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Monthly Archives: July 2014

Feet in stroke patients

What is a Stroke?

A stroke happens when blood supply to the brain is interrupted. Blood is carried to the brain by blood vessels called arteries. Blood contains oxygen and important nutrients for your brain cells. Blood may be interrupted or stop moving through an artery, because the artery is blocked or bursts. When brain cells do not get sufficient amounts of oxygen or nutrients, they die. The area of the brain damage is called cerebral infarct. Brain cells usually die shortly after the stroke starts. However, some can last a few hours, if the blood supply is not cut off completely. If the blood supply can be returned in the minutes or hours after the stroke, some of these cells may recover. If not, they will also die.

What happens after a stroke?

Paralysis is the inability of a muscle or group of muscles to move voluntarily. Muscles are controlled by messages sent from the brain that trigger movement. When part of the brain is damaged after a stroke, messaging between the brain and muscles may not work properly. Paralysis or muscle weakness are sometimes referred to as “movement” impairments, and they affect up to 90 precent of stroke survivors who lose or have impaired motor function. Paralysis or weakness can affect any parts of the body.

Many stroke survivors experience one-sided paralysis, known as hemiplegia, or one sided weakness, known as hemiparesis. These conditions can be seen as paralysed or weak limbs, facial muscles or loss of control of organs such as the bladder. Locked-in syndrome is an example of severe paralysis that leaves a person incapable to move any muscle except those that control the eyes.

Symptoms may include:

– Hemiparesis

– Spasticity/Stiff muscles

– Dysphagia: Trouble Swallowing

– Hemiplegia: One-Sided paralysis

– Foot Drop

– Weakness

– Incoordination

– Sensory deficits

– Balance problems


Hemiparesis is the most common movement impairment which refers to one-sided weakness. Hemiparesis affects roughly 80 percent of stroke survivors, causing weakness or the inability to move one side of the body. Weakness can impact arms, hands, legs and facial muscles.


Spasticity is a form of paralysis that affects roughly 40 percent of stroke survivors and is characterised by stiff or tight muscles. The tight muscles constrict movement, making it difficult to lift things, walk or perform daily activities of living.

Foot Drop

Foot Drop is common after a stroke. The disorder is characterised by weakness of paralysis that limits the ability to rise the front part of the foot. The foot or ankle drops down when the leg is lifted to take a step. A person with foot drop may trip and fall if the foot and ankle are not supported by a brace. Foot drop can result when nerves are damaged during a stroke. Partial or complete recovery is possible with the help of rehabilitative therapy. Physical therapy is central in strengthening muscles and joints.

Podiatrist’s Role

As a podiatrist it is vital to ascertain the cause of the stroke from the medical history. If vessel disease is the underlying pathology, there is a reason to assume similar vascular manifestations are occurring in the lower extremity. Podiatrists also have a role in examining and treating the biomechanical complications that stroke victims have.


– Footwear advice

– Orthotic therapy

– Custom ankle foot orthoses

– General podiatry


What are neuromas?

A neuroma is a benign growth of nerve tissue along a nerve pathway. In terms of foot problems, it is a growth of nerve tissues that progresses in the nerves that lead to the toes, causing pain, a burning sensation or numbness in the forefoot, often starting in the ball of the foot and radiating into the toes.

Neuromas are frequently referred to as “pinched nerves” and “nerve tumours”, although they are tumours only in that they are simply benign enlargements of nerve tissues and are not to be confused with cancerous tumours. Neuromas in the feet are also sometimes referred  to as “Mortons Neuroma”, after the 19th century Philadelphia surgeon who first described the problem.

Neuromas most often develop in the nerve that serves the third and fourth toes, although it can affect other toes as well. It develops in response to problems that cause irritation or inflammation of the nerves, including trauma, biomechanical deformities and arthritis.

The fact that neuromas occur eight more times frequently in women than in men suggests that a frequent cause is wearing tight shoes that squeeze toes and high heels that shift the weight onto the front of the foot and jam the toes into a small toe box.

While neuromas often can be dealt with through conservative, medical treat treatments, surgical correction may be necessary in some instances. The surgical podiatrist of Hartford HealthCare Medical Group are both skilled and experienced in this area.

