(65) PD: FINDING YOUR FEET.

SOMETHING'S AFOOT

In line with sharing thoughts on Parkinson's Disease (PD), I wish to make my feet a feature of this Post and lay bare, foot issues. While we inch forward with gusto, I'll be banging on a conundrum about my ugly hammertoes, problematic flat feet (=overpronation) and unsightly bunions, thereby providing food for thought for sole-food consisting of "'unions", tomatoes and potatoes...(huh?).

Unfortunately, dear reader, I am unable to kick the habit of punning, so, if you wouldn't mind toeing the line with me, we can slowly shuffle forward together. Otherwise, you can buzz forward like a mosquito...(okay, okay, I'll reboot). 

I have been making use of foot specialists since I was 50, across three provinces in South Africa, because of my problem feet. This was also long before my Parkinson's diagnosis.

First, I became self-conscious of my bunions (similar to pic ➠), those bumpy outgrowths on the side of the big toes. In 2002 I discovered that an Orthopaedic surgeon could surgically remove my hallux valgus but, as such a procedure is expensive and can be painful, I didn't proceed with it. 

I may have worn inappropriate footwear when I was growing up which might have caused my bunions and the hammertoes, where the ends of some toes are bent downwards. However, because my parent had bunions and a sibling has overlapping toes as a result of flat feet, like I do (similar to pic ➠), our bunions are likely to be hereditary. Also, bunion removal would have been cosmetic as they weren't painful. 

Next, in 2005, I tried to fix my flat feet, which is when the undersides of one's feet do not have arches, and that's when I discovered medical Orthotists/Prosthetists. Prosthetists (⇽ see video) are those miracle workers who provide artificial limbs (prostheses), for soldiers or accident victims or others who need to be mobile and functional again. 

Orthotists are healthcare professionals who analyse your gait, i.e. the way you walk, either using a laser scan with computerised analysis, or conducting a simple visual inspection or even just making you walk barefoot over powder on the floor (I've done them all). Based on their bio-mechanical assessments, their diagnoses enable them to generate customised, inner soles or shoe inserts. One should have regular assessments to determine any foot changes, something I have sometimes neglected :-(.  

The function of my orthotic inserts - as well as regular reassessments by an Orthotist - is an attempt to realign and support my flat feet through re-formation of my arches. My inserts attempt to correct overpronation, which is where my feet, incorrectly, "roll inwards" when I walk, which has resulted in a gradual flattening of my arches over time. I have been wearing orthotics since 2005. 

Another specialist worth seeing if PD is affecting your gait, as well as the general condition of your feet and ankles, is a Podiatrist. I am fortunate to have a caregiver who's skilled at footcare issues. I used to have swollen ankles and ingrown toenails regularly, until my caregiver, LM, started working on them :-). A pedicure with a Podiatrist or nail technician is worth the effort and expense! 

*NB: attend to your feet when you're young - it will be much harder when you're older.*

BACK, KNEEE AND FOOT PAINS

As I have mentioned, my PD sometimes distracts me from keeping track of all my health issues, so my last visit to a medical Orthotist was in 2002 and I thought my feet were fine. So recently, in October 2015, I consulted JK, who runs a Medical Orthotist and Prosthetist practice in Durban, for an assessment and new orthotic inserts. I had also been struggling with the following: 

1. Since August 2025, I have had painful ankles and heels  (especially the right foot) and I have been wondering why;
2. I have also noticed my knees are flexed and point forward rather than being straight;
3. My back, on either side of my spine, (I've checked my kidneys and they're fine), is often sore during the day; and
4. Of equal concern was that my festination is becoming more prominent and less controllable.

So, I analysed the above problems (feet, knees, back, gait) by noting possible causes before conducting an online search and I came up with three possibilities.

 

1. EXERCISE  

• I have been cycling on a stationary cycle for at least 20 minutes daily. Could that have been the cause of painful knees and ankles. Am I cycling too much? I have been cycling for many years, so why is it suddenly causing a problem?
• Also, the pedals of my stationary, Threshold Mini bike, have adjustable straps above each pedal:  could these have been hurting my feet?

