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All types of dementia, of which Alzheimer’s disease is the most common and the most well known is a devastating condition. We certainly see it in many patients that we see drift away slowly and the impact that this has on their loved ones.

We sometimes get asked if is foot pain associated with dementia and Alzheimer’s disease? Generally, the answer to that is no. There is nothing that is inherent in the physiological processes that go on in those with Alzheimer’s disease that can cause foot pain. However, as those who tend to get Alzheimer’s are older and foot problems are more common in those are older, it stands to reason that they will get the usual and typical types of foot problems that those in that age group get. There are also issues with the ability of those with the Alzheimer’s to care for their own feet and the necessity for caregivers to check the feet on a regular basis for any problems. Also the general frailty associated with the condition does make the foot more vulnerable to damage.

Getting foot care for those with all forms of dementia is just as important as any other health service provided. The development of foot problems is going to affect the mobility and quality of life. Providing foot care can be a challenge at times, mostly due to them failing to understand and appreciate what is going on around them, perhaps even lashing out physically and verbally. Foot problems do develop in Alzheimer’s disease, so please check your loved one and bring them in if there are any problems.

An ingrown toenail is due to a combination of a curved shape to the nail, poor cutting technique and pressure on the toe from the shoe. Many cases can be managed with conservative care periodically and that combined with good self-care can often take care of it. For some, that is not enough and something more drastic and radical seeds to be done to prevent it from becoming such a regular problem.

If you are in that latter category where the problem is ongoing, then please come in and discuss it with us. A minor surgical procedure under a local anaesthetic can remove the side of the of the toenail that is causing the pain and an acid is used on the growing area of the nail to prevent that side or edge of the nail from growing back. Healing afterwards is usually uneventful, but we do like you to wear an open shoe or sandal for up to a week and keep it dry for at least a few days so that it heals up properly. Please come in and discuss your options if you have this problem.

We use a lot of the urea-based creams, specifically the Walker’s brand. We have found it very effective for the dryer skins and the Walker’s comes in two concentrations (15 and 25), so we can choose which is more effective.

Urea based creams have been widely used for since the 1940’s to treat dry skin and conditions like psoriasis and dermatitis. It has next to no side affects, though an allergic reaction is a rare one. Below a concentration of about 20 (ie the Walker’s 15) the action of the urea is to act as a humectant, which means it helps the skin retain moisture. Above a concentration of about 20 (ie the Walker’s 25) it causes a breakdown of proteins in the skin and the dry skin can flake of and soften the skin. We will often choose to use one or the other depending on the clinical needs. Varying the use of the two can prove to be quite effective.

Pain in the foot does have a higher incidence after menopause. This study in a group of women in Spain looked at the foot-related quality of life issues surrounding menopause and found that, yes, there is a poorer quality of life-related to foot pain after menopause. There are a number of physiological changes during the ‘change of life’ that affect foot pain in menopause. These changes include:

  • Changes occur to the properties of the soft tissues. For example tendons become stiffer and this increases the risk for injury to those types of structures.
  • Osteoporosis is much more common after menopause to the changes in the different hormones. This makes the bones ‘softer’ and more likely to have a bone stress injury, a stress fracture or a fracture.
  • there are changes to the hormone control of the small blood vessels and this can predispose to issues with the circulation as the circualtion reacts sluggishly and differently.
  • After menopause, there is almost always in increase in weight. This increase puts more load on the foot and increases the risk for developing a wide range of foot problems.

Menopause on its own does not cause foot pain. It is the physiological changes that happen during menopause that increase the risk for a lot of different types of foot problems. We can help with those foot problems.

Tutankhamun was the 13th pharaoh of the 18th Dynasty of the New Kingdom of Egypt who lived over 3300 years ago and Joseph Goebbels was a Nazi politician in Germany and the chief propagandist for the Nazi Party, becoming Hitler’s Minister of Propaganda from 1933 to 1945. They both allegedly had a clubfoot.

A clubfoot is deformity that is present at birth and occurs 1 to 4 times per 1000 births which makes it a reasonably common issue at birth that obstetricians and midwives routinely screen for it. With a clubfoot one or both feet are rotated in an inward and downward direction. Almost all cases are picked up at birth and treated promptly. Initially they are treated with serial casting to slowly move the foot back into a more normal position. Those that are more rigid and more severe may need a surgical correction.

