We rely on them and take them for granted. We use and abuse them. We rarely like looking at them. And we’re generally pretty bad at taking care of their health. Our poor feet put up with a lot.

And particularly as we age, that can mean that we end up having to put up with all manner of aches and pains in these two crucial, but neglected appendages.

Or do we?

This conversation I had with the brilliant foot and ankle physiotherapist, Jane Baker, will challenge so many of the preconceptions and expectations you have about and for your ageing feet. As well, I hope, as inspiring you to follow her simple, and fantastically effective, strategies for getting and keeping your feet as healthy as possible, now and in the future.

This is a rather longer blog than usual, but honestly, everything Jane had to say was so useful and informative, I couldn’t bear not to pass it all on to you.

So put up those hard working feet of yours and find out how to show them the love they deserve.

HEYDAYS How did you become a foot physiotherapist?

JANE. Good question! I’ve been a physiotherapist for over 30 years and whilst I was a general physio for a long time, I started to see more and more people with foot-involved conditions. For example, they might have had a hip or knee injury, or back pain and I began to see more clearly the connection between their feet and other injuries.

Then there were the people who came in with specific foot pain - hammer toes, bunions, plantar fascia pain, Achilles problems.

I started to get more interested in feet. They’re so complex and you can get really involved the biomechanics, the anatomy, how they work. I did more and more courses, started having conversations with foot and ankle surgeons, watching surgeries and going into clinics. Over the past 15 years, I’ve built a practice and a reputation around treating people’s feet.

What is it that makes feet so complex?

One foot has 26 bones in it, so between them the feet have a quarter of all the bones in the whole body. Then there are 30+ joints and each joint has ligaments that connect the bones to the bones. It has groups of muscles that go from the lower leg into the foot, but also has its own set of intrinsic muscles. There are 4 layers of those intrinsic muscles in the foot.

An image from Jane’s Instagram page showing the bones in the foot

That’s not dissimilar to the hand. But the foot is a weight bearing structure. It works one way when it’s not on the ground, and then, when you put it on the ground, it works in another way that influences the rest of the body.

For example, very simply - if you’ve got flat feet and your feet roll in, what happens in the foot has an effect on the shin bone and the knee and the hip and therefore your whole leg.

So when you’re looking at the foot, you’re looking at how it affects the rest of the body as well.

What is the effect of the normal ageing process on our feet?

When we get past 50, we’re only too well aware of the changes in the rest of our body, well they’re the same in the feet. Just like in the rest of your body, any of the structures in your foot - the muscles, ligaments, tendons and bones can be affected by ageing.

In our body, normal joint movement becomes a little less efficient. For example, our knees get a bit stiffer. In the foot, that could mean that the ankles get stiff, or the joints in the middle of the foot get stiff, and lots of us know people with stiff big toes.

The difference is that we may be aware of the stiffness but we don’t tend to do anything about it. If we have stiff knees we might try and mobilise them. We tend not to do that for our feet. And because we have so many joints in our feet, this has quite a significant knock-on effect.

Then there’s the soft tissue, and the collagen and elastin in the tissue. Our bodies lose the elastic and springy properties in these tissues and that happens in the foot as well. And the foot bones and ligaments can be prone to osteoporosis or osteopenia, the same as the rest of the body.

And just as we get osteoporosis or osteopenia as we get older, we can get the same thinning of the bones in the feet as well.

One function of the foot when we land on the ground is to act as a shock absorber. The foot unlocks when it lands on the ground in order to absorb shock, then as we propel ourselves, it becomes rigid again, and on we go. We have shock absorbency structures such as fat pads, in the heel and under the ball of the foot. Those can atrophy, deteriorate or waste away, so the pads become thinner and we have less shock absorbency.

On top of that, as we age we get into habits. So we may have something simple like a verruca, or some sort of heel pain, and that makes us walk slightly differently, so we’re not using our muscles as we would normally, and very, very subtly over a long period of time, the muscles waste and get weaker and then we get the problems.

