By Mark Davies
We all know that as we get older body parts have a nasty habit of failing.
Whilst organs fail, our skeletons degenerate and whilst we do not talk of skeletal failure that is what inevitably happens with time, to many of us.
Whilst we enjoy good health we rarely pay our feet much attention but when they start to trouble us we become painfully aware of their importance to mobility and therefore independence.
Human beings are living mechanical structures and the feet are our foundations. Any joint in the foot can degenerate and with that process comes pain, swelling and progressive deformity. The same happens as tendons fail. Poor skin quality and inadequate blood supply can present orthopaedic surgeons with major challenges and it is vital, in the elderly, to assess how well a patient will tolerate, not only the surgical procedure, but the imposed immobility, especially when major bony procedures are performed.
People often assume that we have a vast array of treatments to offer but there are really only five things on offer.
- We can do nothing and soldier on but deformity and pain will progress and the patient will never be younger than they are right now.
- Secondly we have podiatry and footwear modification. This can be very helpful and most old people require the services of a chiropodist/podiatrist on a regular basis. Podiatry however, can not reverse or treat the underlying degenerative process.
- Third is physiotherapy but again physiotherapy can not cure the ageing process but it can help elderly people to keep going. Physiotherapy does however come in to its own in the post-operative period.
- Fourth is medication and pain relief and anti-inflammatories can help but there are potential side effects and long term NSAIDs can be lethal. Injection therapy has a role but no injection lasts forever and contrary to popular belief a cortisone injection is likely to be effective for a matter of weeks rather than months and repeat injections tend to be less and less effective.
- The last treatment modality is surgery. In the past we have shied away from operating on the elderly foot but with an ever increasing elderly population who are living longer our threshold for intervening has become lower. Often it is not the procedure that puts patients off the idea of surgery but the recovery period and the imposed restrictions. With appropriate attention to detail and organising help whether it be a nursing home or help at home, these obstacles can be overcome.
Mark Davies is the Founder and a Consultant Orthopaedic Surgeon at The London Foot and Ankle Centre. Established in 2003, the Centre was the first specialist service of its kind in the UK and it has developed into a centre of excellence for foot and ankle disorders.
