Living with Parkinson's Disease – Part 2

Last week I dealt with the causes, symptoms and the foot problems people experience. As indicated then, I’ll deal with categories of Parkinson’s, associated ailments, foot care options, general treatment options, and exercise.

Categories of Parkinson’s Disease

Primary parkinsonism occurs most often in people over 50 years old; its cause is unknown. When someone younger than 40 is diagnosed with primary parkinsonism, it is called juvenile parkinsonism.

Postencephalitic parkinsonism can occur after a person has a brain infection.

Drug-induced parkinsonism can result from taking antipsychotic phenothiazine medications. It is reversible.

Secondary parkinsonism results from trauma to the substantia nigra. This can be striatonigral degeneration, in which other areas of the brain show damage, as well as the substantia nigra. It can also be arteriosclerotic parkinsonism, which involves damage to brain vessels due to multiple small strokes.

Parkinsonism that accompanies other conditions, sometimes called pseudoparkinsonism, can occur. People with disorders such as Huntington’s disease, or Alzheimer’s disease, may show parkinson-like symptoms.

Toxin-induced parkinsonism comes from toxins (poisons) such as manganese dust, carbon disulfide, and carbon monoxide. This is not reversible like the drug-induced disorder.


Associated Ailments


Swelling of the feet can also occur, usually in people with significant problems with slowness of movement. Circulation of the blood relies on movement of the legs, and contractions of the leg muscles that propel the blood in the veins upwards to the heart. If a person is not moving very much, the veins become congested, resulting in some fluid leaking out and accumulating in the tissues of the feet and ankles.

Dystonia and Toe-curling

The muscle cramps and dystonia experienced by people with Parkinson’s are frequently felt in the feet. The contraction of muscles can cause the toes to curl in, in a claw-like way. Occasionally, the ankle may also turn inwards, 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 top of the shoe. These all lead to pressure problems on areas of the foot not designed to withstand these pressures.

In some cases, dystonia can be connected to your anti-Parkinson’s medication. It is best to discuss this with your doctor as they are best placed to advise you whether adjustment of your medication is likely to help your dystonia.

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 the problem of ‘toe-walking’ that some individuals experience.


What can be done to help?


Well chosen footwear can go a long way towards helping. Most people don’t need me to explain the harm that wrong-fitting shoes can cause. Supportive shoes with cushioned inserts or arch supports can absorb some of the shock. It is advisable to wear slippers as little as possible. Although slippers may feel comfortable, they provide the foot with little or no support.

Some people who experience ‘freezing’ (a symptom of Parkinson’s that causes the person to stop suddenly while walking), may find that proper soled shoes permit slippages that facilitate movement, although this may slightly increase the risk of falling through slipping. Others say that a sole with ‘grip’ makes the person think about lifting up the foot to walk, and therefore maintain a more ‘normal’ gait for longer. This does not necessarily reduce the risk of falls, because the prevention of sliding may cause the patient to fall forward. As stated earlier, every person with Parkinson’s is different. Each person should therefore be assessed and advised according to their particular problems and needs.

If you have been prescribed an orthotic, make sure you take it with you when buying shoes. Try to shop for shoes when your feet are at their largest; that’s in the afternoon. What fits in the morning will not be quite so good when you are wearing it in the afternoon. Remember, if a shoe needs ‘breaking in’ it does not fit.


Your specialist can train you to stretch and exercise the muscles concerned in order to lessen the effects of stiffness or rigidity on the foot. They can also instruct care givers in simple massage techniques to improve movement and circulation. A custom-made orthotic device will also spread the forces of ground contact over the whole of the sole of the foot, and by improving the gait will allow the foot and calf muscles to work more effectively. Professional care from a physiotherapist and massage therapist is also advised.


General Treatment Options

While there still isn’t a known treatment option to stop Parkinson’s or reverse the breakdown of nerve cells that cause the disease, medication can work in relief of some symptoms and for pain management. Surgery is an option for only a small portion of patients.

Treatment is different for every person, and the type of treatment you will need may change as the disease progresses. Your age, work status, family, and living situation can all affect decisions about when to begin treatment, what types of treatment to use, and when to make changes in treatment. As your medical condition changes, you may need regular adjustments in your treatment to balance quality-of-life issues, side effects of treatment, and treatment costs.

The different categories of the disease affect treatment effectiveness, as do work/leisure activities. Massages and pedicures would help to aid with callouses, and other foot maintenance issues.

Your feet mirror your general health . . . cherish them!

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