Foot problems are remarkably prevalent among older adults — studies estimate that 77% of adults over age 65 have at least one foot condition, yet fewer than 40% have ever sought professional foot care. This gap matters enormously, because many of the foot problems that are most common in older adults can lead to falls, reduced mobility, social isolation, and serious medical complications — all of which are preventable with appropriate podiatric care.

Why Feet Age Differently

The changes that aging brings to the feet are physiologically distinct from the rest of the body:

• Fat pad atrophy — the plantar fat pad thins with age, reducing the natural cushioning under the heel and ball of the foot by 20–30%
• Ligamentous laxity — years of bearing body weight causes gradual stretching of foot ligaments, contributing to arch flattening and increased forefoot width
• Skin changes — reduced sebaceous (oil) gland activity, thinning dermis, and decreased cell turnover increase dryness, cracking, and bruising susceptibility
• Nail changes — toenails become thicker, harder, and more opaque with age; often difficult to self-trim; become vulnerable to fungal infection
• Circulatory changes — peripheral circulation decreases with age, slowing wound healing and reducing the immune defense against infection
• Neurosensory changes — reduced vibration and proprioceptive sensitivity increases fall risk from impaired balance feedback

The Most Common Foot Problems in Older Adults

Bunions and Hammertoes

Bunions affect an estimated 36% of adults over age 65. Progressive throughout life, bunions in older adults cause significant shoe-fitting difficulty and limit activity. Hammertoes — flexion contractures of the lesser toes — develop alongside bunions and become increasingly rigid with age. Conservative management (wide toe box shoes, custom orthotics, padding) remains effective for symptom control in most patients.

Toenail Fungus

Onychomycosis affects approximately 30–35% of adults over 70. Thickened, fungal nails in older adults are difficult or impossible to trim safely at home, create pressure sores from footwear, and can harbor infection. Regular professional nail care by a podiatrist prevents nail-related wounds and keeps nails safely trimmed.

Diabetic Foot Complications

The prevalence of diabetes increases dramatically with age — over 25% of Americans over 65 have diabetes. Diabetic neuropathy, peripheral arterial disease, and impaired immune function create the triad of conditions that cause diabetic foot ulcers and amputations. Annual comprehensive diabetic foot exams — including monofilament testing, vascular assessment, and nail and callus care — are the cornerstone of amputation prevention. Medicare covers annual diabetic foot exams and therapeutic footwear.

Plantar Fasciitis and Heel Pain

Heel pain from plantar fasciitis and fat pad atrophy is extremely common in older adults and significantly limits walking ability. Custom orthotics with deep heel cups are highly effective for both conditions and are covered by Medicare when medically indicated.

Peripheral Arterial Disease

PAD increases in prevalence with age — affecting approximately 12–20% of adults over 70. Reduced pedal blood flow causes toe and foot pain with activity (claudication), wound healing impairment, and risk of critical limb ischemia. A podiatrist screening for PAD with ankle-brachial index (ABI) measurements can identify patients who need vascular referral before a minor foot wound becomes a limb-threatening problem.

Falls and Balance

Foot problems significantly contribute to fall risk in older adults — 30% of falls in the elderly are attributed to foot and ankle conditions. Foot pain alters gait, reduces walking speed, and increases postural instability. Custom orthotics, appropriate footwear, and treatment of foot conditions that impair proprioception can meaningfully reduce fall risk.

Medicare Coverage for Senior Foot Care

Medicare Part B covers several podiatric services for qualified patients:

• Routine nail care for patients with diabetes, peripheral neuropathy, or peripheral vascular disease
• Annual comprehensive diabetic foot examination
• Custom orthotics when medically necessary
• Therapeutic diabetic shoes and inserts (one pair annually) for qualifying diabetic patients
• Treatment of foot conditions (ingrown nails, warts, plantar fasciitis, etc.) when medically necessary

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.