Foot Pain and Aging: How to Stay Active and Mobile Through the Decades

By Dr. Christopher R.D. Menke, DPM, FACFAS — Double Board-Certified Foot & Ankle Surgeon, Founder of 26 Apothecary

Foot Pain and Aging: How to Stay Active and Mobile Through the Decades

I had a patient in her mid-70s who came in for what she called her “annual tune-up.” She was managing plantar fasciitis with orthotics and a consistent stretching routine, fat pad atrophy with metatarsal sleeves and supportive footwear, and mild hallux valgus with a wide toe box shoe and occasional bunion brace use at night. She was walking 3 to 4 miles daily and playing tennis twice a week. None of her conditions were resolved. All of them were managed. That is the realistic and genuinely achievable goal of conservative care in older adults.

Dr. Christopher R.D. Menke, DPM, FACFAS — double board-certified in foot surgery and rearfoot and ankle reconstruction, founder of 26 Apothecary — explains the conservative care approach to aging foot health.

Managing Fat Pad Atrophy: Replacing What Time Takes Away

Fat pad atrophy is the most consistent age-related change in foot anatomy after the fifth decade. Physician-curated metatarsal gel sleeves replace the cushioning function the thinned plantar fat pad can no longer provide. Footwear with a cushioned midsole provides additional shock attenuation that complements what gel sleeves provide. The combination of physician-curated cushioning products and appropriate footwear represents the most effective conservative approach available for fat pad atrophy.

Managing Posterior Tibial Tendon Dysfunction: Preserving Arch Support

Early posterior tibial tendon dysfunction responds well to semi-rigid orthotic support when intervention begins before the deformity becomes rigid. Paired with appropriate stability footwear, this combination can preserve functional arch height for years — and in some cases indefinitely — without surgical intervention.

Managing Bunions and Hammertoes in Later Life

Conservative management — wide toe box footwear, bunion brace use during rest, gel protection over prominent toe joints — remains appropriate and often provides adequate functional management for people who are not surgical candidates or who choose to defer surgery.

Staying Active: The Connection Between Foot Health and Overall Health

Physical activity in older adults is directly associated with reduced cardiovascular mortality, preserved cognitive function, reduced depression risk, and maintained bone density. Foot pain that limits walking is not just a foot problem — it is a public health concern. Every point of improved foot pain management that allows an older adult to maintain their walking routine represents meaningful downstream health benefit.

When to See a Foot and Ankle Specialist

• Any new foot or ankle condition in an adult over 65 — fall risk evaluation is an important component of any gait-altering presentation in this age group
• Progressive deformity or arch collapse that is worsening despite conservative management
• Any foot concern in an older adult with diabetes, peripheral artery disease, or cardiovascular disease

Frequently Asked Questions

Is it safe for older adults to use orthotics?

Yes — orthotics are generally safe and beneficial for older adults with foot conditions. The break-in period may need to be more gradual than in younger adults, and the choice of orthotic design should account for any balance concerns or footwear restrictions. A podiatrist can guide appropriate selection.

At what point should an older adult consider foot surgery?

The decision to pursue foot surgery in older adults requires careful consideration of overall health status, surgical risk, expected recovery demands, and the realistic functional gain from the procedure. Many older adults are excellent surgical candidates and benefit significantly from procedures that restore function. The conversation about surgical timing and risk is best had with a board-certified foot and ankle surgeon who evaluates the individual’s full clinical picture.

About the Author

Dr. Christopher R.D. Menke, DPM, FACFAS is a double board-certified foot and ankle surgeon — board-certified in both foot surgery and rearfoot and ankle reconstruction. He completed his podiatric medical training at Temple University School of Podiatric Medicine in 2005 and his residency at Northlake Medical Center and DeKalb Medical in Georgia, completing in 2008. He is the founder of 26 Foot and Ankle and 26 Apothecary, and the founder of Surgeons of Service, a Georgia-based humanitarian surgical nonprofit. Every product in the 26 Apothecary catalog was selected through the same clinical lens Dr. Menke applies in the exam room and the operating room.