Most cases respond without any issues and they do not have problems. Some do develop some problems that may show up later in life. These kinds of issues are related to something like the foot not being “100% corrected” following birth, but being say, “85% fixed” which is fine, but over the years of weightbearing and activity there may be some issues with things like aches in some of the joints due to the alignment or maybe things like painful calluses under a metatarsal heads due to too much pressure there. These are quite manageable with inserts in the shoe to change the weightbearing and there are options to deal with the painful calluses. Please get in touch with us if you have any of these long term problems that may be due to a corrected clubfoot when you were a baby.

There is a lot of confusion and debate about Tutankhamun’s clubfoot and Goebbels’ clubfoot. There is no doubt that Tutankhamun did have a genetic disorder (he had a cleft palate), but there is debate if the deformity of his foot due to damage that occurred to the mummy, so the clubfoot could just be a postmortem artifact. Goebbels’ variously described his foot deformity as being due to an infection, an accident or polio. Under German Nazi law, it was possible that his clubfoot was one of the genetic diseases that required compulsory sterilization, so he would not want to be included in that.

An ancient practice in China was to bind the foot of young girls to stop them growing. They were tightly bound and it was painful. In that culture at the time a smaller foot was considered more erotic and a higher price could be demanded by the brides family prior to marriage if the feet were smaller. The practice was barbaric, disabling and brutal and was widely practiced, especially in rural China. The practice was banned many years ago and is no longer done. There are still some older Chinese women alive in remote rural areas who were subjected to this as children.

Chinese Foot Binding

Once this was done, there was no treatment for the pain and the best option for them was to keep the feet bound. Chinese food binding has also been shown to affect cortical issues in the brain.

While this practice has ended in China, a number of social anthropologists have drawn parallels between Chinese foot binding and the practice of women wearing tight fitting shoes in today’s society. Both practices are argued as being something that is done to please the male members of society and both practices are harmful and brutal to the foot.

Obesity has become a significant risk factor for so many medical conditions that is becoming much more common. A few years ago it was estimated that 67% of the Australian population over the age of 18 were either overweight or in the obese category. This has major public health implications.

The risk for so many different medical conditions is increased by being overweight. Foot problems are no exception. It should be obvious that carrying more weight than necessary is going to increase the chance of getting a whole range of different foot problems as well as making existing foot problems more severe.

A recent study has shown that a simulated reduction in weight loss improved the symptoms in the foot for those with arthritis. There is a high correlation between plantar fasciitis and the body mass index reported in another study. This goes to show just how important keeping weight under control is for preventing foot problems (and a multitude of other health problems) and the importance of loosing weight to help recalcitrant foot problems (and a multitude of other health problems).

Burning feet is a common issue that we get asked about and it is often hard to get to the bottom of and difficult to deal with as it will often not be apparent what is causing the symptoms. The burning feet syndrome is frequently characterised by the sensation of burning and a heavy feeling that occurs within the legs and feet. In the past, it was first described by Grierson in 1826 who had been the first person to report the signs and symptoms of burning feet. An even more comprehensive account was written about by by Gopalan in 1946, so for a while the burning feet syndrome has also been often known as Grierson-Gopalan syndrome.

There is normally not any specific cause of burning feet and the cause is often not found. It might be connected with nutritional or endocrine causes such as a vitamin B insufficiency, the painful neuropathy occurring in diabetes, in those with kidney failure especially if on renal dialysis, or with hypothyroidism. The could be a local pinched or irritated nerve problem. Burning feet tend to be more common in people older than 50 years but it could and does come about at all ages. The signs and symptoms are typically characterised by way of burning sensation, a heaviness, a numbness or a boring ache that occurs predominantly in the foot. It tends to follow a ‘sock’ distribution rather than be patchy. In most cases it is just on the bottom of the feet but may ascend to affect the top of the foot, ankles or up the lower legs sometimes. The forearms and palms of the hands are typically not impacted, but when they can be, then this really needs to be investigated further. Sometimes people may possibly report ‘pins and needles’ or tingling kind of discomfort in the feet rather than just the ‘burning’. Normally, the symptoms are usually a whole lot worse during the night and are somewhat improved throughout the day time. They’re also not really made worse with an increased levels of activity or standing which may signal a musculoskeletal condition as opposed to the neural involvement in burning foot syndrome. Evaluation of your feet and legs by a health professional frequently locates no objective signs and symptoms. A range of investigations, especially blood tests are generally often carried out to look for any of the particular problems that might cause the condition.

