(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 2025, 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 

(42) My PD & I: cueing and observations!

BLOG STATISTICS

☺2138 "viewders" between April 2020 & April 2023.

☺Readers' countries = 1. South Africa (majority), 2. Russia, 3. Europe, then Australia, Canada, India, USA, New Zealand and Indonesia.  

☺Top referring URL = Facebook.     

Introduction 

😁 There has been a gradual increase in the readership of this Blog as well as their countries of origin: South Africans represent the majority, Russians second, a growing number of Europeans (presently 9 countries) and others are curious. This is heartwarming and makes the exercise of conceiving, developing and writing these posts a pleasant task! Thank you all, dear readers, for your sustained interest. 

😐 My Parkinson's Disease (PD), however, is making me unhappy. It's becoming an annoying part of life, gnawing away at my body and occasionally at my brain. As you know, I first noticed my right leg quivering early in 2012 so my PD has been around for at least twelve years and it's getting stronger and more dominant. Two years ago I was advised to stop driving = I listened. Last year I was also advised to hire a caregiver = I listened. I was advised by two neurologists (2013 & 2021) to take PD medication (most recently, Sinemet), but some of the side-effects I had been reading about were disturbing, so = I did not listen. 

I did not listen as I wanted to explore. I found one alternative in the natural remedies of the Ayurvedic approach (where their medicines are extracts of herbs and spices). Late in 2021 I engaged with an Ayurveda specialist and then started my PD treatment. Also, I gradually unearthed a range of customised PD exercises online (such as Gentle Chair Yoga, 5 minute Tai Chi), weekly Parkinson's ZA occupational therapy and cycling but one issue persists, namely my poor balance and dizziness. It is likely to be the result of my PD and/or my low blood sugar and/or an ear issue (I've ruled out high blood pressure). 

Today I wish to revisit cueing and spotting in the context of my PD support system. (See cueing in posts 27, 28, 38 and spotting in posts 6, 7, 38, 27). 

Reflecting on cueing strategies

As you know, in March 2020 we moved permanently to Durban into a third-floor apartment with four flights of stairs from the ground level to our front door. Initially, the stair-climbing was doable. When PD started to slow me down in 2021, I started to struggle on these stairs. I had already been using spotting as an external cueing strategy when dressing as it assisted my poor balance (coupled with my weakening arms and legs). In the context of PD, this 'weakening' is also referred to as "passive limb movement". As my balance issue had responded positively to spotting, I wondered if sequences of phrasing -- such as saying to myself "heel-toe heel-toe" -- could assist me to walk down and up the stairs in a measured manner: it did! This was my cueing, version 1.0, and I was walking confidently on stairs.

Later, I substituted the words with numbers. So, during late 2021, my "heel-toe" cue, a concrete concept to encourage my feet to move, evolved into my saying "1-2 1-2" which was more abstract. I was impressed with this adaptation to version 2.0 and believed that my using numbers (i.e. an 'abstract' representation to activate my movement) was superior to using words (i.e. a 'concrete' representation) when on the stairs. But, my reasoning was flawed. 

Moving from concrete to abstract was a mental exercise but it was not helping my motion. During February/March 2023 I noticed that when walking outside I would freeze or slow down quite often and I had no rhythm although I was walking at road-level. Actually, I had had more "rhythm" in 2022 when I navigated four flights of stairs at the old third-floor apartment! Grrr... 

👀OBSERVATION 1: what I neglected to consider was that a shift in my hand dominance (see post 8) might have affected my feet too. I was born with right hand dominance but since PD has weakened my right side, and that dominance has shifted to the left hand for most actions except handwriting! I even type with a dominant left hand! So, my left foot might have become a functioning right foot, as it were, resulting in internal confusion when using numbers ("1-2 1-2") for cueing rather than words indicating an actual foot ("right-left" or "heel-toe"). As soon as I changed my cueing to a clearer interpretation for my mind to interpret and execute, my walking rhythm returned. Also, for short periods I began to swing both arms rather than just the left arm.    

👀OBSERVATION 2: a walk around all three wings takes fifteen minutes but if I walk continuously without a break, then there's a tendency for my legs to go into festination mode where I'd be taking quicker, shorter steps and having difficulty in stopping. It is a scary result of being parkinsed! So, my solution has been to always take short breaks in order to break the rhythm of walking, especially down slight declines or slopes. And that helps. There are useful observations in gait re-education.

My cueing procedure has adapted and in the process I think I have learnt more about the inherent challenges facing the trial-and-error process of treating PD in a drug-free approach, as discussed above.  

My PD - almost a teenager! 

My PD is now 12 years old, technically an adolescent and almost a teenager. This errant child is showing signs of rebellion and bad behaviour and I wish I could ground it!  Why? Well, it thrives on being in me but independent of me, and is a know-it-all! 

👀OBSERVATION 3: the confusion might stem from my being on drug-free treatment. So, when I'm "well", then my brain responds to the Ayurvedic regime as something normal. But, when I'm really "sick" and take drugs (e.g. for a few weeks in March 2023 I had a severe cold with excessive dry cough resulting in my GP prescribing antibiotics - hence the delay in this Post 42), then my PD symptoms tend to worsen. I'm less mobile, I tremor more and tend to be more dizzy. And like a teenager, PD will not listen to me...

I should develop a cue for my PD to take a long walk on its own and never return! Till next time, dear reader, do take care.