Foot and Ankle Specialist St Petersburg FL

Your Aging Feet Part I: Diagnosing Age Related Changes

Everyone jokes “they’re getting older,” when referencing their ability to heal or how they feel overall. But how does age truly effect our feet and ankles? How can we help preserve our youthful and active feet into our old age and when should we start?

In part one of “Your Aging Feet” we will dive into a few objective tests we do at Align Foot and Ankle to understand specifically how age is changing your feet and ankles. Part Two of Your Aging Feet” we will discuss how to keep our unique bodies healthy & moving long into our old age.

So let’s get started!

A large part of what makes us at Align Foot and Ankle, different is due to our thorough diagnostic process. We use a wide variety of advanced technology & diagnostic tests to assess root causes & underlying issues that could be leading to your injury. This helps us evaluate injuries versus age-related changes & informs very specifically HOW each individual should be treated. For example, many people think they have broken bones, when in fact, they have age-related arthritis or gait-related/anatomy-related plantar fasciitis. Extensive research has given insight into changes in normal foot position and function as we age. Common tests we will look at to see age-related changes include gait analysis, x-rays, nerve biopsies, MRIs, range of motion in ankles, and muscle strength tests performed by Dr. Barnett. We have reviewed thousands of these tests and seen some patterns worth pointing out.

Diagnosing Age Related Changes

Is it true that a picture says 1,000 words. In the case of an x-ray, YEP! In-office x-ray is very helpful to assess fractures, foreign bodies, clogged arteries, arthritis, and growth plate patterns and injuries. It is important to get this real-time picture for a most accurate picture of what is actively going on inside your feet and ankles. Even a few days can make a big difference in images, so doing an x-ray in our office at the time of your appointment is the most accurate to the diagnostic process.

Diagnosing Age Related Changes

As we age, it is typical that we see your bones become less dense. Bone mineral density loss is normal as we age, but everyone is different and will experience density loss at different rates. On an x-ray, the whiter & lighter the bone looks, the healthier the bone matter is. Adversely, on an x-ray, the more grey the bone the less dense and more susceptible to fractures and arthritis.

Diagnosing Age Related Changes

In children, we want to see a healthy growth plates, cartilage (as opposed to bone) and healthy tendons and ligaments to understand if they are growing at a steady rate. X-rays help us determine how to design an orthotic around a foot type to help prevent or relieve pain in the natural aging process, determine if a fracture needs surgery, if its a broken bone or arthritis causing pain.

Diagnosing Age Related Changes

Align Foot and Ankle does 3D gait analysis, a way to view how joints, muscles and tendons function while in motion. Geospatial data shows how a limb moves in space, and what position the knee, pelvis and ankle move at various spots during walking. One thing noted as people age is that the pelvis tends to stay stiff and not move as much during walking. The pelvis moves in three planes of motion, tilt (forwards and backwards), rotation (swivel), and frontal (up and down). When the pelvis does not swing, dip and sway as much, it is a sign less balance in the legs is causing the pelvis to stiffen.

Another common gait finding associated with age is shorter stance of gait. The space between steps shorten, usually a sign of worsening balance. Shorter steps help maintain balance. The gait lab allows us to make custom orthotics that correct foot position, plan in-depth physical therapy to stretch and/or strengthen, and work to improve function. The ultimate goal is to fix the root cause of pain. In part two of this blog, we will discuss how in-depth a PT orders from Dr. Barnett look and how it can make all the difference in staying active long into your old age.

As people age, the density of their nerves change. We perform punch nerve biopsies on the ankle and stain the tissue to see how many nerves are in the area, how healthy, and how many blood vessels are around the nerves. After millions of biopsy readings, for healthy and unhealthy people, we have built a standard that we use to see if nerve damage is age-related or an abnormal finding. For example, a 20-year-old has on average, 16 nerve fibers per area, a 45-year-old will have roughly 13 fibers, and a 65-year-old will have about 10 nerve fibers. We see this even on people who are not complaining of any nerve problems.

Now when the number of nerve fibers (of any age) gets to 5, it is considered abnormal and is
something that needs to be addressed. We also see fewer blood vessels around the nerves as we age, a sign the blood flow is slowly decreasing, even if someone has no obvious blood flow issues, the biopsy will show normal age-related blood loss versus one to be concerned about. From there, we can start to uncover what could be causing the loss of nerves or blood flow.

Another great tool we use to see subtle changes to your body as you age is vein mapping. Though not as common as artery tests, vein testing can show degenerative changes versus immediate problems. If a young person gets swelling, it is usually triggered by an injury, illness, or abnormal circumstance. However, as people age, swelling may not be as easy to resolve. As we age, the valve in the deep veins fail and can not be repaired. The width of a vein also widens over time and the combination of the two can cause blood to go “backward” and make the legs swell. The road map for veins is a great test to help find a true cure for leg swelling.

Magnetic Resonance Imaging or MRI, is a magnetic image that we use to see contrasts of different tissues, to evaluate if there is a damaged tendon, fluid where there should not be, and cartilage loss that can’t be seen on an x-ray. An MRI of a bone should be black and it is grey, this may indicate a stress fractures. A solid black line would indicate a fracture. As people age, the colors of the bones and tendons naturally move in the direction of damaged tissue, a sign the tissue is degenerating and breaking down subtly. If all the bones are grey, that would not be normal for an 18-year-old, but for an 80-year-old, is a sign the bone is older but nothing to panic about.

Dr. Barnett has extensive training checks for pronation, supination, inversion, eversion, abduction, and adduction. Heel off, Toe off and Mid-foot locking in gait. Dr. Barnett’s secret (diagnostic) weapon is actually just time spent & active listening to his patients. Its not uncommon to spend a large amount of time with Dr. Barnett at your very first appointment because it takes time to get to know someone & their foot pain/activity level/range of motion.

What are your hobbies? Are you a vegetarian or a red meat eater? Do you like to run or play pickleball or fish? Are you an avid moviegoer or prefer to be outside all day? Where does it hurt, when does it hurt? What time of day is the most painful? All the technology in the world can’t understand your lifestyle that could contribute to your pain or injury & it certainly can’t inform your goals for coming to see Dr. Barnett. If your goal is to be pain-free or to be running a marathon, Dr. Barnett will listen intently and work through solutions to help you achieve your goals. And that’s the best diagnostic tool in his arsenal.

With the invention of advanced diagnostic tools, we can really see what age does to the foot, but what does that mean and how do you improve age-related problems. Stay tuned to find out what you can do to improve your healing and recovery as you age and how to set the proper expectation when you get injured or have surgery.



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Align Foot and Ankle

1615 Pasadena Ave S, Suite 280,
St. Petersburg, FL 33707

Ph: 727.954.8075
Fx: 877.834.0099
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