Diabetic Foot Care: What You Need to Know

Written by Erica Halpern on April 24, 2023

Last updated June 7, 2024

With 11 million Canadians living with diabetes, chances are high that you or someone you know has one of the various forms of the condition. Diabetes can directly impact the health of our feet, which can cause various foot problems if left untreated. From nerve damage and reduced blood vessel functionality in our feet and legs, proper foot care is essential to help manage and live with diabetes. Read on to learn more about common foot conditions in diabetic patients, prevention, and when to seek professional help.

Common foot problems in diabetic patients

Diabetes can cause damage to the nerves and blood vessels in your feet, leading to serious foot problems if left untreated. Proper foot care is crucial for people with diabetes to prevent complications. The most common foot conditions in diabetic patients are:

Neuropathy
Foot ulcers
Infections
Calluses and corns
Dry skin
Peripheral vascular disease
Charcot foot

Because they’re at aa heightened risk of certain foot conditions, diabetes patients should take extra precautions when caring for their feet.

Diabetic foot care prevention and management

So, what does caring for your feet when one has diabetes mean precisely?

The key element of diabetic foot care is prevention; this is the best way to manage the effects of diabetes on your feet. We recommend following a mix of the following to help manage any side effects of diabetes effectively and to help prevent any existing conditions from worsening:

Check your feet daily for cuts, blisters, sores, swelling, or other abnormalities.
Wash your feet with warm water and mild soap daily. Dry them thoroughly, especially between your toes.
Apply a moisturizing cream or lotion regularly, but avoid applying it between your toes, as this can create a moist environment that promotes fungal growth.
Cut your toenails straight across and file the edges when trimming. Avoid cutting the corner or cutting nails too short, as you may increase your risk of ingrown toenails. It is best to get this done by a chiropodist to prevent complications.
Choose shoes that fit well and provide good support. Avoid shoes with pointed toes or high heels, as they can cause pressure points that can lead to blisters and calluses. Pair good shoes with clean, dry socks.
Protect your feet from injury by wearing shoes or slippers at all times.
Have your feet examined by a healthcare provider at least once a year. You should also see a chiropodist or podiatrist for foot care (i.e.: callus treatment, nail trimming) at least every 2 – 3 months, especially if you have foot problems or are at high risk for foot complications. DIY foot care for people with diabetes can lead to unintended complications.

When to seek professional help when experiencing diabetes-related foot conditions

There are several specific situations where we recommend seeking professional help regarding diabetes-related foot conditions. If you experience any of the following, seek medical attention shortly:

Suppose something is on your feet, like a cut, bump, bruise, lesion, or skin irregularities. With diabetes, you’re at a higher risk of these conditions worsening. If you notice any wounds or sores on your feet, you should seek professional help immediately.
A pre-existing condition worsens rather than improves.
You lose feeling in your feet or toes.
Sudden bouts of swelling or inflammation

Since diabetic foot care is all about preventing and managing the effects of diabetes, recognizing signs and symptoms early (whether yourself or through check-ups) is critical to staying healthy.

How a foot clinic can help with diabetic foot care

A foot clinic can be your best friend when managing and preventing foot problems in diabetic patients. Prevention is key when it comes to managing and treating diabetes-related foot complications. Foot clinics offer regular check-ups on common foot conditions, advice on a diabetic foot care routine, shoe fittings, footwear recommendations, and custom orthotics. If you have diabetes, you should attend at a foot clinic every 2 to 3 months

Have your feet checked at Feet First Clinic

If you’re searching for a second opinion or a proper diabetic foot care routine, contact our team at Feet First Clinic. Book an appointment by calling us at (416) 769-3338 or requesting an appointment online below.

About Author: Erica Halpern

Erica is the operations manager at Feet First Clinic. Since 2021, she has been writing, researching and editing website and social media content. She also oversees Feet First Clinic’s daily and strategic operations to ensure the best possible experience for our clients. Her goal is to ensure patients are equipped with the knowledge and solutions they need to help with their pain.

