Foot Care For The Elderly-Podogeriatrics

For podiatrists, podogeriatrics – care of the feet of the elderly – is a daily cause for concern, for a variety of reasons. I know that it is a part of our professional work that is often not looked at with much enthusiasm. There are more "old" people around because we are living longer. The foot care required by the older person is usually considered ‘routine.’ There are often financial considerations, due to lack of funds.

However, in a seminal piece of research published by the Disabled Living Foundation (UK) in 1983, is was found that the elderly (people of pensionable age), were occupying 85.9% of the National Health Service (NHS) podiatrists’ clinical time. There have been many changes in NHS policy and the provision of foot care since then and also to the way podiatry is practised in the UK, but one wonders just how we are doing in South Africa.

I would guess that the majority of our elderly people don’t have access to adequate foot care from a podiatrist. This is largely due to the inbalances in the structure of health care in the country, where the majority of the older people only have access to State care not private. Hence the proliferation of other "foot carers" such as nurses, health care assistants,beauty therapists and others, all of whom have responded to specific needs.

Getting older should not be a punishment for living longer and I believe there exists a desperate need for quality foot care for the older person. Podogeriatrics is not and should not be a case of regular cutting a filing of nails plus some callus reduction, carried out in quick time for a small fee.

Today I was visited by a few "oldies". Mary has just retired from a lifetime of teaching and came complaining about her painful left foot, where she was concerned that "there is a small piece of a fixation pin poking out under my foot, because there is a sharp pain in the callus and my surgeon told me after he had removed the pin originally, that there was still a piece that he could not get out".

By carrying out a simple biomechanical examination of Mary’s feet, I was able to analyse the possible source of the problem and treatment included reducing the painful callus and at the point of greatest pressure, enucleating the corn and recommending appropriate non-adhesive padding. In the long-term a simple cushion insole will probably be necessary.

80 year-old Harry also visited me for the first time asking if I could help him with his increasingly painful left foot and salvage his old but comfortable sandals. Again a careful, but simple, assessment of the structure and function of Harry’s feet (Biomechanical assessment), led to me inserting a pair of preformed moulded insoles (orthotics), into his shoes. To further improve function I added a piece of felt at a strategic spot under the insole – an immediate sense of support and noticeable improvement of foot alignment.

The advice for the sandals was to take then to a local African kerbside shoe repairer with instructions to replace the soles appropriately.  The lesson here is that podiatric care can be a major benefit to the elderly and that it extends far beyond simple nail cutting. (Although that IS all that is required).

Nevertheless, I don’t want to spend all my days cutting and filing toe nails!! What I do enjoy is seeing results of simple care plans. What we need in South Africa is evidence of the real and perceived need for foot care amongst this age group. Then we can lobby Government for improvements in the provision of podiatry services for the elderly nationwide for all our people. 


Andrew has taught at the University as well as providing podiatry services in South Africa since 1977. Twice chair of the Podiatry Association of South Africa and a commentator on care of your feet on both radio and television he now works in private practice in Cape Town and Hout Bay.

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Matt - February 4, 2008 Reply


I live in a rural area and don’t have access to a podiatrist. Do you think these diabetic orthotics would work as a good substitute?

Andrew - June 22, 2008 Reply

Hi Matt,
I really am sorry for failing to get back to you. I’m not very good yet with all this technical stuff. The main point is why do you need othotics anyway? Rather protect your feet with decent shoes (that doesn’t mean expensive). Do all the things we recommend to take good care of your feet as well. Mail order is not the best way to get foot care especially for people with diabetes. Protect your feet with thicker soles and inner soles for cushioning.

RaiulBaztepo - March 29, 2009 Reply

Very Interesting post! Thank you for such interesting resource!
PS: Sorry for my bad english, I’v just started to learn this language 😉
See you!
Your, Raiul Baztepo

    Andrew - March 31, 2009 Reply

    Hi Raiul
    I hope that you enjoy reading the rest of the site


Hayley - March 30, 2009 Reply

Hi, I was wondering if you knew anything about the NHS and how they deal with foot care?

santjie Loubser - March 21, 2011 Reply

Where can I buy suitable shoes for my eldery father who is unable to tie shoelaces? The shoe should offer him support as he is unstable and tends to fall. I am in the Pretoria area. Thank you. Santjie Loubser.

    Andrew - May 24, 2011 Reply

    Santie, try giving Joe Aumuller a call at Muelmed Hospital. he will be able to advise and help you.

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