The Aging Foot

Our feet, by the very nature of their function and purpose, get a lot of wear and tear through the years. In fact, by the time we reach age 65 most of us will have walked more than 75,000 miles (three times around the equator) and borne several million tons of weight on our feet. And, depending on how we’ve cared for or mistreated them, we can actually cause foot problems or make them even worse.

As we age, our feet tend to spread and lose the fatty pads that cushion the bottoms. Any abnormalities we were born with or problems that have developed over time can become more pronounced or painful as our foot joints lose their flexibility and become more rigid. If we carry extra weight, our bones and ligaments can take an extra beating, further exacerbating any foot problems we may have.

Caring for the Aging Foot

As an HME/DME provider, you can be on the first line of defense in partnering with other health care professionals to help care for the feet of your aging patients. Ensuring your patients have properly fitting shoes can mean the difference between their suffering needless pain and continuing to walk easily and comfortably. Ease of walking becomes ever more important for an aging population, because walking is one of the best ways to exercise and stay fit.

Most foot problems can be treated effectively. With basic foot care and prompt attention from a podiatrist when a problem occurs, your patients can stay active and independent. If diagnosed and treated early enough, individuals can avoid potential long-term disability. Often a change in footwear will do the trick, or a pair of custom orthotics designed to treat a specific foot condition may be just what the doctor ordered—literally.

There are other predisposing factors that may make your patients more susceptible to experiencing foot problems as they age, many of which will require the care of a physician and/or podiatrist. These can include, but are not limited to, circulatory problems, diabetes, arthritis, osteoporosis, peripheral neuropathy, flat feet, pronation or supination, obesity, shoe styles and a history of foot injury.

But you can play a critical role in ensuring compliance with doctor recommendations and in providing guidance on sensible shoes that provide the proper support, as well as other foot care products that can aid in maintaining good foot health.

Common Problems

Diagnosing and treating foot problems early can be the answer to avoiding long-term problems and potential disabilities. An HME/DME provider’s role in addressing patient foot problems will often be a referral to a physician or a podiatrist, especially if the patient is at high risk of foot health complications. Foot problems commonly encountered in seniors include:

• Bunions: This deformity of the foot may be an inherited trait, but may also result from many years of friction due to ill-fitting footwear. Flat feet, gout and arthritis also increase a patient’s chances of developing a bunion. While bunions may sometimes require surgery, finding a shoe with extra depth or extra room in the toe box can be a good way of ensuring comfort and continued mobility. Shoes with stretch features can be a good alternative, as can shoes made with materials such as neoprene or stretchable polyurethane—especially in the toe or forefoot area.

• Corns and Calluses: Corns are caused by friction from poorly fitted shoes or socks or from toes rubbing against each other. Calluses are similar to corns, but they develop on the ball or heel of the foot. Relief from corns may be addressed with shoes that are well-fitted and allow ample room in the toe area.

Since corns can also be caused by friction from socks, suggesting the patient try a seamless toe diabetic sock designed to eliminate friction may be an easy solution. Exfoliation and moisturizing feet on a regular basis and identifying shoes that provide proper support and cushion is a good treatment for calluses. Calluses may be treated with either an over-the-counter orthotic with cushioning gel in the heel or toe area or with a podiatrist-prescribed, custom pair of insoles.

• Hammertoes: Hammertoes are caused by abnormal tension in the muscles and tendons around the toe joint, causing them to buckle or flex. Surgery may sometimes be required, but shoes with extra depth or room in the toe box can be a good solution to reduce binding, pinching or rubbing caused by this condition. Wearing shoes made with materials such as neoprene or stretchable polyurethane can also reduce pressure on these sensitive areas.

• Toenail Problems: Many toenail problems can be avoided and/or alleviated by ensuring that there is adequate room in the toe area. There should always be a little finger’s width (approximately half an inch) between the patient’s longest toe and the end of their shoe.

• Diabetic Foot Problems: Diabetic patients may have reduced sensation in their feet, making it difficult to realize that they have foot problems or injuries. In addition, blood flow in the feet of diabetics is impaired, making infections harder to fight off. Therefore, diabetic patients must have a health care or foot care professional examine their feet on a regular basis.

Proper foot care and supportive footwear are critical to the diabetic patient. Footwear that has been Medicare-approved for diabetics (A5500 coded) can help prevent further issues and even potential amputation. Seamless toe, non-binding diabetic socks with moisture-wicking and anti-microbial properties are also a good defense against potential infection. Over-the-counter Medicare approved diabetic inserts (A5512 coded) or custom-molded diabetic inserts (A5513 coded) are specially designed to reduce motion and friction as well as eliminate pressure hot spots and help distribute weight more evenly.

• Arthritic Foot Problems: Osteoarthritis, gout and rheumatoid arthritis are among the conditions that can cause severe foot pain. Often a biomechanically designed shoe that works to ensure that the foot can be controlled while still allowing the normal motion of the body to occur will help to reduce the load on lower body joints and alleviate pain often associated with arthritis.

• Heel Pain: Some heel pain conditions, such as plantar fasciitis, may be caused by poor foot mechanics. This condition can often be treated by over-the-counter orthotics or custom-molded orthotics that provide good arch support and a deep heel cup to hold the heel in place. Biomechanically designed footwear can help to alleviate the pain often associated with this condition.

• Arch Problems: Depending on the nature of the arch problem, pain associated with flat feet and an abnormally high arch can often be treated with shoes that provide good arch support. Additional support in the form of an over-the-counter orthotic or a custom insole may be warranted.

Footcare Central

While adding a foot care section to an HME/DME store may seem like an onerous task based on Medicare or private insurance requirements, it can add potential cash sales to your bottom line. This may be a great opportunity, especially for diabetic patients looking for more than their one pair of shoes allowed per year (under Medicare or private insurance) or for patients just looking for shoes to provide relief from other foot problems. In addition to shoes, a foot care section might also include compression socks, diabetic socks (seamless, non-binding), diabetic insoles, over-the-counter orthotics and even foot creams, lotions and non-prescription antifungal products. Start small and add products as you learn the needs of your patients and as you gauge sell-through of particular items.

Adding Value through Service

Ensuring patients have properly fitting shoes that provide good support and stability and that are appropriate for their particular foot condition(s) is essential. Diabetic shoes must be prescribed by a physician and fit by a qualified individual, such as a certified pedorthist or certified shoe fitter.
Having a shoe fitter on staff can be an added value service for your patients and an opportunity to cross-sell patients coming in for other products (e.g. pain relief, walking aids, etc.). Supportive footwear can often be the solution—or at least a part of the solution—to pain in other areas of the body like the knee, hip or lower back.

Well-being from the Ground Up

Adding a foot care area in your store can be a great source of revenue. Moreover, helping your patients maintain happy and healthy feet is creating well-being from the ground up. Ultimately, your dedication to providing innovative approaches to enhancing and improving foot function and foot health will contribute greatly to the community you serve.