For adults over age 65 with disabling foot pain, being
fitted for off-the-shelf extra-depth footwear reduced pain and improved
function, according to a new study.
This type of footwear is often marketed to people with
diabetic foot ailments, for whom Medicare – the U.S. government health
insurance program for people over 65 - will cover most of the cost of the
shoes.
The structure and function of the foot changes
significantly with age regardless of diabetes status, said lead author Hylton
B. Menz of the Lower Extremity and Gait Studies Program in the School of Allied
Health at La Trobe University in Melbourne, Australia.
“With advancing
age, there is a general tendency for the foot to exhibit increased soft tissue
stiffness, decreased range of motion, decreased strength, and a more pronated
posture, and to function in a more pronated position with reduced range of
motion and less efficient propulsion when walking,” Menz told Reuters Health by
email.
A pronated foot has more weight on the inside edge of
the foot, rather than evenly distributed, which can give the appearance of the
ankles bending slightly toward each other.
In addition, many older people wear ill-fitting shoes
that don’t accommodate the changed shape of their feet, he said.
He and his coauthors had 120 men and women over age 65
with disabling foot pain answer a Foot Health Status Questionnaire and then
divided them into two groups.
Those in the first group were individually fitted for
extra-depth shoes, while those in the second group waited until the end of the
study four months later to receive their shoes. Everyone continued to receive
regular podiatry care.
Dr. Comfort, Orthofeet and Apis brand extra-depth
shoes like those used in the study are available from online retailers in the
U.S. for between $100 and $200 per pair.
The extra-depth footwear group were more likely to
report their foot pain had moderately or markedly improved over the four month
period and developed fewer keratotic lesions, like corns or calluses, than the
comparison group.
Corns and calluses are common for older people;
treating them accounts for up to 75 percent of a podiatrist’s workload, Menz
said.
When the participants took the foot health
questionnaire again, the special footwear group scored 11 points better for
pain and 10 points better for function than the comparison group, according to
the results in the Journal of Gerontology: Medical Sciences.
Patients considered that a worthwhile improvement,
Menz said. And, surprisingly, it didn’t matter what the underlying cause of the
foot pain was: extra-depth shoes seemed to help everyone who wore them.
“Many older people wear ill-fitting shoes, and we know
that ill-fitting shoes are associated with foot problems,” he said.
Regular footwear is generally too shallow and narrow
to accommodate bunions, hammertoes and clawtoes, so the friction that develops
within the shoe leads to pain and reduced function, he said.
“Well-fitting footwear will prevent shoes pressing or
rubbing against the sensitive areas of the foot including joints that have
become arthritic,” said Professor Wesley Vernon, head of Podiatry Services and
Research Lead at Jordanthorpe Health Centre in Sheffield, UK, who was not part
of the new study.
Many patients may be reluctant to switch to “medical”
footwear because of its appearance, the experts noted.
“Some research has shown that people, particularly
women, don’t like the look of this extra deep and extra wide footwear and this
is not age dependent,” said Anita Williams, senior lecturer in the School of
Health Sciences at the University of Salford in the UK.
In her experience, many women prefer to wear pumps,
she told Reuters Health by email.
Aside from trying new shoes, maintaining a healthy
body mass index may help alleviate or prevent foot pain, Menz said.
“It is also important that older people with foot pain
consult a podiatrist, particularly if they have diabetes or changing footwear
does not alleviate symptoms,” he said.
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