Learn more about Erica Halpern

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February 7, 2020

At-Home Diabetic Foot Care

What is Diabetes? Diabetes is a chronic disease that occurs when the body is unable to either sufficiently produce or properly use insulin. Insulin is a hormone secreted by the pancreas to help cells absorb sugar from the bloodstream and use it as an energy source. When insulin is not adequately produced or properly used, it can result in elevated levels of blood sugar, called hyperglycemia. Hyperglycemia can cause deterioration of the body’s blood vessels, nerves and organs, most commonly the kidneys, eyes, and heart. Elevated blood sugars can leave a person more susceptible to slow healing wounds and infection, most commonly seen in the feet. Type 1 diabetes is an autoimmune disease where the insulin producing cells of the pancreas are attacked, resulting in an insulin dependent body. It is also known as juvenile diabetes and is usually diagnosed in persons under 40, most commonly children. People that are diagnosed with Type 1 diabetes require an external source of insulin daily. Type 2 diabetes is an acquired disease where the body does not produce enough insulin or does not properly use the insulin produced. It is most diagnosed in persons who are overweight or inactive physically, in individuals over 40 years old, but is now seen more in children and those under 40. Type 2 diabetes can either be insulin or non insulin dependent based on the severity and chronicity of disease. As of 2008-09, 2.4 million Canadians were living with diabetes. It is estimated that 90-95% of Canadians diagnosed with diabetes have Type 2 diabetes and 5-10% have Type 1. How Does Diabetes Develop? Healthy Diabetes Diet Diabetes development can be multi-factorial. There are many risk factors of type 2 diabetes, including inactive lifestyle, poor diet, family history, smoking, advanced age, or certain ethnicity. Risk factors of Type 1 diabetes are currently not well understood, though there may be a genetic disposition or an environmental trigger that may initiate the autoimmune response. Diabetes is normally diagnosed as either Type 1, or Type 2 and you cannot have both types of diabetes concurrently. Hyperglycemia can be gradually increasing before onset of diabetes, and symptoms may go undetected. Diagnosis is usually made with a plasma glucose test. Hyperglycemic symptoms include; frequent urination, increased thirst, unexplained weight loss. Other symptoms can include blurred vision, fatigue, and nausea. Since these symptoms can be associated with other disorders or disease, diagnosis of diabetes may be delayed. It is best to control modifiable risk factors that may lead to diabetes: staying physically active, eating a healthy diet and eliminating smoking. Why is Taking Care of my Feet Important? At-home Diabetic Foot Care Since diabetes can affect the blood vessels and nerves, the feet, situated the furthest from our nerve and vessel centre, are commonly affected in persons with long standing diabetes. As other diabetes related complications can arise, the feet can become more affected and more difficult to manage. Complications include deteriorating eyesight, and decreased flexibility. Decreased nerve function can reduce sensation in the feet, meaning small cuts and callus that may normally cause pain in a person without diabetes will go undetected. It is important to look at the feet regularly and immediately treat any developing callus or dryness to avoid foot wounds. Decreased healing ability means infection may be a cause for concern in persons with diabetes. The feet generally see more sharp instruments than other areas including nail clippers, and files or blades to remove callus and corns and therefore are at higher risk for small cuts. Taking care of feet in persons with diabetes are very simple and should become habit. The skin should be kept hydrated and elastic with use of cream and water consumption. All nails should be trimmed and filed to avoid any sharp corners. Avoid applying devices or items that are too hot or too cold directly to the skin. Inspect the feet daily. If the feet are difficult to see, a mirror can be used. A friend or family member is the most helpful. The person should be looking for any of the following: increased redness, swelling, blood, foreign objects, callus, corns, dry skin, or deformity (bunion, hammertoe). If any signs are seen, visit a physician or book an appointment with one of our foot specialists. A foot specialist is recommended for regular assessments every 6 months. If there are any concerns with the feet, regular foot care every month or 2 may be indicated. Who Needs to Worry About Diabetes? As of 2008, over 200 000 Canadians are diagnosed with diabetes every year. The increasing age of baby boomers and increased life span are contributing factors to the increase in diabetes diagnoses. The people most likely to be affected by diabetes are those in certain ethnic groups (first nations, African, Caribbean, south Asian and Hispanic), age groups (over 40), and higher weight groups. In 2017, approximately 2.3 million Canadians (7.3% aged 12 and over) have been diagnosed with diabetes. What Problems does Diabetes Cause for my Feet? Diabetes can affect the feet in so many different ways: the skin becomes drier, the muscles start to change where foot deformities can develop, and the nerves are affected where sensation is reduced. Detection of problems can become difficult and due to decreased healing time and increased rates of infection; problems can progress rapidly. Serious cases include undetected wounds, subsequent infection and possible amputation. Undetected wounds can paint a picture of uncontrolled diabetes, where multiple vital systems can be affected (kidneys, vessels, nervous) At every age group, mortality rates are two times those in persons with diabetes than those without. So, What Products Can I Use? For persons with diabetes, it is important to avoid products with acid as an ingredient. Creams with mild acid solution can irritate the skin and cause small wounds. Sharp objects such as nail clippers and foot files may be used in persons with controlled diabetes and with prior instruction from a professional. Feel free to use a daily cream and emollient to hydrate the skin. Be careful using product between the toes, as that area can accumulate too much moisture which can breakdown the skin. Foot soaks can dehydrate the skin, please consult with your doctor or foot specialist before engaging in foot soaks. Persons with diabetes may require shoes that are healthier for their sensitive feet. Shoes with soft foot beds that can reduce friction and increase shock absorption are ideal. Avoid shoes that have rigid seams or stiff out-soles. When wearing shoes, keep an eye out for any red marks on the skin, these are ones to discard or avoid as they can one day leave a wound or laceration. Will it Get Worse? Persons with diabetes may feel their feet are too hot or too cold and try to use hot or cold packs to alleviate the discomfort. Due to decreased sensation, these hot/cold packs can cause hot or cold burns on the skin. Be sure to protect the skin with a towel prior to using these types of warming/cooling packs, and test first on the hands as sensation is usually not as diminished in the hands. Never use hot water or hot packs – make sure the temperature is lukewarm. If you have dry skin, make sure to moisturize; do not use harmful files or electric devices to remove callus or dry skin. Contact your chiropodist as you may be prescribed a cream. Inspect the feet daily, checking for cuts, callus or redness and swelling. Where Can I Get Help? Who Can I Ask? A licensed chiropodist is trained to treat feet, especially in those with diabetes. They can prescribe special creams, and carefully and safely reduce nail problems and callus. They can help reduce pressures by recommending orthopedic shoes or prescribing custom made orthotics. They can improve mobility by offering specific exercises and stretches to keep you moving. And they are primary care practitioners who can monitor and inspect your feet for any new concerns. Persons with diabetes should have a foot specialist examine their feet at least every 6 months. If you have callus or nail problems, a visit to the chiropodist can be a more routine visit at around 2 months. Regular examinations and visits can prevent foot complications that can occur with diabetes. Consult your doctor who can refer a foot specialist in your area or call our clinic today!

