A systematic review and meta-analysis of population-based epidemiological studies was undertaken to determine the prevalence of foot and ankle pain in middle and old age. Searches were conducted in the following electronic databases from inception to October 2010: PubMed, EMBASE, AMED, CINAHL, Cochrane, PEDro, and SportDiscus. Full-text English language articles were included if they used population sample frames, cross-sectional design or analysis, and reported prevalence estimates for foot and/or ankle pain in adults aged 45 years and over. Thirty-four articles from 31 studies involving 75,505 participants provided 529 prevalence estimates based on different case definitions and population strata. Random-effects meta-analyses of studies with comparable case definitions provided pooled prevalence estimates, for frequent foot pain of 24% (95% confidence interval 22-25%; n=3; I(2)=46%) and for frequent ankle pain of 15% (95% confidence interval 13-16%; n=2; I(2)=0). Small sample sizes and low response rates in some studies, together with heterogeneous case definitions, limit confident conclusions on the distribution, subtypes, and impact of foot/ankle pain. Narrative synthesis of evidence from existing studies suggested preponderance in females, an age-related increase in prevalence in women but not men, that the toes/forefoot were the most common anatomical sites of pain, and that moderate disability in an aspect of daily life was reported by two-thirds of cases. This review provides estimates of the community burden of foot and ankle pain in middle and old age. By outlining the scale of this clinical problem, these findings can be used to inform health care planning and provision.