Foot Health After 65: The Most Important Foot Care Advice for Older Adults

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

How Aging Changes Your Feet

The plantar fat pad — your foot’s natural shock absorber — loses approximately 50 percent of its thickness by age 70. This exposes the metatarsal heads and heel bone to direct ground contact, causing pain that many seniors mistakenly attribute to plantar fasciitis when the real problem is insufficient cushioning over bony prominences.

Ligaments and tendons lose elasticity with age, leading to progressive flattening of the arch (adult-acquired flatfoot) and widening of the forefoot. Many seniors need shoes a full size wider than they wore at age 40. Continuing to wear narrow shoes compresses the toes, worsens bunions, and creates painful corns and calluses that can break down into dangerous ulcers in patients with diabetes or poor circulation.

A 2024 study in the Journal of the American Geriatrics Society found that 87 percent of adults over 65 had at least one foot problem, and those with foot pain were 2.3 times more likely to experience a fall within the following year. This makes routine podiatric care as essential as regular eye and dental examinations for maintaining quality of life in older adults.

Fall Prevention Starts With Your Feet

Falls are the leading cause of injury-related death in Americans over 65, and foot problems are a major modifiable risk factor. Impaired proprioception — the ability to sense foot position — declines with age and is worsened by peripheral neuropathy, contributing to balance instability. Toe deformities like hammertoes and bunions alter weight distribution and reduce the foot’s ability to make corrective adjustments during balance challenges.

Footwear selection directly impacts fall risk. Dr. Tom Biernacki recommends shoes with a firm heel counter, low heel height (under 1 inch), thin but supportive soles that allow ground feedback, and a secure closure system (laces or Velcro rather than slip-ons). Avoid walking in socks on hard floors, wearing backless slippers, or using shoes with worn-out soles that have lost their tread.

A comprehensive fall prevention assessment at Balance Foot & Ankle includes evaluation of ankle strength, proprioceptive function, gait pattern, and footwear appropriateness. Simple exercises like single-leg stance practice, toe yoga (lifting the big toe while keeping the small toes down), and heel-to-toe walking performed daily significantly improve balance and reduce fall risk.

Circulation Problems and Peripheral Arterial Disease

Peripheral arterial disease (PAD) affects approximately 20 percent of adults over 70 and can silently reduce blood flow to the feet. Early signs include cold feet, slow-healing wounds, thin shiny skin on the legs, decreased hair growth on the toes, and intermittent claudication — calf cramping with walking that resolves with rest.

Annual foot examinations should include palpation of the dorsalis pedis and posterior tibial pulses and ankle-brachial index (ABI) screening when PAD is suspected. An ABI below 0.9 confirms significant arterial disease and warrants vascular evaluation. Early detection is critical because PAD is a marker for systemic atherosclerosis — patients with PAD have a 3 to 6 times higher risk of heart attack and stroke.

Dr. Biernacki performs vascular screenings at both our Howell and Bloomfield Hills offices and coordinates with vascular specialists when intervention is needed. Daily foot inspections, smoking cessation, walking exercise programs, and proper wound care are the cornerstone of PAD management in the feet.

Diabetic Foot Care Essentials for Older Adults

Diabetes affects 25 percent of Americans over 65 and is the leading cause of nontraumatic lower limb amputation. The combination of peripheral neuropathy (nerve damage causing numbness), PAD (reduced blood flow), and impaired immune function creates a perfect storm where minor injuries go unnoticed, heal poorly, and progress to serious infections.

Daily self-inspection is the single most important habit for diabetic foot health. Check the tops, bottoms, and between all toes for cuts, blisters, redness, warmth, or callus buildup. Use a mirror or ask a family member to help inspect areas you cannot see. Any break in the skin — no matter how small — warrants a call to your podiatrist within 24 hours.

Medicare covers therapeutic shoes and custom insoles for patients with diabetes and documented foot complications through the Therapeutic Shoe Program. At Balance Foot & Ankle, we perform comprehensive diabetic foot examinations including monofilament testing for neuropathy, vascular assessment, and biomechanical evaluation, and we can prescribe and fit therapeutic footwear through this Medicare benefit.

Common Foot Conditions in Seniors and Their Treatment

Toenail problems become increasingly common with age. Fungal nails (onychomycosis) affect over 50 percent of adults over 70, causing thickened, discolored, and sometimes painful nails that can press into surrounding skin. Ingrown toenails in seniors are particularly concerning because impaired circulation and immune function increase infection risk.

Bunions and hammertoes that were tolerable at age 50 often become painful by 70 as the fat pad thins and protective cartilage wears down. Conservative options including wider shoes, custom orthotics, gel toe spacers, and padding provide relief for most seniors without surgery. When surgical correction is considered, Dr. Biernacki performs a thorough risk-benefit analysis factoring in bone quality, healing capacity, and activity goals.

Heel pain in seniors is frequently caused by fat pad atrophy rather than plantar fasciitis, though both can coexist. The treatment differs significantly — fat pad atrophy requires cushioning and shock absorption (padded insoles, cushioned shoes), while plantar fasciitis responds to stretching and arch support. Accurate diagnosis prevents the frustration of treating the wrong condition.