2. AGEING 

• I am 73 years old and have a slight stoop. Could there be spinal changes, together with weakening muscles and poor posture, resulting in my body adapting to improve my balance. 

3. FOOTWEAR 

• I regularly wear slippers that do not offer firm support for my heels and ankles.
• I have been wearing the same sandals (I have two pairs so I can alternate!) since 2023. They are comfortable and easy to put on and to fasten, but offer little arch and ankle support.
• I also have a good, lightweight pair of shoes. While they offer good ankle and foot support, they are difficult to put on, nowadays laces are difficult to tie and I need to wear socks (difficult to put on). 

MY OBSERVATION All three possibilities above (1.Exercise, 2.Ageing and 3.Footwear) could have resulted in my sore back, knees and ankles. By the week of 13 October, my caregiver, for a whole week, had to rub my feet and my lower back with a cannabis-infused "butter". There was some relief during the day but little overnight. By Wednesday 22 October, my wife had to rub my back again with the cannabis-infusion during the night because I was in pain. 

A mould of my feet was made to construct a new orthotic insert, and on Friday 24 October 2025, I collected my new orthotics from JK, a medical Orthotist I had consulted. This was 11 days after the cannabis massage started. I tried on my new inserts that day and that night my feet were sore, a standard response to a new orthotic insert. And then there was gradual relief... 

PD & FEET

MY OBSERVATIONS 

• The indirect effect of Parkinson's Disease, particularly my tendency to stoop and hunch forward, results in an imbalance of my weight. That stoop, in turn, puts pressure on my knees, ankles and heels. The orthotic insert, attempts to correct my flat feet by creating a slight arch that shifts my stance and balance by making me straighten my knees. This moves my centre of gravity slightly backward. By Friday 31 October most of the pains had subsided. YaY, new orthotics!
• Over the past 20 years I have taken the humble orthotic insert for granted, until 2025. Now I respect its presence and the expertise of the medical Orthotist.   

OTHER OBSERVATIONS

• A research project in Spain on foot health, by Navarro-Flores, et al. (2022) examining 62 patients with PD, concluded that Parkinson's "...presents a greater negative impact on foot health and quality of life which appears to be related to the chronic neurodegenerative disease." While this project used a small sample, in the context of my Blog, this conclusion is significant for me and my experience, in the context of Parkinson's.

• Linked to foot health, is the incidence of falling as researched by Creaby and Cole (2018) in their research where they concluded that "Falls represent a significant problem for people with idiopathic Parkinson's Disease (PD), with ∼60% of people with PD falling per year." I have been very conscious of preventing myself from falling, especially at home, where there is furniture, sharp edges and other natural hazards. Any walking inside or outside is to be taken seriously by us PwP. Also, I try to do outside walks after having taken my anti-PD meds.

CONCLUSION

My prosthetist, JK, said to me "joints love movement". I paid attention to his comment, hence this topic. 

According to physiotherapist Ramaswamy in the Parkinson's UK Magazine, the ankle and foot have 26 bones, 33 joints and more than 100 muscles, tendons and ligaments. That would explain why it was so difficult to address my recent foot and ankle pains (as described above) with a standard massage. 

Also, according to Ramaswamy, "The heel striking the ground is the body's signal to the brain to generate the power to push forward." With PD and the sometimes accompanying festination, the heels do not play a major part in shuffling. Now I understand the importance of the cue 'heel-toe-heel-toe' for motion and balance.

I have renewed "respect" for the presence and impact of this bl)0@£y movement disorder!

Till next time, dear reader, stay well and safe.

ADDITIONAL READING

1. How orthotics helped one patient with Parkinson's walk 18 miles pain-free = Podiatry Clinic UK 
2. Choosing the right shoes for Parkinson's = Parkinson's UK
3. The effect of personalised shoe insoles on Parkinson's = ARTICLE
4. Impact of footwear and foot deformities on patients with Parkinson's = ARTICLE 
5. Parkinson's foot pain: problems and treatments = info
6. Effect of foot health and...patients with Parkinson's Disease = ARTICLE