PARKINSON’S disease is a chronic progressive disease of the nervous system. It is marked by tremors, muscle rigidity and slow, imprecise movement. It is usually diagnosed in middle-aged and elderly people, and is associated with the degeneration of the basal ganglia in the brain and the deficiency of the neurotransmitter, dopamine.

Parkinson’s disease cannot be cured, but it can be treated and the symptoms may be reduced. Treatment includes surgery, physiotherapy, occupational therapy, and medication.

Most people with Parkinson’s will find that they have problems with their feet. This results in difficulties with their gait, walking, posture, and cramps.

Patients may experience a loss of balance and find that their stride gets shorter as well as that the amount of time their feet remain in contact with the ground increases.

People with Parkinson’s tend to lose the typical heel-to-toe pattern of walking due to stiffness in the ankles. This can lead to a shuffling, flat-footed action and cause foot, ankle, leg, and knee pain. Most patients will feel like they are walking on their toes due to the excessive stiffness.

Stiffness and muscle contraction in the calf muscles make it harder to flex the ankle, affecting the body’s ability to absorb the shock of coming into contact with the ground. This, in turn, causes callus and tissue breakdown (ulcers).

Your podiatrist would be able to remove the callus and manufacture paddings and insoles to spread the force of the contact with the ground evenly over the entire foot.

DYSTONIA

People with Parkinson’s disease may experience muscle cramps and dystonia in their feet. Here, the muscles tighten involuntarily, causing the toes to curl. Occasionally, the ankle may turn inwards and put pressure on the outside of the foot again, causing callus development and pain.

SWELLING

Swelling or oedema can also be a problem due to the restricted movement of the patient. Blood circulation relies on movement and the contraction of muscles to propel it around the body. If you can’t move very well, the veins become congested, resulting in fluid pooling in the tissues around the ankles.

A physiotherapist can help if you experience this problem. Patients should consult their doctors to control their Parkinson’s so that they are able to move around more freely, to avoid swelling.

FOOT CARE TIPS FOR PEOPLE WITH PARKINSON’S DISEASE

1. All patients should ensure that they wear well fitted shoes that are not too narrow and the heels not too high.

2. Choose shoes with a low, broad heel that fasten over the top of the foot, close to the ankle.

3. Do not wear slip-on shoes or flip-flops as these offer no support.

4. Purchase lightweight shoes. Sneakers made from natural or breathable materials are ideal.

5. Shop for shoes when your feet are at their worst, usually late in the day. It is very important to note that if shoes need to be broken in, they do not fit.

Your podiatrist can advise you on stretching and to exercises to reduce the effects of stiffness and rigidity on your feet. They should also be able to advise you regarding massage techniques to improve movement and circulation.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville (962-2100), Ocho Rios (974-6339), Kingston (978-8392), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.