Building a Senior Foot Care Routine

A daily foot care routine takes just 5 minutes and prevents the majority of serious foot complications. Wash feet with lukewarm water and mild soap (test water temperature with your elbow, not your feet, if you have neuropathy), dry thoroughly between toes, and apply moisturizer to heels and soles — but not between the toes where excess moisture promotes fungal infections.

Trim toenails straight across, not curved, and file rough edges rather than cutting them. If you cannot reach your feet safely, have a podiatrist perform routine nail care — this is covered by Medicare for patients with diabetes, PAD, or neuropathy. Never use sharp instruments, corn removers, or medicated pads on your feet without professional guidance.

Schedule comprehensive podiatric evaluations at least annually — more frequently if you have diabetes, PAD, or neuropathy. These visits catch problems early when they are most treatable and least dangerous. At Balance Foot & Ankle, Dr. Tom Biernacki and our team provide gentle, patient-centered care designed specifically for the needs of older adults.

The Most Common Mistake We See

The biggest mistake seniors make is dismissing foot pain as a normal part of aging. While some structural changes are inevitable, pain is never normal at any age. Ignoring foot pain leads to compensatory gait changes that cause knee, hip, and back problems — and can trigger the falls that rob older adults of their independence. If your feet hurt, something is wrong, and it is almost always treatable.

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In-Office Treatment at Balance Foot & Ankle

Our team provides sport-specific evaluation and treatment to get you back to your activity safely. We offer same-day X-ray, in-office ultrasound, and custom orthotic fabrication.

Same-day appointments available. Call (810) 206-1402 or book online.

Frequently Asked Questions

How often should seniors have their feet checked by a podiatrist?

Seniors over 65 should have a comprehensive podiatric examination at least once per year. Seniors with diabetes, peripheral arterial disease, or neuropathy should be seen every 3 to 6 months. Medicare covers routine foot care for patients with qualifying medical conditions. Regular examinations catch problems early and prevent serious complications including infections and falls.

Does Medicare cover podiatric care for seniors?

Medicare covers podiatric care for medically necessary conditions including diabetic foot care, fungal nails causing pain, ingrown toenails, heel pain, bunions, and hammertoes. Medicare also covers therapeutic shoes and insoles for diabetic patients through the Therapeutic Shoe Program. Routine nail trimming is covered when a qualifying medical condition like diabetes or PAD is documented.

What are the best shoes for seniors to prevent falls?

The best shoes for fall prevention in seniors have a firm heel counter, low heel height under 1 inch, a thin but supportive sole that allows ground feedback, secure closure with laces or Velcro, and a wide toe box. Avoid slip-on shoes, high heels, flip-flops, and shoes with worn-out soles. Look for shoes with rubber outsoles that provide good traction on various surfaces.

When should a senior see a podiatrist urgently?

Seniors should seek urgent podiatric care for any open wound that does not improve within 48 to 72 hours, sudden foot or ankle swelling without injury, red streaking from a wound, fever with foot symptoms, sudden inability to bear weight, or sudden change in foot color or temperature. These signs may indicate infection, blood clot, or vascular emergency requiring immediate treatment.

The Bottom Line

Your feet are the foundation of your independence — and caring for them properly after 65 is one of the most impactful health investments you can make. From fall prevention to diabetic foot care to managing the natural changes of aging, proactive podiatric care keeps you mobile, safe, and active. At Balance Foot & Ankle, Dr. Tom Biernacki provides compassionate, comprehensive foot care for seniors at our Howell and Bloomfield Hills offices.

Sources

1. Menz HB et al. Foot problems and fall risk in community-dwelling older adults: prospective cohort study. J Am Geriatr Soc. 2024;72(4):678-687.
2. Bus SA et al. IWGDF guidelines on offloading foot ulcers in persons with diabetes: update 2024. Diabetes Metab Res Rev. 2024;40(3):e3647.
3. Hatton AL et al. Footwear interventions for fall prevention: systematic review and meta-analysis. Age Ageing. 2025;54(1):afae245.
4. Lopez DL et al. Prevalence of foot disorders in adults over 65: population-based study. Foot Ankle Surg. 2024;30(2):112-119.

Expert Foot & Ankle Care in Southeast Michigan

Whatever foot or ankle condition you’re dealing with, a board-certified podiatrist can diagnose the underlying cause and create a personalized treatment plan. At Balance Foot & Ankle, we offer comprehensive podiatric care at our Howell and Bloomfield Hills offices.

Explore Our Treatment Options → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Thomas MJ, Roddy E, Zhang W, et al. The population prevalence of foot and ankle pain: a systematic review. Pain. 2011;152(12):2870-2880.
2. Riskowski JL, Dufour AB, Hannan MT. Arthritis, foot pain and shoe wear: current musculoskeletal research on feet. Curr Opin Rheumatol. 2011;23(2):148-155.
3. Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study. J Foot Ankle Res. 2008;1(1):2.