The therapy for burning feet syndrome will either have specific measures which can be aimed at what’s causing it (eg diabetic neuropathy, pinched nerves, thyroid conditions) and general steps that can be useful in most cases. These common options range from the using of open and comfortable shoes, perhaps those having arch supports, as well as wearing natural cotton socks might possibly be somewhat helpful. Relief from the signs and symptoms may be obtained by immersing the feet in chillier water for around 15 minutes. It’s also vital that you steer clear of exposing the feet to sources of heating. There are pharmacological therapies that include tricyclic antidepressants and other drugs such carbamazepine and gabapentin which can be used in the more significant conditions. You will find side affects associated with these drugs, but they are essential at giving reduction to the symptoms when it’s necessary. Despite having the usage of drugs, the treating of the symptoms could be a tough and some individuals will have to be evaluated by a specialist pain facility and presented strategies to help live with the pain sensation.

Short version: no

Long version: no, they don’t.

do circulation boosters really work

There are several brands of the so-called ‘circulation boosters’ on the market that make cautious claims about boosting the circulation. The claims are made with caution as there is no evidence that they actually do. You often see them being promoted on the morning TV shows, in infomercials and commercials with celebrity endorsements (I have certainly lost respect for those that do endorse the circulation boosters). The concept behind a circulation booster is that it uses electric muscle stimulation to contract and relax the muscles, thereby increasing blood flow to your legs and feet. They may well do that for the short time that you are using that device, but the effect will last no longer. If you really want to boost your circulation then get out and go for a walk. That will do substantially more for improving your circulation than spending money on one of these devices.

The electrical stimulation may prove usual for some people with some type of neurological pain in their feet, so there is no shortages of testimonials that they “work” as they could help some of these problems. They do not help by improving the circulation. Despite the length of time that these have been on the market there is a distinct and obvious lack of scientific and medical research supporting their use.

Another way of looking at it, why are all the vascular surgeons not recommending the circulation boosters for their patients? There is a reason for that.

There is also a reason why so many are being sold second hand on eBay and Gumtree. That is because the circulation boosters no not really boost the circulation and so many are selling their devices.

Short answer: with difficulty.

Ballet flats are a particular shoe design inspired by the shoes used by ballet dancers. By design these shoes are very minimalist. They do very little to the foot except cover it and come in a wide range of attractive designs. They also tend to be very snug fitting to help them stay on the foot. There is nothing inherently wrong with these types of shoes provided that are fitted properly and are of the right size for the user.

The issue with these minimalist types of footwear is if there is a foot problem that needs some sort of arch support, even on a temporary basis. The main sorts of problems that this might be needed are especially if you are on your feet all day and the feet and legs get very tired. Due to the minimalist nature of the design and the typically snug fit of the footwear, there is not going to be a lot of room in the shoes to do much. Clinically, choices or options can be limited if you spend most of your time in this type of footwear. There is simply no way that a typical foot orthotic is going to fit into these types of shoe. Sometimes a cut down foot orthotic might be able to fit in the shoe. Other times the problem can be managed by changing to a different type of footwear that foot orthotics can easily be used in for a period of time until the problem gets better. It is always best to see a podiatrist and discuss the options that you have if you really do need some sort of support and if it can be accommodated in your ballet flats style footwear.

Arch Support in Ballet Flats

There are a very limited number of ballet flats on the market that do have arch support type designs built into them. However, they are hard to find and may not be suitable for you. There are the instant arches types of self adhesive pads that can be stuck in the shoe to give some sort of support and this is often a good compromise if that is what is needed to deal with your problem. We do use them from time to time when there is no other more suitable workaround to getting support into a ballet flat type of shoe.

Long answer: it can be done, but there has to be compromises made.