Michael Zimmerman, DPM, a podiatrist and foot surgeon with CHI Health Clinic Foot & Ankle, sees a lot of seniors in his practice. Whether the cause is age-related, such as arthritis or stress fractures from brittle bones, or injury-related, from an accident or overuse, debilitating foot pain affects many in their golden years, prohibiting them from living their best life.

Unfortunately, many of them come to him after suffering in silence far too long.

“The biggest mistake people make is not getting treatment soon enough,” Zimmerman said. “A lot of the people in that age group, especially. They wait until the pain is more severe, especially when it comes to deformity issues, like hammertoes and bunions.

“If treated early, they could have a faster, easier recovery. Instead, the treatment plan takes longer, is more extensive.”

It’s estimated than one in four adults over the age of 45 suffer from foot pain, which can greatly affect one’s mobility and balance. In fact, one study showed foot pain was associated with a 62% increased risk of falls. Maintaining good foot health as one gets older is vital to maintaining overall health and an active lifestyle.

With 26 bones, 33 joints, and dozens of muscles, tendons, and ligaments, the foot is a complex system that needs personal attention. Zimmerman said many foot ailments affecting seniors can simply be avoided with good practices.

“Age, overuse, injury or strain, not allowing injuries to properly heal, improper shoe gear…these are all causes of foot pain,” Zimmerman said. “And in many cases these causes are not completely unpreventable.” 

One of the most common ailments Zimmerman sees is seniors is plantar fasciitis, which is caused by inflammation of the tendon, or fascia, that runs along the bottom of the foot and connects the toes to the heel. 

“There’s general pain at the insertion point where the fascia hits the heel bone, and it can vary from a sharp, stabbing pain to a just an ache,” he said. “The pain is worst when you first awake and step out of bed or walk barefoot.”

While rest and icing the sore fascia help relieve the pain, Zimmerman said stretching the achilles tendon first thing in the morning and several times throughout the day is the at-home therapy he recommends most. “All-day management offers the best outcome for treatment and prevention.”

If at-home therapy fails, he typically prescribes the patient anti-inflammatory medication, or prescription medication such as oral steroids. “We also may try over-the-counter orthotics, sometimes prescription orthotics….Maybe steroid injections at the pain site, or physical therapy. 

“Typically, 80-95% of patients see signs of improvement within four to six weeks” with these treatments, he said. “A combination of therapies is best, not just one modality.”

Rarely is surgery needed. Zimmerman said patients must try conservative therapies for at least six months (with little success) before surgery is initiated. “Only then do we take an MRI and determine the right surgical treatment. (After surgery), the patient walks in a boot for a week or so, then moves to normal shoe wear.”

Another very common foot ailment Zimmerman sees in seniors is Achilles tendonitis, which is typically caused by overuse/injury of the Achilles tendon—the largest tendon in the body—which connects lower calf muscles to the heel bone. Like plantar faciitis, tendonitis can be treated with eccentric (or elongation) stretching.

“(For the Achilles) this involves stretching the tendon by placing your foot on a step so the heel hangs off, then slowly lowering the heel, elongating the tendon,” Zimmerman said. “Patients should do this three to five times a day and hold for 10 to 15 seconds each time.”

Treatment may also require placing a heel lift in the shoe—full time at first, then gradually less time—to relieve some of the tension on the heel. These inserts can be bought over the counter at retailers like The Good Feet Store or Kohll’s Pharmacy.

Should stretching and heel lifts not prove sufficient, physical therapy, including deep tissue massage, and anti-inflammatory medication (either oral or topical) may be prescribed. “Again, surgery is a last resort,” he said.

Zimmerman said he’s encouraged by a host of newer foot pain treatments that are being employed by physical therapists to treat plantar fasciitis and tendonitis, including dry needling. The technique, also called myofascial trigger point needling, uses a thin filiform needle to go through the skin and stimulate underlying muscular and connective tissue for pain management.

“It’s similar to acupuncture, but the treatment goes to one area,” he said.

Another cutting-edge treatment showing promise is platelet-rich plasma injections, or PRPs, Zimmerman said. The treatment involves extracting the patient’s own blood platelets and injecting them into the injured muscles, ligaments, and other body tissues to accelerate the healing process. 

Though some patients seek great benefits from rehab treatments, over-the-counter solutions, and physical therapy, there are still those who require surgical solutions. However, there is progress on that front, Zimmerman said, encouragingly.

“We’re also doing more minimally invasive procedures, too, which involve smaller incisions and sometimes using cameras to do surgery, rather than a large, open surgery,” he said. “These allow for a faster recovery.” 

This article first appeared in the "60 Plus" section of the May 2020 issue of Omaha Magazine.