April 3, 2025

Why Poor Blood Flow Causes Toenail Problems

Healthy toenails need healthy circulation, but when blood flow is compromised, they can become brittle, discoloured, or grow slowly. Additional toenail conditions can also develop. Poor circulation and toenail problems are closely linked, especially for those with health problems like diabetes or peripheral artery disease. Understanding why poor blood flow affects toenails can help you take the right steps to protect your foot health and prevent complications. https://www.youtube.com/shorts/3JAUqiqJfus The Importance of Blood Circulation In order to understand the link between poor circulation and toenail issues, we have to start by understanding what blood flow is and what it does. The circulatory system, comprising the heart, blood vessels, and blood, serves as the body's transportation network. Its primary function is to deliver oxygen and essential nutrients to cells while removing waste products like carbon dioxide. The heart pumps oxygen-rich blood through arteries, which branch into smaller arterioles and capillaries, reaching every tissue and organ. This process ensures that each cell receives the necessary components for energy production, growth, and repair. Efficient blood circulation is vital for overall health. Oxygen transported by red blood cells is crucial for cellular respiration, the process by which cells generate energy. Nutrients absorbed from digested food are distributed via the bloodstream to support various bodily functions. Key nutrients delivered by the bloodstream include: Glucose: A simple sugar derived from carbohydrates in our diet, glucose serves as the primary energy source for cells, fueling various physiological processes. Amino Acids: These are the building blocks of proteins, obtained from the digestion of dietary proteins. Amino acids are crucial for tissue growth, repair, and the synthesis of enzymes and hormones. Fatty Acids and Lipids: Essential components of cell membranes and energy storage molecules, fatty acids and lipids are transported to cells for incorporation into cellular structures and for energy production. Vitamins and Minerals: These micronutrients support a range of cellular functions, including maintaining bone health and facilitating nerve transmission. Hormones: Although not nutrients in the traditional sense, hormones are vital signaling molecules transported by the circulatory system to regulate various physiological activities, such as metabolism, growth, and mood. Impaired circulation can slow down healing processes—even for seemingly innocent and minor problems like cuts and scrapes. Likewise, organs and tissues deprived of adequate circulation can suffer damage over time, increasing the risk of conditions such as peripheral artery disease, stroke, and heart attacks. Toenail Health and Circulation: The Connection The circulatory system delivers oxygen and essential nutrients to the nail beds, supporting the growth and maintenance of strong, clear nails. When blood flow is compromised, the nails may not receive adequate nourishment, leading to various issues such as brittleness, discoloration, and slowed growth. In some cases, poor circulation can cause nails to develop ridges, indicating underlying vascular problems. Reduced blood flow can also increase the risk of infections like toenail fungus (onychomycosis). A weakened circulatory system impairs the body's ability to combat pathogens, making the toenail environment more susceptible to fungal overgrowth. This often results in yellowed, thickened nails that you can’t treat without the help of a chiropodist or podiatrist. They must remove the infected portion of the nail so they can apply the correct medicine. Poor blood flow on its own may not cause a problem with your foot health, but it can contribute to the following toenail conditions: Slow or halted nail growth: Inadequate blood flow deprives the nail matrix of essential nutrients and oxygen, resulting in reduced or ceased toenail growth. This can be very frustrating if your toenail falls off or cracks and you’re waiting for it to grow back, leaving your feet vulnerable. Brittle and discolored nails: Insufficient circulation can cause nails to become brittle and change color, often appearing yellowed or darkened. Thickened nails: Poor blood flow may contribute to the thickening of toenails, often via toenail fungus, making them difficult to trim and maintain. Poor blood flow also affects the nail growth process, which can cause nail cells to pile on top of each other and lead to thicker toenails. Ingrown toenails: While not directly caused by poor circulation, individuals with compromised blood flow, such as those with diabetes, are at higher risk for complications from ingrown toenails, including infections and delayed healing. Diabetes, Toenail Health and Circulation Diabetes can lead to two significant complications affecting foot health: diabetic neuropathy and peripheral artery disease (PAD). Diabetic neuropathy results from prolonged high blood sugar levels damaging the nerves, particularly in the legs and feet, causing numbness, tingling, or a loss of sensation. This diminished sensitivity means that innocent injuries, such as cuts or blisters, may go unnoticed, increasing the risk of infections and complications like ulcers, or in severe cases, life threatening problems like gangrene, which require amputation. This is also the case for seemingly minor problems with the toenails. Simultaneously, PAD causes blood vessels to narrow and harden, reducing blood flow to the extremities. This impaired circulation hampers the delivery of oxygen and essential nutrients needed for healing, making the feet and toenails even more susceptible. Regular foot inspections and nail care with a chiropodist or podiatrist, maintaining proper hygiene, and promptly addressing any abnormalities are crucial steps for diabetics to prevent toenail-related complications stemming from poor blood flow. https://www.youtube.com/shorts/QFWBwM6mGqM?feature=share Foot and Nail Care for Poor Circulation Maintaining proper foot and nail care is essential for individuals experiencing poor circulation, as reduced blood flow can lead to various complications. Here are some recommended practices and treatments: https://youtu.be/5PCZuM5E6RU Regular Exercise: Maintaining good circulatory health through regular exercise, a balanced diet, and avoiding smoking is essential for ensuring that the body's systems function as well as possible. One of the best circulation maintenance tips for foot health is working the muscles in the lower extremities. Exercises like toe splays, toe flexes and raises, massage ball rolls, pen pick-ups and seated toe pulls can work wonders. Click here to learn the five best foot exercises to improve blood circulation. They’re particularly helpful in the winter, but are useful all year round. Regular Self Inspections: Conduct daily checks for cuts, sores, or changes in nail color and texture to detect issues early. Moisturizing: Keep feet hydrated to prevent cracks and fissures that can lead to infections. Learn how to moisturize properly here. OnyFix Nail Correction System: For those with ingrown or involuted toenails, the OnyFix system offers a non-invasive, pain-free solution. This innovative treatment involves applying a composite material to the nail, which helps guide it back to its natural shape as it grows, without the need for surgery. It's suitable for various nail shapes. Medical Pedicures: Unlike traditional cosmetic pedicures, medical pedicures are performed by trained foot care professionals, such as chiropodists or podiatrists, in a sterile environment in a foot clinic. They focus on health, addressing issues like nail trimming, callus reduction, and infection prevention. They are especially helpful for dealing with irregular shaped toenails caused by poor circulation - cutting and maintaining these on your own can be very difficult. For people with diabetes, who are at higher risk for foot complications due to poor circulation and neuropathy, medical pedicures are a common and recommended treatment. These specialized pedicures help prevent complications like infections or ulcers by ensuring meticulous foot care. Proper Footwear: Wear well-fitting shoes that provide adequate support and reduce pressure points to promote better circulation. Proper Nail Trimming: Trim nails straight across and avoid cutting them too short to prevent ingrown toenails. And if your toenails are too thick or difficult to cut on your own, book an appointment with a foot specialist.

