Foot Care for Stroke Survivors
by Dr. Marc D. Klein, Doctor of Podiatric Medicine
One of our friends had trouble cutting his toenails, and his family doctor suggested visiting a podiatrist every 6-8 weeks. The podiatrist cut his toenails and examined his toes and feet. We wanted to write about the importance of good foot care and prevention, so we asked Paul's high school & college friend, Marc Klein, who practices podiatry in Massachusetts, just north of Boston.
Paul & Stephanie asked me to write an article on foot tips for stroke survivors from a podiatric point of view. Hopefully the following is helpful, interesting, and educational.
Tip 1. Keep your feet clean and dry. I know that this a "Duh" statement but it needs to be said.
Tip 2. Dry well between toes after bathing. Fungus thrives in a moist, dark, warm environment. The fungus that causes athletes foot (tinea pedis) is often the same one that causes thick, discolored, ugly and hard to cut toenails (Onychomycosis). The fungus will spread from skin to nails and vice versa. Prevention is cheaper than treatment and avoids potential pain and drug interactions as both tinea pedis and nychomycosis may require oral medication to resolve.
Tip 3. Socks and Shoes. The average pair of feet sweat approximately 1/2 pint of fluid per day. That sweat is absorbed mostly by shoes as socks have a limited ability to absorb much moisture. It takes a leather shoe about 30 hours to dry out. So, have at least two pair of shoes and alternate them. If you have really sweaty feet, cotton/wool/polyester blends have traditionally been recommended as old studies show these absorb the most moisture. Pure cotton absorbs well but quickly mats down preventing further absorption. Adding wool and polyester to the cotton gives buoyancy and allow for more wicking action.
The classic military sock absorbs the most sweat, wicking the moisture away from the skin. However, a newer product—Drymax socks (see click here)—are even better at keeping the skin dry and preventing blisters.
Tip 4. Smelly feet. Sometimes associated with sweaty feet (called hyperhidrosis) is smelly feet (bromhydrosis). This is due to the breakdown of the oils in sweat by the bacteria that normally inhabit your skin. Bromhydosis can be treated by removing the sweat as discussed above, preventing the sweat by use of foot antiperspirants, or by use of an over the counter product called Hibiclens which bonds to the skin, kills the bacteria and remains active in the presence of sweat. So you too can have sweet smelling feet.
Tip 5. Wear shoes that fit. If you have any insensitivity in the stroke affected leg make sure that a professional fits your shoes.
Tip 6. Protect your feet and examine them daily. Your stroke affected leg is probably thinner and the atrophy (smaller and weaker) is not limited to the muscles. The arteries can also be affected so that you may have developed peripheral arterial disease (PAD, poor circulation) in the effected extremity. So, how do you protect your feet from damages? First, see 1, 2, 3, 4 and 5 above. Also, if you need a brace, use it. If you have foot-drop, don’t walk around letting your foot slap or flop: it can be injured or you can fall and break something. Again, prevention is so much easier, cheaper, and less annoying than treating a problem that should have been avoided in the first place.
Tip 7. Exercise. Weight bearing exercise has been shown to help prevent osteoporosis. And since bone can atrophy along with other tissues in the stroke affected leg, it is important to exercise regularly to support the bones that support you. Exercise also helps control blood pressure: hypertension is another risk factor for stroke.
Tip 8. Prevent another stroke by control of weight, and not smoking (one cigarette constricts the arteries for hours), and dietary and/or pharmacologic control of serum lipids—cholesterol plaques are a major risk factor for stroke.
I want to thank Paul and Stephanie for inviting me to write this article. This was an interesting endeavor as there seems to be relatively little on this very general subject in the professional literature. Most articles examine single issues, usually a small part of a single issue. I hope this was helpful and a little entertaining.
To contact Dr. Klein, write or call his office: Marc D .Klein, D.P.M., F.A.S.P.S., Methuen Podiatry Associates, LLP, 191 Broadway, Methuen, Massachusetts 01844, Telephone (978) 682-0382.
To find a podiatrist near you, contact the American Podiatric Medical Association at: http://www.apma.org
Copyright (c) Paul E. Berger & Stephanie Mensh
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"Stephanie Mensh is a speaker and author.
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or call (703) 241-2375."