Stroke and Foot
People who have suffered from stroke are prone to many foot problems, often because of two complications of strokes: nerve damage (neuropathy) and poor blood circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation.
Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection. When you have had a stroke, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels.
Furthermore, after a stroke, small foot problems can turn into serious complications. A lot can be done to prevent difficulties with walking and even prevent amputations by taking two important steps: Follow the proactive measures discussed below—and see your foot and ankle surgeon regularly.
The American Heart Association has compiled the following statistics, which are not only very interesting but also exceedingly relevant to foot-related vascular problems:
- Peripheral arterial disease (PAD) affects eight to 12 million Americans and is associated with significant morbidity and mortality.
- PAD affects 12-20 percent of Americans age 65 and older, but only 25% of persons with PAD are seeking treatment.
- In the general population, only about 10 percent of persons with PAD have the classic symptoms of intermittent claudication. About 40 percent do not complain of leg pain, while the remaining 50 percent have a variety of leg symptoms different from classic claudicating.
- The risk factors for PAD are similar to those for coronary heart disease, although diabetes and cigarette smoking are particularly strong risk factors for PAD.
- Persons with PAD have impaired function and quality of life. This is true even for persons who do not report leg symptoms.
Having a stroke puts people at risk for developing a wide range of foot problems:
- Infections and ulcers (sores) that don't heal. Because of poor circulation in the feet, cuts or blisters can easily turn into ulcers that become infected and won’t heal. This is a common—and serious—complication of a stroke and can lead to a loss of your foot, your leg, or your life. An ulcer is a sore in the skin that may go all the way to the bone.
- Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
- Dry, cracked skin. Poor circulation can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores.
- Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they're not professionally treated, they can lead to ulcers.
- Hammertoes and bunions. Motor neuropathy (nerve damage affecting muscles) can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
- Brittle bones. Neuropathy and circulation changes may lead to brittle bones (osteoporosis). This makes you susceptible to breaking a bone, even without a major blow or injury occurring.
- Blocked artery in the calf. After a stroke, the blood vessels below the knee often become narrow and restrict blood flow. A severely blocked artery is a serious condition that may require intervention from a vascular surgeon. If vascular surgery fails and the wound does not heal, amputation may be necessary.
According to Dr. Majewski, a local foot surgeon and member of the American College of Foot and Ankle Surgeons, a major goal of the foot and ankle surgeon is to prevent amputation. There are many new surgical techniques available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other health care providers to prevent and treat complications from a stroke.
The goals of treatment of stroke-related foot problems are not only to save the life and limb, but also to get the patient healed and moving about as soon as possible. If vascular surgery cannot improve blood flow and podiatric surgery cannot restore function, amputation may be the only solution that gets the patient walking again. Amputation may involve one or two toes, part of the foot, or part of the leg. It is selected on the basis of the patient’s condition and level of predicted healing. A return to normal life is especially possible today because of advances in prosthetics.
Your Proactive Measures: You play a vital role in reducing complications.
According to Dr. Majewski, it is best that you follow specific guidelines to prevent injury.