March 13, 2025

Do Flat Feet Cause Bunions?

Flat feet are a condition in and of themselves. However, flat feet also have an impact on future foot health and can lead to other more painful foot conditions. But can flat feet really cause bunions? While it seems unlikely that a toe deformity can be linked to a flat arch, you'd be surprised how interconnected our lower extremities are, especially the feet! Today’s article will explore how flat feet cause bunions, what you can do to prevent them, and how a foot specialist like a Chiropodist or Podiatrist can provide treatment. What are Flat Feet? Flat feet, or pes planus, cause the entire sole or most of it to contact the ground when standing and walking. For some people, this condition can extend into adulthood from childhood (children have flat feet before the arch forms) when the arch fails to form.When you have normal arches, they provide an elastic, springy connection between the forefoot and the hindfoot, allowing forces incurred during weight-bearing to be distributed properly. When these arches don’t exist, this mechanism is disrupted, leading to pain and other complications. What are Bunions? https://www.youtube.com/shorts/sXF8lWHad0g Bunions, or hallux valgus, are bony protrusions that form on the inside edge of the first metatarsophalangeal (MTP) joint at the base of the big toe. They develop when pressure causes the big toe to deviate toward the second toe, resulting in a misalignment of the joint. Emerging research indicates that hypermobility in the midfoot (specifically the mid-tarsal joint between the navicular and the base of the first metatarsal) may be a key underlying factor in the development of bunions, and this hypermobility is often genetic. Common Bunion Causes and Risk Factors: Ill-Fitting Footwear: Wearing the wrong shoes for years is a major risk factor for most foot conditions, especially bunions. Wearing tight, narrow, or high-heeled shoes can exacerbate pressure on the big toe joint, contributing to bunion formation. Your toes need space to splay and rest comfortably! Gender and Age: Women, particularly those over 60, are more prone to developing bunions, generally due to decades spent making poor footwear choices, or possibly due to hormonal influences that affect the ligaments in the foot. Inflammatory Conditions: Diseases like rheumatoid arthritis can cause joint inflammation, which increases stress on the big toe and the risk of bunions. Foot Injuries: Trauma to the foot can alter its mechanics, leading to bunion development. https://www.youtube.com/shorts/KZiVzLyBUMo Flat Feet and Bunions: The Connection If you’re not proactive, the shape of your foot arch can have a big impact on our foot health over time. You may know that flat feet can lead to plantar fasciitis, and you may also know that high arches can lead to back pain, but our arch shape can affect us in countless ways. Let’s talk about the science behind why a flat foot can lead to a painful bunion. It all boils down to flat feet causing an abnormal gait (walking pattern), and the damage caused by walking with that abnormal pattern for a long period of time.The structural anomaly of flat feet and barely having an arch, or no arch at all, can significantly impact foot mechanics—particularly during walking. In a typical gait cycle, the foot pronates (rolls inward) to absorb shock and then supinates (rolls outward) to create a rigid lever for propulsion. Individuals with flat feet often experience overpronation, where the foot remains excessively rolled inward during the push-off phase. The altered biomechanics increases pressure on the first MTP joint, leading to instability and misalignment. Over time, this persistent stress can cause the big toe to deviate toward the second toe, resulting in a bunion. Moreover, flat feet can lead to muscle imbalances that exacerbate bunion formation. Weakness in the intrinsic foot muscles (a group of tiny muscles inside the foot) and the tibialis posterior muscle (a muscle in your lower leg) compromises arch support, worsening overpronation. This chain reaction places additional strain on the big toe joint, accelerating bunion development. Therefore, the combination of altered foot mechanics and muscle imbalances associated with flat feet plays a significant role in the development and progression of bunions. https://www.youtube.com/shorts/pdyv58z1D2Y Preventing Bunions With Flat Feet First and foremost, it’s all about the shoes! Selecting footwear that fits properly with a wide toe box and adequate arch support is crucial. A spacious toe box prevents crowding of the toes, reducing pressure on the big toe joint and minimizing the risk of bunion formation. Adequate arch support helps maintain proper foot alignment, distributing weight evenly and alleviating stress on MTP joint. Avoiding high heels and narrow shoes is essential, as they can exacerbate foot misalignment and increase the likelihood of developing bunions. Incorporating custom orthotics can provide even more arch support if you have flat feet. These orthotics help correct overpronation—which we know now is a common issue—by stabilizing the foot's movement during the gait cycle and keeping it in neutral alignment. By improving foot alignment, orthotics reduce undue pressure on the big toe joint, reducing your risk of bunion development. Lastly, Engaging in specific exercises can strengthen the muscles supporting the foot arch, enhancing stability and function. These exercises should aim to: Strengthen Foot Muscles: Targeting the intrinsic and extrinsic muscles of the foot to provide better support for the arch and improve overall foot stability. Improve Flexibility: Enhancing the range of motion in the toes, feet, and ankles to prevent stiffness and reduce strain on the MTP joint. Enhance Balance and Coordination: Developing proprioception to ensure proper foot placement and gait mechanics, thereby reducing the risk of misalignment. Regular practice of these exercises can improve foot biomechanics, reduce overpronation, and subsequently lower the risk of bunions. See below for an example of a great flat foot exercise. https://www.youtube.com/shorts/whJ3TZAOn00 Foot Clinic Bunion Care If you already struggle with bunions and foot pain, don’t worry; there are plenty of options available to you. Bunions cannot be reversed after they form, but they can be managed with guided care from a podiatrist or chiropodist. The goal is to avoid invasive surgical intervention while still preventing bunions from impacting your daily life as much as possible. Most of these bunion treatment options are available at our downtown Toronto foot clinic: Footwear Modification. Wearing shoes with a wide toe box and avoiding high heels can help reduce pressure on the bunion. Orthopedic shoes designed to accommodate bunions provide additional support and comfort. Anti-inflammatory Medication. Over-the-counter NSAIDs, such as ibuprofen, can help reduce inflammation and alleviate pain associated with bunions. Bunion Splints and Aligners. Devices like bunion splints and toe spacers can help realign the big toe and reduce discomfort. They can provide symptomatic relief, and you can try a more rigid device if your bunion is severe. Therapeutic Taping. Applying tape to the foot can help maintain proper alignment and reduce strain on the bunion, providing temporary relief from pain and inflammation. Shoe Stretching. Professional shoe stretching can create additional space in the shoe, reducing pressure on the bunion without altering the overall size of the footwear. Supportive Insoles or Custom Orthotics. Custom orthotics can provide support to the arches and correct faulty biomechanics. This can potentially slow the progression of bunions by reducing pressure on the first MTP joint. Bunion Exercises. Strengthening foot muscles through specific exercises can improve joint stability and decrease bunion-related pain. Try these 5 simple exercises for bunions. Shockwave Therapy: This non-invasive treatment can address tight muscles and soft tissue injuries associated with bunions. This can potentially reduce pain and improve function. Implementing these non-surgical interventions can significantly alleviate discomfort and slow the progression of bunions, enhancing overall foot health and quality of life. https://www.youtube.com/shorts/8g43ZWreZ1g

