Medical Effects of Health on Feet & Legs
When general health is affecting the feet, putting them at risk, a regular check up and programme of care can help
When the body's systems start to change because of age, deteriating health, disease or trauma - the effects on feet and legs can be quite significant. Sometimes the tablets, drugs and other treatment you need for a condition in another part of your body will have a direct impact on the feet and legs. There is a range of diseases which are described as being systemic as they will have effects on several of the body's organs and networks, which indirectly can affect the feet.
We have experience of a wide range medical conditions that will affect the feet and are often able to help through assessment, treatment : including skilled scalpel work, medicaments, shoe inserts, orthoses, and targetted advice.
The range of health issues we have experience of and skills in helping with the effects on feet include, for example:
This is a systemic disease that can affect many of your body systems and organs - pancreas, kidneys, vision, cardio-vascular, peripheral blood supply, and nervous system.
The feet of a person with diabetes can be then be affected in several ways, including for example, poor circulation, or loss of sensation. This can lead to small breaks in the skin, as the person is not aware that they have hurt, or wounded their foot. They may not even be aware that they have a drawing pin in their shoe. Once the wound is established it may become infected and be slow to heal.
The medical standard for monitoring diabetic foot and leg health may be used So we carry out regular diabetic foot checks which can help monitor the status of the circulation to the feet and legs; and the sensation types and levels. In turn, we are able to alert a patient, their doctor and their family of any changes. We advise on a whole range of ways of maintaining diabetic foot health to minimise the liklihood of hospitalisation, wherever possible.
For example: Rheumatiod Arthritis, Psoriatic Arthritis, Lupus, Scleroderma, Ankylosing spondylitis
These are a group of diseases that are classed as auto-immune diseases. They affect many systems of the body including the musculo-skeletal system, heart, lungs, skin etc.. The disease may have phases of being active and causing damage, and then periods when the disease is inactive and body systems are stable. The treatments prescribed by specialists in hospitals and by GPs may be powerful - helping to reduce the damage whilst the disease is active. However, some drugs prescribed and the disease, itself, will have effects on the legs and feet. This may show as pain, deformity, thinner skin and loss of fibro fatty tissues that protect the bony parts of the foot. There can be an increased risk of wounds and slow healing ulcers. Loss of joint movement and flexibility , causing stiffness in the spine, leg joints, and hands may mean that the care of feet is no longer achievable by their owner!!
During active phases of these diseases, patients may be seen in specialist hospital or community NHS Podiatry facilities. However, in lower risk cases, or where the disease has been stable for some time, patients may seek out alternative providers of podiatry care in the independent sector, such as Achilles Foot Health Centre.
So, we carry out regular foot health checks which helps to monitor the overall condition of the feet and legs; as well as a broad range of treatments to maintain optimum foot health - minimising the effects of Rheumatic Disease in the foot and leg to maintain mobility.
Paul uses a Rheumatology foot assessment system based on a regional Clinical Effectiveness Group's recommendations for the foot in rheumatic disease.
For example: Stroke, brain injury, neuropathy - numbness, phantom limb pain; parkinsonism.
There are many causes of damage to the nervous system that can affect us in several important ways:
Loss of Motor skills - Our ability to move around easily can be reduced by stroke, vascular dementia, Parkinsonism, Diabetic neuropathy, we may be less flexible or unable to carry out basic footcare at home
Loss of Sensory awareness - Our ability to be aware of our body and feel the key senses of pain, hot/cold, touch/pressure, vibration, or the loss of smell ( especially with feet!!), or vision ( to see the condition of feet ) can mean that damage or disease is putting the feet at risk without us being aware.
Loss of Autonomic control - These are activities of the nervous system that we may not have any awareness of or control over, such as sweating, heart beat regulation and blood flow. The effects on the foot may cause dryness due to lack of sweating leading to cracks/fissures on th heels, or the poor circualtion affecting the quality of the skin.
Loss of intellectual skills - due to Alziemers, Vascular Dementia, depression etc. may lead to loss of awareness, forgetfulness, stubborness, denial of loss of self care abilities leading to gradual deteriation in the health and appearance of a persons feet.
Often, we find that we are contacted at Achilles Foot Health Centre, when a visitor to person with these sort of impairments sees their feet, at home. The visitor, whether it be a friend or more usually a daughter or son, are surprised and unjustifiably embarrassed at the changes in the feet and levels of mobility. However, with a course of treatment, there is a good liklihood of improvement over the short , medium or long term.
For example: Peripheral Arterial Disease (PAD), Intermittent Claudication, Raynauds Disease, Chilblains, Lymphoedema, cardio-vascular disease, venous system issues - varicose veins, eczema, ulcers
The legs and feet are dependent on a good flow of arterial blood to bring oxygen and food for the maintenance and repair of their tissues at cell level. They need the valves in the veins to work to help carry the waste products away with each compression of the calf muscles - as we walk and move around. The lymph system which bathes the cells in fluid to help with food transfer carries away more waste products.
Doppler measurements using hand held probe will check blood flow When any one or more of these systems start to fail, the nutrition and health of the leg and foot can be impaired. There may be mild side effects at first, however, over the years the condition of the lower limb can deteriate, putting the person at risk of ulcers, limited ability to walk any distance, discomfort and pain, loss of their former quality of life.
So, to help optimise the foot health and keep people active, we monitor the condition of the feet - measuring pulses, blood flow, oedema / swelling; advise on ways to help keep the feet's good condition, carrying out footcare and treating any lesions in a safe way. Maintaining limb integrity, mobility and independence.
When people are treated for blood diseases or leukaemia, lymphomas, and cancers etc. there are sometimes unwanted side effects.
This can be seen with changes to the growth of finger and toe nails and the skin quality within the foot and leg. Sometimes, this leads to thick or distorted nails which may 'grow in' or shed and crumble away.
Some drugs such as Vincristine can cause neuropathy, parathesia and loss of ankle reflexes. Patients with Hodgkin's disease are particularly susceptible to infection because of cellular immunity, bone marrow supression and of the immune system generally.
We are experienced in such cases, both as clinicians and in our personal / family lives . We monitor the skin and nail effects using our skills to minimise issues, aiming to heal infections without resorting to surgery, unless, all other avenues have been explored.
Immune suppressed patients
When people are prescribed immune suppressing drugs for a medical condition that they have been diagnosed with by their Specialist or GP, there can be an impact on their health generally. The immune system suppressing drugs may have been prescribed for a broad range of health issues: Rheumatic Diseases, some blood disorders, leukaemias, lung disease, organ transplant, MS etc..
So, as the medical condition and the drugs prescribed may have effects on the legs and feet, we monitor the health of the feet and deal with any issues that arise - supporting the tissue quality and healing ability.
Drugs with side effects
We often see people who are on medication for a wide range of medical conditions that can affect the leg and foot. For example: thrombosis / embolism risk - anticoagulant therapy (Warfarin, Aspirin), inflammatory / auto-immune disease - DMARDS, cardiac and blood pressure reduction, etc..
The medical condition or the effects of the prescribed drugs can cause issues: increased risk of bleeding, if skin is cut; increased bruising, reduced blood flow and consequently impaired nutrition of the foot and impaired healing.
We aim to maintain the health of the feet through regular checks and nail care and treatment of any areas of concern to the patient or their family.