The Foot and Parkinson’s Disease

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Involvement of foot:
Foot dystonia (sustained muscle contraction  twisting, repetitive patterned movement or an abnormal posture) triggered by walking and relieved by rest can occur in up to a third of those with PD. Stewart (1898) first described a dystonia in which the lessor toes of the foot flexed and the great toe hyperextends while walking in the early stages of some patients with PD. After standing still for a few minutes, it resolves. Dystonia of the lower limb is the presenting feature in up to 1-3% of those with PD – most of these involve the foot ; usually brought on with walking – may also get cramp like pains in arch. If not treated early  usually an equinovarus posture with an extended great toe (not to be confused with Babinski’s sign). In all patients who developed levodopa induced dystonia’s, the first site of initial involvement was the foot on the opposite side to which the Parkinsonism first developed. Dystonia’s seen in the ‘off’ period of levadopa dose cycle are usually painful and start in the foot, usually on side with initial or most severe forms of Parkinson's . Plantar pressure changes have been described – mean heel force at contact reduced, increased loading in midfoot, decreased force during propulsion . Significant changes in plantar pressure patterns are also seen in those in mild to moderate disease, with a tendency to higher forefoot loading and a medial shift in the load, which may be related to strategies to reduce unsteadiness of gait .

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