What are the symptoms of neuromas?

Pain in the ball of the foot that radiates between the toes is the prime symptom of a neuroma, especially pain that comes while walking or wearing tight shoes. Often, this pain will wear off when you take off your shoes and perhaps massage your feet. It is uncommon to experience it when you have been off your feet, such as during or a night after sleep.

The pain may take the form of a burning pain in the ball of the foot, shooting pain toward the toes, tingling or numbness.

What causes neuromas?

Neuromas develop in response to abnormal pressure or irritation that cause inflammation of swelling of nerve tissue. This can be a result of such issues as biomechanical problems in the motion of the feet, disease that may cause inflammation or swelling of the nerve tissue. This can be a result of such issues as biomechanical problems in the motion of the feet, disease that may cause inflammation, or poorly-fitting shoes. The simple repetitive stress of a job that requires you to be on your feet all the time, such as waitressing, can lead to the development of neuromas.

– Biomechanical problems: Flat feet or feet with high arches are susceptible to instability around the foot joints. If your muscles, tendons and ligaments don’t work properly together, the stress on your toes may result in the inflammation of a neuroma.

– Poorly fitting shoes: Tight shoes that squeeze your toes or high heels that shift your weight onto your toes are a major cause of all foot problems, including neuromas.

– Inflammation from disease: Diseases such as arthritis may cause inflammation of the tissues surrounding the phalangeal joints can cause the development of neuromas – as well as the physical stress of walking in a manner to compensate for the arthritic pain.

– Trauma: Injuries to a toe or toes can cause inflammation that leads to the development of a neuroma.

How are neuromas diagnosed?

Your Physician can diagnose your neuroma through a physical examination of your feet to see if the enlarged nerve tissue represented by the neuroma can be felt, perhaps placing pressure against your toes and the ball of your foot to try to replicate the pain. Other causes such as arthritis or stress fractures can be ruled out with a range of motion tests and probably x-rays.

What can be done to treat neuromas?

Roomier shoes – You should look for shoes that conform the shape of your feet as much as possible and give plenty of room in the toe box, ensuring that your toes are not pinched or squeezed. You should make certain that, while standing, there is half a inch of space for your longest toe at the end of each shoe. Make sure the ball of your foot fits comfortably in the widest part of the shoe.

Low-Heel Shoes – High heel shift all your body weight onto the front of your foot and jam your toes into the front of your shoes, tremendously increasing the pressure on them and the joints associated with them. Instead, wear shoes with low (less than two inches) or flat heels that fit your foot comfortably.

Padding – You can buy pads at most drug stores to wear inside your shoes to cushion your feet and areas of pain.

Medications – Over-the-counter medications such as aspirin or ibuprofen can help reduce  inflammation and pain. Non-steroidal cortisone injections administered by your physician can help with this also.

Orthotics – Orthotics are shoe inserts that can help correct mechanical foot-motion problems that cause pain and inflammation.


Gout is a common form of arthritis characterised by recurring attacks of extreme pain, swelling and redness. Gout is more common in men, and often several men of the one family can be affected by gout.

While most other types of arthritis progress slowly, an attack of gout happens suddenly, often overnight. The most commonly affected joint is the big toe, but gout may be experienced in the feet, ankles and knees, and less frequently in the elbows, hands, and other joints. For some people, even the weight of a bed sheet can cause intolerable pain.

Causes of Gout

Gout occurs when uric acid builds up in the bloodstream and deposits urate crystals in the joint. The build-up of uric acid is most commonly caused by under-excretion of uric acid by the kidneys, but may also be caused by the over production of uric acid by the body.

Some people have higher levels of uric acid in their blood stream when compared to others. This condition is called hyperuricaemia and can be hereditary. Other causes of gout can include the use of diuretics (fluid tablets) which can cause the retention of too much uric acid.

Risk Factors of gout

A person with gout is more likely to have an attack when they:

– have elevated levels of urate in the blood

– consume to much alcohol (particularly beer)

– consume a diet high in ‘purines’ such as meat, sweetbreads, offal, shellfish, and fructose (found in fruit juices)

– are obese

– use diuretics

– injure a joint

– become hydrated

 Dealing with an attack of gout

With no treatment the attack usually resolves within one or two weeks, however with medications the attack can be resolved within several days.

