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

Foot Pain Is Common in Older Adults — But It Isn’t Normal

Studies consistently find that foot pain affects 20–35% of adults over age 65, making it one of the most prevalent musculoskeletal complaints in older populations. Many older adults accept foot pain as an inevitable part of aging — something to tolerate rather than treat. This fatalistic attitude is understandable given how long the symptoms may have been present, but it is medically incorrect. Foot pain in older adults has identifiable causes, responds to treatment, and when left untreated, contributes to falls, reduced physical activity, social isolation, and declining quality of life.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, Dr. Tom Biernacki DPM, Dr. Carl Jay DPM, and Dr. Daria Gutkin DPM are committed to helping older patients understand that treatment is available and effective for the vast majority of age-related foot conditions. Modern podiatry offers non-surgical and minimally invasive options that are well-suited to older patients who may not be candidates for major surgery.

How Feet Change with Age

The plantar fat pad — the cushioning layer that protects the metatarsals and heel from impact forces — thins progressively with age, reducing the foot’s natural shock absorption. The result is increased pressure on bony prominences, metatarsal heads, and the heel, producing the diffuse burning, aching pain that many older adults describe as “walking on bones.” Custom orthotics with appropriate cushioning materials can partially compensate for fat pad atrophy.

Ligament and tendon elasticity diminishes with age, contributing to acquired flatfoot deformity as the arch’s passive and dynamic supports weaken. The posterior tibial tendon, which actively maintains the arch during walking, undergoes degenerative changes that may progress to frank posterior tibial tendon dysfunction — a significant cause of adult flatfoot that is particularly common in women over 50. Tendons also become more susceptible to injury, explaining the higher prevalence of Achilles tendon problems and partial thickness tears in older individuals.

Joint cartilage degenerates over decades of use, producing osteoarthritis in the ankle, first metatarsophalangeal (big toe), and midfoot joints. Arthritic changes in the first MTP joint produce hallux rigidus — stiffness and pain of the big toe joint — which significantly alters gait mechanics and can cause compensatory pain throughout the foot, knee, and hip. The reduced synovial fluid production of older joints exacerbates arthritic symptoms.

Skin and nail changes in older feet deserve specific attention. Toenails thicken and become more difficult to trim safely, increasing the risk of ingrown nails and nail infections. The skin on the soles becomes drier and more prone to fissuring, particularly at the heels. In patients with diabetes or peripheral arterial disease, these seemingly minor skin changes can initiate serious wound-healing complications.

Falls and Foot Pain: A Critical Connection

Foot pain is an independent risk factor for falls in older adults — a relationship with serious consequences, given that falls are the leading cause of injury-related death in people over 65. Painful feet alter gait in multiple ways that increase fall risk: shortened stride length, reduced walking speed, decreased single-limb balance time, and avoidance of the normal heel-to-toe gait pattern that provides stability. Wearing ill-fitting shoes to avoid painful areas further destabilizes gait.

Treating foot pain reduces fall risk through multiple mechanisms: improved gait mechanics, better proprioception (facilitated by appropriate footwear), and greater confidence in ambulation. Any older adult with a history of falls and concurrent foot pain should be evaluated by a podiatrist as part of a comprehensive fall prevention program.

Treatment Options Well-Suited to Older Patients

Custom orthotics and appropriate footwear are the foundation of foot pain management in older adults. Shoes with a wide, deep toe box accommodate bunions, hammertoes, and swollen arthritic joints without creating pressure points. A rocker-bottom sole design reduces the range of motion required at arthritic joints for comfortable walking. Depth shoes accommodate custom orthotics with adequate cushioning and offloading for fat pad atrophy and pressure-sensitive areas.

Injection therapies — corticosteroid injections for joint inflammation, and increasingly hyaluronic acid (viscosupplementation) for osteoarthritic joints — provide meaningful pain relief with minimal systemic effect, making them particularly attractive for older patients taking multiple medications. Ultrasound-guided injections improve accuracy and safety.

Minimally invasive surgery — small-incision procedures for hammertoes, bunions, and arthritic spurs — has expanded the surgical options available to older patients who might not tolerate traditional open procedures. These approaches typically involve less soft tissue disruption, reduced anesthesia time, and faster recovery, making surgical correction of painful deformities feasible for a broader population. When the primary goal is pain relief rather than cosmetic correction, focused minimally invasive procedures can achieve excellent outcomes with manageable recovery demands.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Age-Related Foot Changes

Aging brings natural changes to feet — including fat pad atrophy, arthritis, and tendon weakening — that require adaptive care. Dr. Tom Biernacki at Balance Foot & Ankle provides comprehensive foot care for older adults to maintain mobility and prevent falls.

Learn About Our Foot Pain Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Menz HB, et al. “Foot problems in older people: a systematic review.” Journal of Foot and Ankle Research. 2008;1(Suppl 1):O1.
2. Mickle KJ, et al. “ISB Clinical Biomechanics Award 2009: toe weakness and deformity increase the risk of falls in older people.” Clinical Biomechanics. 2009;24(10):787-791.
3. Dunn JE, et al. “Prevalence of foot and ankle conditions in a multiethnic community sample of older adults.” American Journal of Epidemiology. 2004;159(5):491-498.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.