WHAT FOOT PROBLEMS CAN PEOPLE WITH PARKINSON’S EXPERIENCE?

There are a number of general foot problems, such as corns,
bunions and verrucae, that can affect everyone, regardless
of whether they have Parkinson’s or not. But there are
other difficulties people may experience because of their
Parkinson’s symptoms.

PROBLEMS WITH WALKING

Many people with Parkinson’s experience loss of balance, poor
posture and gait (manner of walking) problems. Some people
ind their stride gets shorter and the amount of time their feet
remain in contact with the ground increases.
People with Parkinson’s can also lose the typical heel-to-toe
pattern of walking — striking the ground with the heel and then
pushing off with the toes — because of the stiffness in their
ankles. This can lead to a more shuffling, lat-footed action.
A lat-footed gait can cause foot, leg and even knee pain, as well
as reducing the foot’s ability to absorb the shock of striking the
ground. In the long term, this type of lat-footed stance may
affect your mobility.
Some people with Parkinson’s feel as if they are walking on their
toes. Stiffness can affect the ankle joint and, in particular, its
ability to bend the foot up. Due to this stiffness, the foot holds a
downward-pointing position and the person feels as if they are
‘toe-walking’.
Stiffness and/or muscle contraction, particularly in the calf
muscles, make it harder for people to lex their ankles, affecting
the body’s ability to absorb the shock of contacting the ground.
This, in turn, may lead to pressure problems, such as too much
hard skin on the soles of the feet.
Some people with Parkinson’s may find they have problems with their feet. This may be a result of the
difficulties they have with their gait and walking, posture or cramps. They may also have difficulty bending over to
take care of their feet.
A podiatrist, a healthcare professional specialising in the care of
feet, along with a physiotherapist can suggest exercises to help
with this. Alternatively, a custom-made insole can spread the
force of contact with the ground over the sole of the foot.

DYSTONIA AND TOE-CURLING

People with Parkinson’s may experience muscle cramps and
dystonia in their feet. This is where one of your muscles or a
group of muscles tighten or shorten (contract) involuntarily.
Sometimes this may cause the toes to curl in, in a claw-like way.
Occasionally, the ankle may also turn inwards (this is known as
inversion) and put pressure on the outside of the foot. There may
also be ‘hyperextension’ of the big toe, which causes it to stick
up and rub on the shoe. This can lead to pressure problems on
areas of the foot that are not meant to deal with such pressure.
In some cases, dystonia can be connected to your Parkinson’s
medication — speak to your specialist or Parkinson’s Community
Educator to see if changing your dosage helps. A podiatrist can
also advise you on suitable treatments for toe-curling.
Dystonia can also affect the Achilles tendon at the back of the
heel, causing it to tighten up and pull the foot in a downward
position. This is another possible cause of “toe-walking”.

SWELLING

Swelling can be a problem for people with Parkinson’s. It may be
more common in people with slowness of movement.
Blood circulation relies on the legs moving and the leg muscles
contracting to propel the blood in the veins upwards to the
heart. If you don’t move very much, the veins become congested,
resulting in some fluid leaking out and gathering in the tissues of
your feet and ankles. This is known as oedema. A physiotherapist
can help you if you experience movement problems.
Swelling usually builds up during the day and goes down
overnight. Sometimes this is called ‘postural oedema’ because
gravity causes the build-up of fluid around the ankles when
you stand up. While the swelling is usually mild, some people
describe their legs as feeling heavy and they can have difficulty
in putting on tight shoes. Wearing footwear that can be
loosened during the day may help.
Ankle swelling may be a side effect of some Parkinson’s
medications. You should discuss this with your neurologist.
Swelling may lessen if your Parkinson’s is under control and you
are able to move around. If you are not able to move around too
much, lying lat with your legs slightly raised three to four times
a day can help some of the excess fluid to clear.
Sometimes a diuretic drug can be taken. Diuretics help to remove
excess fluid from the body by increasing the amount of fluid lost
as urine. Your GP, Parkinson’s Community Educator or podiatrist
should be able to advise you.

WHICH PROFESSIONALS CAN HELP?

If you have problems with your feet, you can visit a podiatrist
for advice. Podiatrists look at all areas of foot care including the
analysis of how the foot should work during ‘normal’ walking
and the problems cause by not walking in a ‘typical’ pattern.
Podiatrists work in a variety of places including clinics, hospitals,
rest homes, shoe shops and marae. Podiatrists often work with a
physiotherapist to help with foot-related mobility problems and
to help prevent falls.
A podiatrist can also develop and produce tailor-made insoles to
help reduce foot and leg pain and improve gait. These include,
for example, inserts or arch supports that can be place in your
shoes (or into specially made pairs), and ankle and foot insoles,
which can be particularly helpful if you have balance problems.

WHAT CAN I DO TO HELP MYSELF?

FOOTWEAR
Make sure your shoes it well, as ill-fitting shoes can damage
your feet. If you wear shoes that are too narrow, your toes get
cramped together and may overlap.
Try to choose shoes that have a low, broad heel and fasten over
the top of the foot close to the ankle. Shoes with laces, Velcro
or a strap and buckle are better than slip-on shoes—your toes
have to grip too much in slip-ons. Try to wear slippers as little as
possible. Although they may feel comfortable, they give your feet
little or no support.
You also need to make sure that you have enough room to
wiggle your toes. Look for lightweight shoes, especially if you
have problems starting movement. For example, you could try
trainers made from natural or breathable ibres.
If you have been prescribed an insert, make sure you take it with
you when you buy shoes. And try to shop for shoes when your
feet are at their worst. Remember, if a shoe needs ‘breaking in’, it
does not it.

EXERCISE

Your podiatrist can train you to stretch and exercise your
muscles to reduce the effects of stiffness or rigidity on your feet.
They can also show you and your carer (if you have one) simple
massage techniques to improve movement and circulation.

TOE SPLINTS

A removable silicone ‘splint’ can help to stop toe-curling from
getting worse and give the toes something to grip.
If you still have some flexibility in your toes, they can be
supported in a straightened position with a simple and effective
device made from quick-setting silicone rubber. This is moulded
around the toes and allowed to set, ensuring it its properly.
If you experience toe-curling, a podiatrist can give you advice on
the best treatment for you.

GENERAL FOOT CARE TIPS

• Wash your feet daily in warm, but not hot, water with a
gentle soap that does not irritate the skin. Do not soak them
for any longer than an average bath time. Dry your feet
carefully, especially between the toes. Do not try to get a
towel between the toes if they are curled or rigid.
• If your skin is dry, use moisturising cream all over the foot
except between the toes.
• Remove hard skin by rubbing gently with a pumice stone.
Apply moisturiser little and often—twice a day if possible. If
hard skin is painful, consult a podiatrist.
• Do not cut corns, calluses or ingrown nails yourself or treat
them with ‘corn cures’ or ‘corn plasters’.
• File your toenails weekly, if possible, using a file with a
rounded end or an emery board. Don’t file the nail too short,
and don’t ile them down at the corners as this can lead to
ingrowing nails. Do not use sharp instruments such as nail
instruments or clippers, especially if you experience tremor
or involuntary movements. If you ind it hard to manage
your toenails yourself or your carer is unable to help, speak
to your podiatrist.
• Keep feet warm and exercise when possible to improve
circulation.
• Don’t wear the same shoes all the time. Alternate daily if
possible, as this will spread the pressures on your feet.