If you have not had an attack of gout before, your doctor will look for elevated urate levels in your blood and may aspirate (remove a sample of fluid from the joint) to make a definite diagnosis. If you have gout, uric acid crystals can be seen in large numbers under a microscope.

Once the diagnosis is confirmed, your doctor will consider the following treatment options:

– non-steroidal anti-inflammatory drugs (NSAIDs)

– colchicine

– corticosteroids injections or tablets.

Some of these medications have side effects, your doctor will be able to advise the most appropriate treatment for you.

The methods  of managing an acute attack of gout vary from the ongoing methods for managing gout. The main goal in everyday management is to reduce the level of uric acid in the blood so it cannot form crystals in the tissues or joints. The benefits of reducing uric acid in the blood long term include:

– Slowing the progress or risk of kidney disease which maybe be caused by deposits of urate in the kidneys

– Possibly reducing the risk of heart disease.

If you have frequent episodes of gout your doctor may prescribe medications to reduce the formation of uric acid and increase the excretion of uric acid.

Changes to lifestyle can help in the long term

if you suffer from gout you will benefit in the long term from healthy changes to your lifestyle. Suggestions to assist in the lifestyle management of gout include:

– Maintain a healthy body weight. If you do need to lose weight, ensure your weight loss is gradual as “crash” diets can increase uric acid levels

– Cut down on alcohol consumption and avoid binge drinking

– Keep hydrated – drink plenty of water

– Consult a dietitian to get advice on a diet that limits the purines that are though to cause gout

– Exercise regularly

– Manage high blood pressure

– Work closely with your doctor to prevent further attacks and actively manage your condition.

Where to get help

– Your doctor

– Rheumatologist

Things to remember

– Gout is a type of arthritis caused by too much uric acid in the bloodstream.

– Excess uric acid settles in joints and causes pain and swelling

– Healthy lifestyle choices combined with a correct treatment program should mean that gout can be successfully managed.


Tinea Pedis

Tinea Pedis is a fungal infection of the foot caused by parasites on the skin called dermatophytes. Tinea Pedis is usually cased by anthropophile fungi. The most common are Microsporum, Edpidermophyton and Trichophyton. These account for 90% of all skin fungal infections, commonly referred to as ring worm.


Symptoms of Tinea Pedis include and itching, stinging, or burning sensation between the toes. This also occurs on the soles of the feet. Itchy blisters and peeling, cracking skin can also develop in these areas. It is sometimes accompanied by excessive dry skin on the bottoms or sides of the feet. Tinea Pedis also causes the toenails to become thick, ragged or discoloured. The toenails may crumble or separate from the nail bed. You can also develop a toenail fungal infection called Onychomycosis, another common disease of the nails that constitutes about a half of all nail abnormalities.


The fungus that causes Tinea Pedis, called dermatophytes, thrives in damp, moist areas. They Commonly grow in damps socks or shoes, especially shoes made out of plastic. When the fungus comes into contact with skin, it infects the top layer of skin, causing the top layer of skin to produce more skin cells then normal. This creates Tinea Pedis and its symptoms.


Over the counter anti-fungal treatments, such as Miconazole, Clotrimazole or Tolnaftate, helps clear up the infection. Google Health recommends using it for up to two weeks after the infection disappears to ensure the infection does not return. If it does not respond to over the counter anti-fungal treatments, prescription anti-fungal treatments are used. Doctors typically prescribe Ketoconazole or terbinafine. They may also prescribe antibiotics if there are infections on the foot caused by Tinea Pedis. Doctors can recommend the proper dosage and length of use.


Tinea Pedis is prevented by limiting where the Tinea Pedis fungi can live. Preventative measures include wearing well ventilated shoes made out of leather, wearing sandals at a pool or public showering facility and completely drying both feet are they get wet, including after swimming or taking a bath.

Other preventative measures include changing socks often, or once a day or more, to prevent moisture accumulation. Rubbing anti-fungal or drying powder on both feet also helps keep them dry, preventing infection.