March 6, 2025

Palmoplantar Keratoderma: What is it?

Figuratively speaking, it’s a good thing to have “thick skin,” right? But if you have palmoplantar keratoderma, it’s a different story. This condition, sometimes shortened to PPK, refers to a group of foot skin disorders characterized by thick, rough, and yellowed skin on the hand palms and feet soles. These conditions can be either inherited or acquired. In today’s article, we’ll explore the symptoms, causes, and, most importantly, the treatment options available. This type of skin thickening may warrant a trip to a foot clinic and the expertise of a foot care professional, such as a Chiropodist or Podiatrist. However, successful treatment may depend on the underlying cause of the skin thickening. What is Palmoplantar Keratoderma? This condition combines two scientific terms: palmoplantar, which specifically refers to the skin on the soles of the feet and the palms of the hands, and keratoderma, a term for epidermis (skin) thickening. In less common cases, transgradient keratoderma can affect the top of the hands and feet. The feet are usually more severely affected than the hands. Palmoplantar keratoderma (PPK) causes thickened skin on the palms and soles due to an overproduction of keratin, the protein that forms the outer layer of the skin. Normally, keratin helps protect the skin from friction, pressure, and environmental damage. However, in PPK, something disrupts the balance of keratin production and shedding, leading to excessive buildup. This happens because of genetic mutations or external factors that affect how skin cells grow and mature. Inherited forms of PPK often involve mutations in genes that control keratin formation or the connections between skin cells. These mutations make the skin cells more resistant to breaking down, so they pile up instead of naturally shedding. Since the palms and soles experience the most pressure and friction in daily life, they are especially prone to this excessive keratin buildup. Over time, the thickened skin can cause pain or become hard and cracked, depending on the severity of the condition. Some types can also cause blisters to form. Types of Palmoplantar Keratoderma and Associated Symptoms https://www.youtube.com/shorts/-iNFLGednYY Genetic (hereditary) keratoderma is usually divided into three main categories: diffuse, affecting the entire hand palm and foot sole; focal, where thickening is limited to pressure points; and punctate, which appears as small, hard lesions. Some genetic PPKs - particularly diffuse - are syndromic, meaning they are associated with other health conditions and additional symptoms, ranging from hearing loss to nail abnormalities to internal organ damage. Acquired PPK, on the other hand, is always syndromic and develops later in life due to external factors such as infections, inflammatory diseases, or underlying systemic conditions like internal malignancies. Acquired forms may be easier to treat since you and your healthcare team can address the underlying cause. Acquired PPK is also more common than genetic, since there are more causes and risk factors associated with it. Most types of PPK cause varying degrees of thick skin, potential foot odor (as a result of sweat combined with thick skin) and yellow/discoloured skin. Genetic PPK Types and Symptoms Diffuse PPK This form presents with even thickened skin on the palms and soles, often with a red border at the edges. Symptoms typically appear in early childhood and may include excessive sweating (hyperhidrosis). The thickening is usually confined to the palms and soles, without extending to the tops of the hands or feet. Focal PPK This type is characterized by linear (striate) thickened areas on the palms and soles, often following the lines of skin tension. It is typically caused by mutations in genes encoding desmosomal proteins, which are crucial for cell adhesion. A specific type of focal PPK called Pachyonychia Congenita is a rare genetic disorder that can also cause thick toenails. Punctate PPK This form is characterized by multiple small, hard, corn-like lesions scattered on the palms and soles. It is associated with mutations in genes that play a role in skin cell function. Acquired PPK Types and Symptoms PPK from Infections (syphilis, etc) Rough, scaly and yellow thickening on the palms and soles. May come with a rash or other symptoms affecting the whole body. Clears up when the infection is treated. PPK from Inflammatory Skin Conditions (psoriasis, eczema) Thickened, inflamed skin with redness and scaling. Can extend beyond just the palms and soles. Often improves with medicated creams or treatments that calm the immune system. PPK Linked to Other Health Conditions (cancer, hormone disorders) Yellow thickening of the palms and soles that appears suddenly in adulthood. Can sometimes signal an underlying health issue, like cancer. Needs further medical evaluation to check for possible internal diseases. What is the Difference Between Palmoplantar Keratoderma and Calluses? PPK is not the only cause of skin thickening on the feet and hands. In fact, it is more rare than another common culprit: calluses. But how do you know which condition you have? Calluses are localized areas of thickened skin that develop as a protective response to repeated friction or pressure. Commonly found on individuals who are physically active or spend long hours wearing ill-fitting shoes, they are much less severe than PPK. PPK tends to be thicker and more noticeable, alarming and unsightly than calluses, often covering a larger, symmetrical area on the palms and soles. It can appear hard and more yellow, or red and flaky. In some PPK cases, you may observe a red band at the edges of the thickened skin. Calluses can have a more mild appearance (but not always; they can sometimes be thick and painful!), with some people not even realizing they have them. Does that mean that PPK is the same as having excessive calluses? Not exactly. Calluses are only caused by friction and pressure----whereas PPK always has a driving force behind it, whether it's a genetic mutation or the result of an illness. https://www.youtube.com/shorts/yBACD8bUim0 Palmoplantar Keratoderma Treatment: Can a Chiropodist or Podiatrist Help? While there is no outright cure for certain forms of PPK, Chiropodists and Podiatrists can help manage symptoms, reduce discomfort, and improve mobility. This typically involves regular debridement (carefully removing excess skin), possibly prescribing medicinal products, and offering footwear advice to minimize friction and pressure. The latter may also include prescribing custom orthotics to properly distribute pressure on the bottom of the feet, especially if the thickened skin is impacting daily life. Scheduling an initial assessment is a good start! Naturally, since PPK can be linked to an underlying condition, more comprehensive care may be needed. A Chiropodist or Podiatrist might become a part of a broader team of healthcare professionals that can help you, including a dermatologist, your family doctor or other specialists trained to tackle the root cause. You may need advanced treatments such as topical retinoids, corticosteroids, or even laser therapy in some cases. https://www.youtube.com/shorts/sBIdll7qylQ