It helps to understand the changes that happen to our feet as we age

Do you think people are less aware of what’s going on in their feet than they are in the rest of their body?

Absolutely. I’ve discovered a couple causes for that which I think are really interesting.

One is that lots of people don’t like their feet. They’re not generally particularly pretty, and as they get older they might get more bony, more wrinkled, have a few bent - or hammer - toes, or bunions. None of that is very attractive.

The other is that because they’re at the bottom of our legs, they’re sort of quite…far away. Lots of people don’t actively wash their feet in the bath or shower. And in a similar way, you put moisturiser on your face, neck and body, but most people don’t put it on their feet.

So they’re generally in the periphery and ignored.

We have thousands and thousands of sensory nerve endings in our feet, so if you don’t touch them, they become a lot less responsive and you can’t feel stuff as well and the knock on effect of that is you’re not getting the input from the environment which is so important for things like balance, standing and walking.

As you’ve said, we all know that our bodies change as we age and we also know that it is possible to do things - like exercising and eating well - to slow down that process. Can you do the same with your feet, to keep them as healthy as possible, or indeed, restore them to something more healthy?

Definitely! First of all though, I would say that if you have pain in your feet, see a physio, podiatrist or chiropodist and get some treatment. There’s lots of information on my website and on Instagram page.

There are so many people walking around with painful feet and thinking when you get older, that’s normal, everyone’s feet hurt. That’s rubbish.

To take the best care of your feet yourself, there are different areas to focus on - strength, mobility and balance and proprioception - the awareness of where we are in space via information that we get through our sensory nerve endings.

Starting with sensory side, you simply need to touch your feet. If we think about where the brain is and where our feet are, they’re a long way away from each other. It’s not like our hands which we can see all the time. So every bath and shower, actively wash your feet and put cream on them afterwards (but please don’t walk on a slippery surface right afterwards!) Whatever way you do it, touch your feet. Wake up those sensory nerve endings. Wake up those muscles.

Jane showing how to give your feet some massage love in a rather fuzzy screen grab (apologies) from her informative Instagram page

Feeling your feet also helps you get familiar with them. If there are any lumps and bumps or any painful areas.

When it comes to flexibility, can you move your ankles up and down? Can you do circles with them? Doing these movements lubricates the joints and gets them mobile. Can you move your toes? Can you move your big toe - which has muscles that are separate from the other four toes - separately from the others? Your feet CAN become very dexterous - think about people who don’t have use of their upper limbs and use their feet to do things like hold pencils - we just don’t use them that way.

Then there’s strength. When we were kids we could probably pick up things with our toes. It’s much harder now. Can we use our toes that way? Can we stand on one leg? Balance is really important and we use the muscles in our feet to help us balance. So a really simple way of strengthening our feet is to do balance exercises. For some people that might mean balancing on one leg. For others that could be balancing with two feet together. Or with one foot in front of the other.

Another really important element of foot health is skin and nail health. Check your nails for ingrowing toe nails and your feet for toe fungus, verrucas, heel cracks (which can be incredibly painful and affect how we walk, which in turn affects the rest of the body).

Be honest, are we destined from a certain age to only wear terribly sensible flat shoes?

If you talk to the purists, they would say: no-one should ever be in any kind of shoes other than those with very wide toe boxes. And walk around barefoot as much as possible.

I treat a lot of women who I could say that to until I was blue in the face but they still wouldn’t do it! Probably the most common conversation I have with my patients is ‘can you recommend a good looking shoe for my feet’ and it’s a challenge, that’s for sure.

My advice would be: everything in moderation. I wear high heels, but I don’t wear them all the time, and I balance them with being bare foot and wearing wider shoes. I make sure my feet are strong and flexible and then I can get away with doing that.

I don’t promote wearing heels, and I’m very clear about the negatives of wearing them, particularly as we get older as our fat pad under the ball of the foot gets thinner. It’s not that comfortable! But if you do want to continue wearing high heels, what can you do to make sure your feet and ankles are strong and fit enough to do that.

