Aging takes its toll on your feet and ankles just as it does with the rest of the body. Last week we looked at the changes in the shape and functioning of the feet that occur with aging. But in addition to changes in the structure of the feet, there are circulatory and skin changes.

Circulation problems
Due to the infirmities of age there are changes in circulation often related to diabetes or other vascular diseases. Varicose veins are also problems encountered more often in the elderly. Poor circulation may be accompanied by pain in the feet or legs. These problems will have to be diagnosed and treated by your podiatrist, vascular specialist or family physician. Once a proper diagnosis is made you will be treated with proper footwear and hosiery, stockings and socks.

For venous problems, mild to moderate compression stockings/socks with at least 15 millimeters of pressure should be used. They should be put on first thing in the morning before putting your feet down and the swelling sets in. If people have low blood flow to the feet, they are encouraged to wear socks that are loose and do not leave "tight rings" around the ankles. They should be comfortable to wear at all times and can be worn to bed at night to keep the feet warm.

Dry, flaky skin
With increasing age, the skin's ability to produce sweat, oil and other fatty substances diminishes. The skin cells also divide more slowly, and the skin becomes thinner. As a result, the water content of skin is reduced and the skin becomes dry which in turn leads to age-related dry skin.

Here are some common age-related dry-skin problems people may experience -- peeling and flaking skin, itchy skin that bleeds easily when scratched. The skin may appear yellow or brown in color, and may become inflamed due to itching and scratching. The dry skin may become thick and hard, especially around the edges of the heels. The skin may become so dry that it cracks and fissures, which in turn causes pain when walking. Dry and cracked skin is prone to bacteria and fungal infections, which can cause serious problems.

Self-help treatments: Moisturize, moisturize, and moisturize again, especially after bathing. Make sure you pat your skin almost dry, but while it is still damp, apply the moisturizer. This moisturizer will hold the water in and keep the skin from drying. You can add some oil to your bath to soothe dry irritated skin and help the skin "lock in" moisture. Avoid nylon and rayon socks because they may cause dryness. Seeing a podiatrist can help with exfoliating and moisturizing the feet to soften and hydrate the skin.

Thick, dry and discolored toenails
The toenail changes most commonly associated with aging are due to decreases in blood flow to the toes. As we age, the small blood vessels in our feet and toes narrow and become thicker, reducing the amount of blood and nutrients that gets to the ends of our feet. Without proper nourishment the toenails become dry, brittle, deformed, and discolored.

Trauma to the nails over the years gradually destroys the normal appearance of the nails, cuticle, and nail bed. Nail fungus is the most common cause of discolored, thick, and deformed toenails in people of all ages, but especially in older people. Seniors are especially susceptible to these infections because of reduced circulation to the toes. Decreased circulation means fewer antibodies and infection fighting blood cells are available to ward off the nail fungi.

Self-help and treatments: Help avoid ingrown toenails and nail fungus by clipping toenails straight across, and disinfect instruments used to cut nails. Do not cut or push back toenail cuticles. The dark, warm, moist environment in our shoes makes it a perfect place for the fungus to grow.

When the cuticles are left intact, they keep germs from entering the area where new nail grows from. People, who have sweaty feet, or those who practice poor foot hygiene, are more susceptible to skin fungal which can lead to nail fungus. Each day, wash and dry feet, and put on a pair of clean socks.

Constantly wearing nail polish prevents air from getting to the nail plate and the harsh chemicals in the nail polish may help to destroy the normal structure of the nail. This can make it easier for a fungus to invade and penetrate the nail. The fungus must be treated, often with antifungal medication applied to the nail or skin.

Crooked toes and feet
As we age, the ligaments, tendons and joint capsule begin to weaken and stretch. When this occurs, the bones are not held tightly in their correct positions and they begin to move out of alignment. The joint's cartilage wears down due to the normal wear and tear, leading to thickened joints and toes that are no longer straight, but are crooked.

Self-help and treatments: Self help and treatments need to be directed toward keeping your feet and toes comfortable. It is best to measure your feet, every time you try on and buy new shoes. Stand when your feet are measured because your feet expand when standing. Make sure you have at least a little finger's width between your longest toe and the end of your shoe.

Always wear appropriate shoe styles. The shoes need to match the shape of your feet. Do not purchase shoes that feel too tight, expecting them to "stretch to fit". Most materials, including leather, do not stretch enough to make a big difference.

If you have hammertoes, corns, bunions, arthritis of the toes, consider purchasing shoes with a deep and wide toe box (the area of the shoe that encloses the toes). This extra depth and width may keep the shoes from pressing against sensitive skin on the tops of the toes. Custom-made orthotics may help address a foot's biomechanical deformities and help with comfort and control. Sometimes surgery may be needed to correct these foot deformities.

Regular exercise, like walking, and maintaining a healthy weight goes a long way to help prevent foot complications and promote good foot health well into the senior years. Changes can, and do occur with aging but the do not have to lead to pain and dysfunction. If you do have pain or concerns about your feet, see a podiatrist to have a full evaluation and treatment if needed.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

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