of 34 studies found poorer balance and a higher risk of falls with diabetic neuropathy. Because pain won't warn you about a cut or a blister, numb feet need checking every day.
Sources 17, 18, 19
Circulation: leg ache on walking, and pain at restStrong evidence
About 20% of people over 60 have some narrowing of the leg arteries (peripheral arterial disease, PAD), often with no symptoms, NICE says. The usual symptom is an ache in the calf, thigh or buttock on walking that goes after a few minutes' rest (intermittent claudication). Other signs include hair loss on the legs and feet, brittle, slow-growing toenails, shiny skin, skin turning paler or blue, and sores on the feet or legs that don't heal. Leg pain on walking isn't "just part of growing older", the NHS says: see a GP.
Most people's claudication stays stable, but about 1 in 5 go on to a more severe stage, NICE says. Then the foot burns even at rest, the skin turns pale, wounds don't heal, and the toes may go cold and numb, then red and then black: contact a GP immediately. An NHS Scotland vascular pathway adds that this rest pain is constant, worse at night and eased by hanging the foot down. A foot that suddenly goes cold, pale and painful is an emergency.
Sources 20, 21, 22, 23
Gout becomes more common with age, in women tooStrong evidence
Gout affected 2.49% of UK adults in 2012, rising with age; new cases were most common at 80 to 84 in men and women, and the gap between men and women narrows with age. A gout attack brings sudden, severe pain in one joint, often the big toe, with hot, swollen, red skin, and an untreated attack lasts 1 to 2 weeks.
A joint infection (septic arthritis) looks similar and is urgent: severe pain in one joint that started suddenly, swelling, a change of colour or difficulty moving it, usually with a high temperature, although not everyone has one. That is why a first hot, swollen joint needs checking the same day.
Sources 24, 25, 26, 27
With diabetes, look after your feetStrong evidence
NICE sorts the feet of people with diabetes into low, moderate and high risk, and asks for a foot check at least once a year, more often at higher risk; the NHS type 2 diabetes page gives every 2 years if your last check was fine, which is less often than NICE. With an active problem (a new ulcer, an infection, or a hot, swollen foot that may be a Charcot foot, where the bones of a numb foot weaken and change shape), NICE asks for a specialist foot service within 1 working day, and for an ulcer with a fever, poor circulation or gangrene to go straight to hospital.
Sources 28, 29, 30, 31
Feet, shoes and fallsEmerging evidence
In Australian studies of 176 and 312 older people, disabling foot pain and weak toes predicted falls, and toe deformities were more common in fallers. In the Framingham study in the US, severe foot pain went with 3.25 times the odds of falling twice or more in a year. These studies show links, not proof that foot pain causes falls.
Going barefoot or in socks indoors went with about 11 to 14 times the odds of a fall in two studies, and slippers were the commonest footwear at hip-fracture falls in another. NICE's falls assessment and the World Falls Guidelines include footwear and foot problems.
Sources 32, 33, 34, 35, 36, 37, 38, 39, 40, 41
When a scan or test helpsStrong evidence
Most foot pain needs no scan. NICE diagnoses osteoarthritis from your symptoms from the age of 45, without an X-ray. Tests answer specific questions: a blood test for uric acid with suspected gout (repeated at least 2 weeks after a flare if it's low), and fluid taken from the joint if gout or infection is uncertain; an ankle brachial pressure index (ABPI), comparing blood pressure at the ankle and the arm, for circulation, which can look falsely normal with diabetes; a 10 g monofilament test of feeling at diabetes foot checks; and an X-ray, then a magnetic resonance imaging (MRI) scan, for a suspected Charcot foot.
After a fall or injury, an X-ray helps when you can't put weight on the foot or it has changed shape. For heel fat pad pain, an ultrasound can support a diagnosis, not make it.
Sources 42, 27, 25, 23, 20, 28, 16
How it usually goesEmerging evidence
New foot pain or a flare usually begins to settle within 6 weeks, NHS inform says, and age-related changes can make it flare "now and again, often for no reason". Disabling foot pain often lasts: 7 in 10 still had it 3 years later in North Staffordshire, while 3 in 10 didn't. Bunions don't go away, but most don't hurt. With treatment, most people's PAD symptoms stay stable and some improve. Neuropathy may improve if its cause is treated, or may be permanent. No one can promise a timescale.
Sources 43, 4, 25, 44, 11, 21, 17
