What’s Feet got to do with it?

An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry

HOW DIABETES, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, JOINT CONDITIONS & VITAMIN DEFICIENCIES CAN AFFECT YOUR FEET

It’s easy to think about feet as those two things that hang from the end of your legs and take you to different places. In fact, many of our patients frequently ask, ‘what’s feet got to do with it?’ when they come in for a routine check-up. Apart from a brilliant play on words from an iconic song (Tina Turner is the gift that keeps on giving), your feet can tell us a lot more about your general health than you may think. In this post I’ll highlight a couple of conditions that can impact your feet!

Diabetes

Diabetes is a complex condition that affects the whole body – even your feet. It’s a result of uncontrolled glucose levels circulating in the blood from low or insufficient amounts of insulin, which normally converts glucose into energy. Having diabetes increases the risk of foot complications which include:

– Reduced circulation (blood flow) from narrowing and hardening of artery walls. Cuts and wounds take longer to heal with decreased blood flow

– Impaired nerve sensation (ability to feel). Not being able to detect feeling under the foot can lead to more damage before treatment is sought

– Stiffening of the joints

– Impaired nail and skin health

– Decreased muscle strength

These complications can put the feet at higher risk of developing bacterial and fungal infections, foot ulcers, and amputations. Podiatrists can help to reduce the risk of these complications occurring by identifying potential risk factors and providing helpful tips to manage and maintain your foot health.

Hypertension, high cholesterol, and other cardiovascular conditions

High blood pressure (or hypertension) and high cholesterol (or hypercholesterolaemia) are common cardiovascular conditions that affect blood flow throughout the body. As the feet are far away from the heart, decreased blood flow can lead to decreased circulation in the legs and feet. Significantly decreased circulation can contribute to developing peripheral arterial disease which can reduce quality of life and lower limb health, and increase the risk of heart attacks.

Signs of decreased circulation to keep an eye out for include: change in skin colour, sudden change in skin temperature, especially if feet are feeling unusually cold, sudden swelling around the legs and feet that aren’t related to exercise, loss of hair on the legs and feet, cramping or burning sensations in the feet at rest, wounds that take longer to heal than what they used to and cramping or fatigue in the calf when exercising which immediately goes away with rest.

Podiatrists are equipped to identify and test arterial flow and work with doctors so your feet and overall health can stay in tip-top shape.

Osteoarthritis

Osteoarthritis is a degenerative joint condition that is often caused by repetitive overuse of the joint.
In the feet, osteoarthritis most commonly affects the big toe joint, the midfoot joints (second cuneometatarsal and talonavicular joints), and the ankle joint. Those with osteoarthritis can experience:

– Pain during and after activity

– Stiffness after periods of inactivity

– Joint swelling and discomfort

Osteoarthritis can be discouraging because it can limit you from doing the activities that you enjoy. Diagnosis of osteoarthritis often involves x-rays, but they aren’t always needed. When it comes to treatment ‘motion is lotion’. Movement and exercise therapy has been found to be very effective in improving pain, stiffness, and physical function. Your podiatrist can work with your doctor, physiotherapist, and/or exercise physiologist to manage your osteoarthritis.

Connective tissue conditions

Connective tissue is found everywhere in the body – it connects, maintains, and supports structures in your body. Examples of connective tissue conditions you may have heard of include:

– Ehlers Danlos syndrome

– Lupus

– Scleroderma

– Rheumatoid arthritis

– Sjogren’s syndrome

For example, common foot health problems in those with Ehlers Danlos syndrome include nail deformities or difficulty cutting nails due to muscle weakness in the hands, increased callous formation due to changes in skin elasticity, delayed healing, and frequent joint dislocations, low muscle tone, and muscle aches due to hypermobility.

Vitamin deficiencies

Just like any other part of the body, vitamin deficiencies can affect our feet.

Vitamin B12 deficiency has been linked to peripheral neuropathy, which means altered sensation affecting peripheral areas like your toes and fingers. A vitamin B12 deficiency can happen if you’re taking certain medications, aren’t eating enough B12 in your diet (common with strict vegetarians), or if your body simply can’t absorb it due to an underlying condition. Low B12 levels can lead to changes in the myelin sheath that wrap around your nerves. We can compare this to compare this to an electrical cord – if the protective outer layer is damaged, the electrical cord still works but the function may be impaired.

Symptoms of peripheral neuropathy can include numbness and tingling in the feet, loss of coordination, pins and needles, or changes in temperature that don’t correlate to how they feel when you touch your feet. Because there are many causes of peripheral neuropathy (including diabetes), your podiatrist can work with you and your doctor to identify the cause and provide management solutions to improve comfort levels.

Vitamin D helps your body absorb calcium, which we know is important for bone health. Low vitamin D levels have been linked to decreased bone density and muscle weakness, which can lead to an increased risk of bone fractures and muscle injuries. In Canberra, our long winters mean that a lot of people don’t have as much of an opportunity to get out into the sunshine for our daily dose of vitamin D. In fact, when I was diagnosed with a tibial stress fracture in 2020, one of the factors that affected my low bone density was my low vitamin D levels. The easiest and best way to obtain vitamin D is through the sun, but if that isn’t an option for you daily vitamin D supplements can do the trick. Your podiatrist may refer you to a GP for blood tests or a dietician for further advice on increasing vitamin D and calcium intake.

Feet are a part of the body that don’t get as much love and attention as they sometimes need. If something is bothering you about your foot and ankle, your podiatrist is well equipped to help you!

any causes of peripheral neuropathy (including diabetes), your podiatrist can work with you and your doctor to identify the cause and provide management solutions to improve comfort levels.

Resources

Aitken, S. (2020). Peripheral artery disease in the lower limbs: The importance of secondary risk prevention for improved long-term prognosis. Australian Journal of General Practice. doi:10.31128/AJGP-11-19-5160

Bhattoa, H. K. (2017). Vitamin D: Musculoskeletal health. Reviews in Endocrine and Metabolic Disorders, 363-371. doi:https://doi.org/10.1007/s11154-016-9404-x

Edward Roddy, H. B. (2018). Foot osteoarthritis: latest evidence and developments. Therapeutic Advances in Musculoskeletal Disease, 91–103. doi:10.1177/1759720X17753337

Kade L. Paterson, L. G. (2019). Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment. Drugs Aging, 203-211. doi:https://doi.org/10.1007/s40266-019-00639-y

Prof Anthony Redmond, D. H. (2016). Footcare in hypermobile Ehlers-Danlos syndrome. Retrieved from Ehlers-Danlos Support UK: https://www.ehlers-danlos.org/information/footcare-in-hypermobile-ehlers-danlos-syndrome/

The Foundation for Peripheral Neuropathy. (2016). Nutritional and Vitamin Deficiency Neuropathy. Retrieved from The Foundation for Peripheral Neuropathy: https://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/vitamin-nutrition-deficiency/

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