February 27, 2025

The Connection Between High Arches and Back Pain

Dealing with high arches and back pain can be a challenging combination, as the two are more connected than they seem. Understanding how high arches contribute to back pain is key to finding effective treatments and preventing further issues. Whether you’re dealing with foot pain, back pain, or posture problems, addressing high arches can significantly improve overall comfort and protect the rest of your body—especially your back. What are High Arches? https://www.youtube.com/shorts/osC-UmBtgNk High arches (or cavus foot or pes cavus) is a condition where the foot has an abnormally pronounced arch (as opposed to a flat foot or a normal arch). Having high arches can be due to simple genetics, inheriting structural abnormalities in the foot from your parents. They can also be caused by several neuromuscular disorders, which are conditions (ranging from mild to severe) that cause dysfunction or muscle weakness and leave certain muscles inactive. High arches generally develop during or after childhood when the flat feet most children have start to take shape and the foot arch forms. In some cases, idiopathic pes cavus occurs without a known cause (like genetics or neuromuscular disorders), and is just a case of simple variations in bone and ligament structure. A pronounced foot arch is usually quite discrete, aesthetically, and isn’t a serious condition. However, high arches are a common cause of foot pain and discomfort. High arches put extra pressure on the heel and ball of the foot, affecting normal pressure distribution and making it harder to absorb shock properly. This can lead to heel pain (plantar fasciitis— which is also commonly linked to flat feet feet), arch pain, and more, as the muscles and ligaments supporting the foot work overtime to stabilize each step, leading to inflammation or strain. High arches often cause the foot to roll outward, a motion known as supination. This can place extra stress on the ankles and knees, further disrupting alignment and increasing the risk of injuries like sprains and shin splints. It’s important to schedule an assessment with a foot specialist, like a podiatrist or chiropodist, if having high arches affects your daily life. The Connection Between High Arches and Back Pain https://www.youtube.com/shorts/7m3SQ5dXaeg A pronounced arch can also lead to back pain. But how do high arches affect the back when the two areas seem relatively far apart? The answer lies in how the body stays balanced. Many foot problems, not just high arches, often cause back pain—along with knee, leg, and ankle discomfort—because the feet serve as the body's foundation (carrying your weight) and closest connection to the ground. When that foundation is misaligned and overworked, the entire body has to compensate, leading to strain in other areas. Simply put, everything is connected, and the feet play a crucial role in maintaining functionality throughout our body’s kinetic connection! When it comes to the back, pain and poor posture often coexist. As we know, when the arches are too high, they can throw off the body's natural alignment, affecting the way you stand and walk. Uneven weight distribution forces the lower body to compensate, which can lead to foot pain and posture issues over time. The strain on the feet may cause the ankles to supinate, shifting stress to the knees and hips. This misalignment can travel up the spine, making it harder to maintain proper posture and increasing the risk of chronic discomfort. Without proper shock absorption, the impact of each step travels up through the joints, leading to tension in the lower back and shoulders. Over time, these small imbalances can create lasting posture problems, making everyday movements more difficult. Treating High Arches and High Arch-Related Back Pain When you treat high arches, you’re also preventing any potential back pain that may occur further down the road. But if you already struggle with high-arch related back pain, you can still focus on treatment methods that simultaneously target both issues. Video Gait Analysis https://www.youtube.com/shorts/Rhuga6vLdc0 This is when a Chiropodist or Podiatrist assesses your walking patterns (also known as your gait) using video gait analysis equipment. It can give foot care professionals insight into the potential damage your high arches could cause, so they can recommend preventative treatments. Custom Orthotics and Insoles A Podiatrist or Chiropodist can prescribe custom orthotics that you can wear inside your shoes. They will provide much-needed arch support, distribute weight evenly, and reduce strain on the feet and spine. Another option is over-the-counter Superfeet insoles, with the Superfeet Green: All Purpose High Arch being a good choice to ask your foot specialist about. Supportive Footwear Look for shoes with good arch support, cushioning, and shock absorption to minimize impact on joints. People with high arches should wear shoes with flexible midsoles or rocker soles to improve movement and reduce strain. Cushioning running shoes with shock absorption help counteract supination, ensuring even pressure distribution and healthy biomechanics. Avoid high heels, rigid soles, and unsupportive flats, as they can increase discomfort. Read more about the link between footwear and back pain. Stretching and Strengthening Exercises https://www.youtube.com/shorts/-EeyHTdkrEs Targeting the feet, calves, and lower back can improve flexibility and stability, reducing pain. Some of the best include towel stretches (where you place a towel under your foot arch and pull towards you), seated toe pulls (pulling the top of your foot towards you - see above!), ankle circles and massage ball rolls (rolling your foot arch on a therapeutic massage ball). You can read more about them, including how to perform them, here. You can also try clamshells on an exercise mat with your ankles together (this will also help soothe hip pain. See below for a demonstration! https://www.youtube.com/shorts/ZODK0Q4zOws

