By age 50, the average person will have walked 75,000 miles, according to the American Podiatric Medical Association. That’s a lot of steps, even without the Fitbit tracker.
However, when those “miles” include walking in improperly fitting or high-heeled shoes, coupled with the natural changes to our feet as we age, it’s a recipe for foot pain.
Even more, the foot and ankle have 26 bones (accounting for one-quarter of the bones in the human body), 33 joints and more than 100 muscles, tendons and ligaments. It means there are a lot of places where things can go wrong — and that’s just on the inside.
Nails, bunions, callouses and other things can cause pain and problems on the outside of our feet.
Podiatrists can work with older adults before or after a foot problem develops to create a care plan and work within the guidelines of what preventive treatments will be paid by Medicare and Medicaid.
“People might be surprised to know that if they are in the groups that Medicare/Medicaid considers to be ‘at risk’ that they can get foot treatments paid for, even such basic things as nail trimming,” says Dr. Malisa Monson, a podiatrist who has practiced in Eugene for more than 20 years. “General foot care for the older person looks at the nails, do they have fungus or ingrown toenails, heel pain, callouses, bunions, those types of things. If a person is at risk due to something like diabetes or peripheral neuropathy that decreases sensation in their feet, things like that can lead to ulcers or even amputation.”
Yes, problems with the feet can be serious enough to lead to amputation.
Because the foot is an extremity, blood flow there is often not sufficient for wound healing. Infections can be hard to treat.
Because of this, Medicare will pay for regular foot care for at-risk patients having diabetes, peripheral neuropathy, poor blood flow for any reason, arteriosclerosis, peripheral vascular disease, swelling, lymphedema, decreased sensation or numbness.
If you’re not sure you have a problem, or you fear that one is developing, it pays to check in with a podiatrist.
Medicare considers many treatments to be preventative, so even if you’re not having a problem now, a doctor could still help you with callouses, nail trimming and shoe orthotics at no charge.
“I’ll go through their medical history and check their feet to see if they fall into any of Medicare’s at-risk categories and if they do, Medicare says we can see them about every two to three months to keep up on callous trimming, nail care, and other things so that we don’t have complications,” Monson says. “If you’re not sure just come in. Any podiatrist should be able to tell you whether you’re at risk. And you don’t have to have a diagnosis of anything to be at risk.”
Nails, which curve and thicken over time, cause the most common problems that older adults have with their feet.
Fungus infections, which are very common, thicken the nail, making it harder to trim. Older folks may have loss of movement or they can’t see well enough to properly trim their nails. If the person’s shoe is too small, that can put pressure on the nail, which can lead to an infection.
If you are having a problem, a foot doctor will look most importantly at the type of shoes you wear and how they fit.
About every seven to 10 years, Monson says, a person’s shoe size will increase a half-size in length, and will get wider as feet flatten with age.
If problems are more serious, podiatrists can also perform surgery. Monson is qualified to do any surgery on soft tissue or bones below the knee. Surgical corrections are available for bunions, stiff big toe joints, foot arch pain, hammer toes, corns, plantar fasciitis (inflammation of the connective tissue found on the underside of the foot), bone spurs and other issues.
Monson, 59, started her practice by purchasing the clinic on Division Avenue in Eugene from another doctor.
Her husband, Dennis DiFeo, is the office manager.
Her practice consists primarily of older patients and, unlike larger practices where you may be shuffled around to a billing manager and a scheduling manager who doesn’t know what your insurance pays for, DiFeo handles it all.
“Most patients are not well-versed in their insurance coverage so if they give us a call we can let them know what their insurance covers and if they need a referral,” DiFeo says. “Questions like, ‘Is it covered? or ‘What does Trillium cover?’ are very common.”
It’s common to see patients who have purchased expensive orthotics elsewhere, later finding it wasn’t what they needed. Some places push expensive orthotics on to patients, promising that they will cure any problem, Monson says.
Orthotics may solve a particular problem, but it wasn’t what the patient needed, she adds. And even if they do help, orthotics might cost more than they should.
Custom orthotics, Monson says, aren’t as expensive as you might think.
An orthotic is a prescription medical device that fits inside your shoes to correct biomechanical foot issues such as problems with how you walk, stand or run; or problems with foot pain from a medical condition. Orthotics can help with many common foot issues such as bunions, hammer toes or heel pain.
“If they have a lot of foot pain they should see a podiatrist,” Monson says. “Do not spend money on orthotics because it might not be the right orthotic and in that case, you’ve lost a lot of money for no reason. I can get excellent custom orthotics that cost a lot less than what you see in some stores or on some websites.”