The importance of good foot care in Parkinson's: Q&A with podiatrists

Can you briefly outline how you support people with Parkinson’s in your role as a podiatrist?

Podiatrists have an important role to play in caring for people with Parkinson’s.

This includes developing management plans to help prevent issues such as falls. Podiatrists also help improve their patient's quality of life by improving their walking and balance, footwear and support, and treatment of their regular foot care needs such as skin and nail conditions.

All of these can have positive impacts on foot health and welfare.

For people with Parkinson’s, wearing incorrectly sized footwear (in terms of length, depth and width) is significantly associated with poor foot health and a decreased quality of life. Some podiatry teams, such as the team at South Warwickshire University NHS Foundation Trust, provide shoe fitting clinics where patients can find appropriate shoes for their foot type, style of walking (gait) and to accommodate any deformity or swelling. All podiatrists offer advice on footwear best suited to their patient's needs.

Along with suitable hosiery and insoles, this creates a stable, efficient, economical gait and helps improve the person’s confidence as with an improved balance they have a better posture and this, in turn, reduces their risk of falls and discomfort. 

Are there any common symptoms you see when treating people with Parkinson’s? And if so, what advice do you give them? 

There are often changes in the gait of someone diagnosed with Parkinson’s, including a slow walking speed, increased stride variability and short, shuffling steps. These can lead to alterations in the function of the foot, an increased risk of falling and foot ulceration, specifically on the apices (tips) of the toes.

We would advise that all people with Parkinson’s see a podiatrist to ensure that appropriate footwear, insoles and foot assessment can be carried out. The NHS podiatry services should have a referral process for patients presenting with a high risk of ulceration or who require a biomechanical, vascular or neurological assessment. 

You should also consider referring to podiatry if your patient is presenting with falls risk or general pain in their feet, even if there are no apparent skin or nail changes. The podiatry team can give appropriate advice on foot care, footwear and will develop a care package appropriate to the patient. Ongoing routine podiatry may not be provided by the NHS. This will be dependent on the health care provider and the specific risk factors of the foot. However, private podiatrists can also offer ongoing routine care. Visit the Royal College of Podiatary's website to find a private podiatrist near you.

Podiatrists work with other healthcare professionals including orthotists, physiotherapists and occupational therapists to provide appropriate footwear and adaptations to insoles, ensuring comfort and pressure relief to prevent ulceration or pressure sores. 

What key things do you want other healthcare professionals working with people with Parkinson’s to know about good foot care in Parkinson’s?

It is important to encourage patients to check their feet daily, particularly around any pressure areas. Be mindful that neurological changes could mean that feet are not responding to pain or pressure and ulceration can develop. Additional pressure and friction are common due to gait and mobility changes and self care is often harder due to changes in hand dexterity and ability to bend. 

Providing advice on spotting the warning signs of infection is also key. This includes looking for differences in temperature, swelling and changes in colour (often red and shiny skin). Any bruising, discolouration, presence of blood, pus or fluid should always be seen by a podiatrist. 

We’d also advise checking patients’ footwear too. It’s important that shoes can be fastened and altered, for example Velcro straps. Shoes such as unsupportive, loose slippers, ballet pumps or flip flops are not ideal as they increase friction, pressure and the risk of trips and falls. 

Are there any other ways that other Parkinson’s healthcare professionals can work more closely with podiatrists?

We would advise making contact with your local NHS podiatry service or booking with an independent podiatrist in your area by visiting the Royal College of Podiatry website.

Podiatry branches often seek out training and Continuing Professional Development (CPD) opportunities so as a healthcare professional, you may like to think about delivering a session on Parkinson’s and your own roles to provide an opportunity for joint working and a more holistic approach to care. We spend a lot of time with the patient when providing care so it's important that we know which other healthcare professionals are involved in their care.

Is there anything else you would like healthcare professionals to be aware of?

The key thing to highlight is that regular podiatry intervention maintains good foot health and comfort for the patient. If a person with Parkinson’s has comfortable, well-managed feet, for example, their corns, callus and nails are looked after properly, their symptoms such as clonic tremors and pain related to sensory stimuli are reduced. This in turn leads to a better quality of life.

From our extensive clinical experience of working with patients who have Parkinson’s, we know that good foot care is vital to people’s overall wellbeing.