February 6, 2025

Why High-Stack Running Shoes are So Popular

The HOKA trend is the rise in popularity of HOKA's high-stack running shoes, or running shoes with extra cushioning, extra height, a high heel stack and a rocker sole. They aren’t the first popular running shoes trend, and they certainly won’t be the last. Although people exclusively associate this type of trendy running footwear with HOKA, many other brands like ASICS and Saucony make footwear with the same high-stack shoe technology. Today, we’re diving into why these shoes offer more than just style—they come with real benefits. But they’re not for everyone, so we’ll also cover who should steer clear of this particular design. https://www.youtube.com/shorts/ySn158c143c What are High-Stack Running Shoes? High-stack running shoes, often called “super cushioned” or even “chunky,” by those who don’t know the terminology. They have transformed modern footwear design for many high-quality brands. Often attributed to HOKA for “starting the craze," these shoes feature thick midsoles packed with advanced cushioning foam technologies that enhance energy return, provide sufficient shock absorption, and improve comfort over long distances. Despite their benefits, high-stack shoes aren’t without controversy. Some runners prefer lower-profile shoes for better ground feel and stability, while others find high-stacks beneficial for injury prevention and endurance. Their chunky aesthetic has also sparked mixed opinions—some love the bold look and the added height without having to wear a true high heel while others see them as clunky. High-Stack Shoe Technology The defining feature of high-stack shoes is their thick midsole, which can measure over 40mm in some models. These midsoles use lightweight, resilient foams such as Pebax or EVA blends that provide exceptional cushioning while maintaining responsiveness. The goal is to reduce muscle fatigue by absorbing more impact, allowing runners to maintain performance with less strain on joints and soft tissues. Another key factor in their performance is the rocker geometry, rocker bottom shoe or rocker sole—curved soles designed to promote a smooth heel-to-toe transition. This feature helps conserve energy, particularly during long runs, by reducing the work done by the calves and ankles. ASICS Gel Nimbus 27 The Benefits of High Stack Shoes High-stack running shoes offer several benefits for foot health, especially for individuals dealing with arthritis, diabetes, and metatarsalgia. Here's a breakdown of their advantages: Enhanced Cushioning: High-stack running shoes feature extra cushioning, which absorbs shock and reduces impact on the feet during movement. This is particularly beneficial for people with conditions like arthritis, where joints are sensitive to pressure and movement. Pressure Redistribution: The additional cushioning and rocker sole work together to redistribute pressure across the foot. In the case of diabetes or metatarsalgia, this can help alleviate excess pressure on specific areas of the foot, such as the forefoot or metatarsal heads. For those with diabetes, reducing pressure can help prevent the skin damage that leads to ulceration, as it lowers the risk of tissue damage and enhances comfort. (However, people with diabetes and balance issues may wish to avoid rocker soles - more on that later). Joint Protection: The rocker sole limits the motion of foot joints. This helps manage conditions like osteoarthritis and hallux limitus (big toe arthritis). By restricting unnecessary movements, it prevents excessive strain on the joints, protecting them from further damage. This is especially useful for the big toe joint, where excessive motion can lead to increased pain and discomfort. It's also highly beneficial for people with high arches. People with high arches tend to experience joint rigidity (particularly hallux limitus) and lack of shock absorption. The rocker sole offsets the restricted mobility. Improved Biomechanics: The curved design of the rocker sole encourages a smoother, more efficient gait. The shape propels the foot forward with each step, facilitating a natural walking motion and reducing strain on the joints. This is particularly beneficial for those with ankle, midfoot, or big toe arthritis, as it helps maintain normal walking patterns without overloading the affected areas. Pain Reduction: Rocker soles are especially effective in reducing pain associated with conditions like hallux limitus and metatarsalgia. By minimizing motion at the big toe joint and redistributing pressure under the ball of the foot, these shoes can significantly reduce the discomfort felt during daily activities like walking or standing. https://www.youtube.com/shorts/qByZ0GRFoaQ When to Avoid High Stack Shoes Here are some individuals who might want to avoid them or consult a foot care professional, like a Chiropodist or a Podiatrist, before wearing them: People with Balance Issues The rocker sole on high-stack shoes can make them less stable for individuals who struggle with balance or proprioception (awareness of body position). Those at a high risk of falls, such as elderly individuals or those with severe neuropathy, may find that the rocker sole from stacked heels throws off their balance. People with Diabetes Complications from diabetic neuropathy can lead to balance issues. Therefore, while the cushioning of a stacked heel is great for addressing joint issues, the "rolling" effect of the rocker sole is not suitable for people with diabetes. Individuals with Ankle Instability The increased midsole height and curved design can reduce ground feel and make it easier to roll an ankle, especially on uneven surfaces. People prone to ankle sprains or with a history of ankle instability might be better suited to lower-profile shoes with more lateral stability, or stability shoes with posting in the midsole (like the ASICS Gel-Kayano), which is constructed to cradle the foot and control ankle movement. In shoes like the ASICS Gel-Kayano, even though there is a stacked heel, the foot actually sits below the sole to provide stability. https://www.youtube.com/shorts/osC-UmBtgNk