If you’re going to wear heels, make sure your feet are strong and fit enough

Do men have less problems with their feet as they age, simply because they’re never - or at least as far as we know! - worn heels.

Men do tend to have less problems with feet. I certainly see more women with bunion problems and hammer toes than men.

If we even look at the sort of shoes we put young children into and as they age, girls will tend to want to wear more fashion focused shoes, which generally tend to pull toes in, whereas boys tend to be in wider shoes.

What are the key things we should do regularly to take care of our feet?

These are my three go-to exercises (if you do have any foot pain, get it checked before doing them).

I’m quite specific in my instructions, which I go through in detail on my website and Instagram page.

Exercise one

One of my favourite exercises is massaging a ball under the arch of the foot. You can do this sitting or standing, and use various densities of ball. I tend to start people with a soft ball - like an old tennis ball that has some give in it - and use harder ones as they get more tolerant. This gives a sensory input and there’s a massaging effect that wakes the muscles up. I always say it needs to be comfortable, not painful. If it’s painful, you’re pressing too hard. It’s not a no pain, no gain situation! If you’ve got tight arches and you’re the type of person who hobbles because their feet hurt, it’s a really nice thing to do first thing in the morning.

Jane demonstrating ball rolling in one of the excellent videos on her website

Exercise two

The second is balance exercises. Test your balance - in a safe space obviously, maybe in a doorway. Can you stand on one leg? If you can’t then it’s really appropriate to start doing some balance exercises. You might start with trying to balance with your feet together, or in a step stance or stand in a split stance and see whether you can balance. Practice and progress to balancing on one leg. I would expect people to be able to stand on one leg for up to a minute. That’s something you could do when you’re cleaning your teeth, for example.

Exercise three

The third is to get some dexterity into the feet. That could be doing something as simple as, when you’re sitting on the loo, trying to spread your toes out. Then keeping the big toes down, lift the other four, then the other way - with the four down, try and lift the big toes.

And along with all of that, try to spend some time at least walking around barefoot.

Is walking around barefoot a good thing to do even if you have flat feet? If you’ve been told to wear orthotics in your shoes, isn’t it counterintuitive to walk barefoot?

That’s a really good question. If we think of orthotics as an adjunct to treatment, then we can put in place a programme where you’re in orthotics to relieve pain or help function, but around that you’re doing a strengthening programme to help support your feet. Think of it like this - you wouldn’t just put a back brace on and then not to any core exercises.

Building up to walking barefoot, if you’re not used to it, could be part of your overall foot health activities. So it might be that you do some exercises and spend five minutes barefoot if you’ve been in shoes and orthotics all the time and very gradually build up the amount of time you spend barefoot, making sure you’re not stressing anything.

Many people wear orthotics, either because they’ve been told to, or because they find they help them to feel more comfortable. Are they good or bad?

You can’t divide them that way. It’s very individual. One thing I always say to patients is if they’re given orthotics, they should also be given an exercise or strengthening programme. So if you go to a podiatrist are given orthotics and you aren’t given a protocol for wearing them or exercises for strengthening your feet - ask what you can do.

It’s also important to remember that feet change. If you’ve had orthotics for a long time and haven’t had them reviewed, that’s like having a pair of glasses for years and not having them checked by the optician. Or a set of braces without going to the dentist.

So review your orthotics on a regular basis, especially if you’re strengthening your feet, because it might be that you don’t need them as much.

Yes they’re very valuable and can significantly reduce pain or disfunction. But the other element is what you are doing to help strengthen your feet.

There’s so much you can do with your feet to keep them healthy and improve them if they’re not. Be as proactive as you can and go to see somebody if you have problems.

In case you hadn’t worked that out already, there’s lots of information , along with some helpful exercise videos, on Jane’s website, where you’ll also find all her contact details, and on her Instagram page