Podiatry and Parkinson’s: common foot problems and treatments

Feet carry the body’s entire weight and provide an important function: walking.  It is therefore vital to seek advice on foot problems as, if left untreated, they may become painful, reduce mobility and falls could become more likely.

Those with Parkinson’s may be particularly susceptible to certain foot problems and may also find it harder to care for their feet – leaning over to cut toe nails for example or safely using nail scissors.  The following outlines some of the problems that may arise:

• gait – in ‘normal’ walking the heel strikes the ground first and the toes are the last point of contact as the foot lifts from the ground again.  But in Parkinson’s a more flat-footed style of gait tends to occur as stride length is shortened and the ankles are more rigid.  This can lead to a shuffling walk which poorly absorbs the impact of the foot making contact with the ground, potentially resulting in foot, leg and knee pain.  It can also make balance and mobility more difficult.

In contrast to flat-footedness, some people with Parkinson’s tend to walk on their toes as rigidity in the ankle can also lead to the foot pointing downwards.  This ‘toe-walking’ adds pressure on the toes and may impact mobility and balance.

A podiatrist, usually working with a physiotherapist, will be able to suggest exercises and strategies to correct poor gait or prevent ‘toe-walking’, as well as ways to ensure that the stride is more even and the foot more flexed to improve heel-to-toe contact with the ground.

For further information, see Where can I get more information.

• stiffness – stiffness or cramps in the calf muscles can make it harder for the foot to absorb the impact of it striking the ground when walking and pressure problems may arise, such as calluses on the soles of the feet.  General stiffness can affect walking and prevent the foot from making proper contact with the floor.
  
  A podiatrist will help with this and may also refer you to a physiotherapist.  They will suggest exercises to stretch the muscles to reduce stiffness.  A podiatrist can also advise on specially tailored devices called orthoses which are custom-made to fit your foot and will help spread the impact of making contact with the ground across the whole foot.  This can improve gait and mobility and allows the muscles in the calves and feet to work properly.

• dystonia – dystonia and muscle cramps frequently occur in the feet.  Typically the toes curl into a claw-like position, the foot turns inwards at the ankle (inversion), and occasionally the big toe sticks up (hyperextension).  This position, caused by spasms in the calf muscles, can be very uncomfortable and make it hard to fit feet into shoes.  The toes may also rub on footwear and pressure problems may arise on areas of the foot not designed to withstand pressure.
  
  The Achilles tendon may also tighten as a result of dystonia which can cause ‘toe walking’ as the foot is pulled downwards.
  
  Your podiatrist will be able to suggest ways to prevent toe-curling, possibly using orthoses such as toe splints.  Such splints can help prevent toe-curling and are made of silicone which gives the toes something to grip on when walking.  If splints do not help sufficiently, then a podiatrist can also make a special mould from quick-setting silicone rubber which forms a casing around the toe and, when set, helps to keep the toes straight.  In some cases adjusting medication can help with dystonia so discuss this with your doctor or your Parkinson’s Disease Nurse Specialist.
  
  For further information on dystonia and its treatment see the dystonia section.

• oedema – this is swelling resulting from theaccumulation of excessive fluid in the tissues and is more likely to occur in those who experience bradykinesia, i.e. slow or reduced movement.  If you have swollen feet or ankles you should visit your doctor to eliminate other causes, such as heart or renal problems or Deep Vein Thrombosis.
  
  For people with Parkinson’s the swelling may be caused by reduced movement and prolonged periods spent sitting.  Blood circulation back through the veins relies on the movement of leg muscles, so if movement is reduced the veins can become congested and the pressure forces fluids into the surrounding tissues. Those who spend excessive amounts of time standing may suffer from postural oedema as gravity causes excess fluid to collect around the ankles when upright.
  
  Oedema can be alleviated by lying flat for at least an hour during the day to improve circulation, or by keeping the legs raised when seated.  Your doctor may prescribe a diuretic - a medication which increases the production of urine and stimulates the movement of toxins through the kidneys.
  
  A podiatrist or physiotherapist can help with exercises, such as ankle rotations to prevent fluid build-up in the legs, and as oedema can make it difficult or uncomfortable to wear shoes, a podiatrist will be able to advise on comfortable forms of footwear, for example shoes that can be loosened during the day if swelling occurs.  Both therapists can also show your carer how to give you a gentle foot or leg massage to improve circulation.