January 9, 2025

4 Tips For Living With High Arches

Living with high arches can be a challenge, but if you pay attention to your foot health, you can manage them effectively. Let’s explore what high arches are, their impact, and our top 4 tips for living with high arches. What Are High Arches? https://www.youtube.com/shorts/13rmyA18ZzY High arches (pes cavus) is a condition where one has - you guessed it - abnormally high foot arches. They are essentially the opposite of flat feet, which are characterized by having a minimal or non-existent arch. High arches may be hereditary or caused by neurological disorders such as Charcot-Marie-Tooth disease. From a biomechanical perspective, the raised arch reduces the surface area in contact with the ground, which can result in an uneven distribution of weight across the foot. High arches often place excessive pressure on the ball and heel of the foot, leading to discomfort, instability, potential injuries and chronic foot conditions. High arches also impairs shock absorption, which causes progressive wear-and-tear on the joints over time. Side effects of high arches include foot pain, issues like calluses and hammertoes, and an increased risk of ankle sprains. Individuals can also develop conditions like plantar fasciitis (this can also frequently occur in people with flat feet), or Achilles tendonitis due to the strain placed on the muscles and ligaments. The lack of shock absorption can also reverberate up the body and lead to joint disorders like arthritis. High arches are associated with supination, also called underpronation, a condition where the foot rolls outward during movement. This gait pattern places additional stress on the outer edges of the foot and ankle, leading to instability and overuse injuries. Consequently, individuals with high arches should pay close attention to their walking or running patterns to prevent long-term complications. High arches can also lead to changes in posture and gait. This, combined with the lack of shock absorption, may result in secondary issues such as knee, hip, or back pain over time. Tips for Living with High Arches https://www.youtube.com/shorts/2et0ZUSx4OM Living with high arches requires thoughtful adjustments to your daily routine and habits. Here are some ways to keep your feet comfortable and supported: 1. Choose the Right Footwear Proper footwear is essential for managing high arches. Opt for shoes with ample shock absorption, arch support and cushioning. Shoes with flexible midsoles or rocker soles can also be very helpful: People with high arches tend to have rigidity in the toes and ankles due to joint wear-and-tear, which means the toes and ankles do not flex as much as it should during the gait cycle. A flexible midsole and rocker sole counteracts this and make movement easier. Likewise, people with high arches should avoid high heels, rigid soles, and unsupportive flats, which can exacerbate discomfort. Due to supination, people should look for cushioning running shoes. These provide balanced cushioning and plenty of shock absorption and flexibility to support the foot’s natural motion and healthy biomechanics. This design helps distribute pressure evenly, enhances comfort, and reduces the risk of injury. 2. Wear Custom Orthotics Custom orthotics are a valuable tool for redistributing pressure evenly across the foot. You can work with a specialist, like a podiatrist or chiropodist, at a foot clinic to create orthotics tailored to your specific needs. Scientifically, custom orthotics help correct abnormal biomechanics, such as excessive supination, by stabilizing the foot and encouraging a more neutral gait. They can also provide added cushioning to reduce the impact of your stride on your joints. Over time, this can alleviate pain, reduce fatigue, and prevent the development of secondary issues in the knees, hips, or lower back. 3. Maintain a High Arch Foot Care Routine Foot baths and massages can soothe foot pain, relax the muscles in your feet and boost blood circulation. Soak your feet in warm water with Epsom salts, or foot bath products from reputable companies like Gehwol, to alleviate tension. Gehwol products, such as their Herbal Foot Bath, are available to buy at our Toronto foot clinic, Feet First Clinic! Gently massage the arch, heel, and toes to improve circulation and relieve tightness. Read this article to learn how to give yourself a foot massage from home. 4. Try Stretching and Strengthening Exercises Foot stretches and exercises play a crucial role in managing high arches by improving flexibility, reducing muscle tightness, and promoting better blood circulation in the feet. High arches can lead to stiffness and imbalances in the tendons and muscles, increasing the risk of discomfort and injury. Over time, these stretches can support better alignment and strengthen the foot's ability to handle daily stress, making them an essential part of high arch foot care. Here are some simple routines you can try today! Toe Flex and Raise: While standing, plant your toes and lift your heels off the ground. Hold for 15-30 seconds and repeat 5 times. Seated Towel Stretch: Loop a towel around your foot and gently pull it toward you, holding for 15-30 seconds. Pen Pick-ups: Stay seated. Then, lay three pens, or similarly shaped objects, in front of you–spaced apart evenly. Using your toes, pick up each pen and place it in a bowl. Seated Toe Pulls: Sit on a chair and cross one ankle over the opposite knee. Grab the top of your foot and gently pull it toward your body until you feel a stretch on the top of your foot. Hold for 15-30 seconds and repeat 2-3 times per foot. https://www.youtube.com/shorts/-EeyHTdkrEs Additional High Arch Pain Relief Tips More practical approaches for high arch pain relief include: Ice Therapy: Apply an ice pack to sore areas for 15-20 minutes to reduce inflammation and soothe discomfort. If your feet are particularly painful, take this one step further by practicing the RICE method (Rest, Ice, Compression and Elevation). Supportive Inserts: Use over-the-counter insoles with firm arch support. A good choice for high arches is the Superfeet Green or the Superfeet Run Cushion High Arch insoles. However, talk to a podiatrist or chiropodist about if you need more customized support from orthotics. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage pain. Seek Professional Help: Visit a podiatrist or chiropodist for a biomechanical assessment to determine how prominent your high arches are, how they are affecting your body, and any contributing biomechanical factors. These foot specialists can also fit you for custom orthotics, provide shoe recommendations and curate a full treatment plan. When to See a Specialist For High Arches If high arches are causing persistent discomfort or limiting your mobility, it’s essential to seek professional advice. As we mentioned, visiting a foot clinic ensures access to personalized treatment plans. Consulting a foot specialist is especially important if you notice: Increased frequency of ankle instability or sprains. Development of deformities like hammertoes, claw toes, or bunions. Chronic pain that makes simple activities like walking increasingly difficult. A foot specialist can recommend the appropriate treatments, depending on the severity of your condition. They may also suggest physical therapy to improve balance, coordination, and overall foot function. Regular check-ups and assessments with a podiatrist or chiropodist can prevent seemingly minor issues from becoming major concerns. Don’t hesitate to seek their expertise! https://www.youtube.com/shorts/XZUfVhny5pY

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