Standing posture, gait, and balance are major issues in Parkinson�€™s Disease, all of which, when deranged, contribute to major disability. The good news is that despite abnormalities due to multifactorial, interconnected, additive or even synergistic influences, these major concerns are at least partially remediable with various physical techniques. Prophylactic therapy, to avoid or delay onset of problems is even more effective and should certainly lead to a better quality of life.The take home messages are-

A- maintain flexibility and agility--as the tendency is for increased anterior flexor tone leading to a stooped, head forward posture with a general shift of the bodies center of gravity to a more forward position, incompatible with normal gait and increasing the tendency to fall.

B- exercise, exercise exercise! - keep moving

C-strengthen the legs and the core while using meds/PT, etc to avoid or reduce the time that muscle rigidity leading to a classic PD posture/walk are flexible, e.g. the strongest hip flexor (the iliopsoas), the upper chest muscles, especially the pectorals minor, and the muscles that produce neck flexion (e.g. the sternocleidiomastoid).

D-become a foot worshipper-the feet are the base of the entire kinetic chain and loss of mobility, strength, proprioception (awareness of body in space), and abnormal tone affecting the tremendously complex structure/physiology of the feet can often be the dominant factor explaining countless local and distant sources of pain and disability. Do exercises to strengthen and reinforce a stable foot tripod (most weight on the 1st metatarsal-phlangeal joint, 5th metatarsal phalangeal joint. and the middle of the heel (calcaneous). Maintain or develop the three foot arches, especially the medial longitudinal arch. Work towards standing>sitting with pressure equal on the forefoot and hindfoot as well as the right and left foot symmetrically. Avoid squeezing the toes together and try to mimic our natural (barefoot) state., e.g., wear shoes that have a wide toe box, gradually move towards footware with a minimal heel> toe elevation, increase barefoot time and walk on variable surfaces.

Though my experience over the several weeks may sound familiar to a small % of you, I think the phenomenon is under-appreciated in PD. Although what I will describe is not uncommon in the general population, both the incidence and impact of my foot pathology is increased in PD. Importantly, many of us begin and remain quite asymmetric- my left side has always been far more "Parkinsonian". In addition, my feet (statically or dynamically, standing or walking) are also very different; I overpronate on my right- with the foot rolling inward and becoming more flexible (normal during the early stance phase of gait after foot strike, allowing for maximum shock absorbtion). My left foot oversupinates ( foot tends to roll laterally, normally producing a rigid, locked lever facilitating push off of the trailing foot while walking or running. Excessive pronation/supination in me is marked by obvious wear on my right sneaker medially (towards my great toe) and on the lateral (little toe) side of my left sneaker. To walk "normally" I would require 2 different insoles (which over time will exaggerate the underlying imbalances, e.g of muscles, bones, strength, tone, etc, or, (what I have done), if my foot issues are primary I exercise/observe/experiment/inquire/research how I can correct what is correctable to produce symmetry or, at least, maximize functional compensation. After 10 years, despite putting in hard work the entire time), the left versus right disparity became worse. I began having almost daily a.m. toe curling dystonia (predominating on my �€œbetter�€� left side) and noticed that my toes on both feet were becoming more crooked, with a prominent bunion forming on the inside of the right big toe (with my that toe bending towards and rubbing the 2nd toe). More importantly, on my left foot ("PD-side"), as I started putting even more pressure laterally, I noticed there were dramatic flexible mallet toes. The second "knuckle" was elevated and the toe tips were bent down. Over time I felt twinges of pain, as my crooked toes rubbed together, and then dramatic pain as I began walking on the tips of my toenails and then, especially during "off periods", was walking on my toe tips as my gnarled digits began to crawl under their neighbors. The result- redness and irritation where toes rubbed together, thickened, dark nails and suffering. I was forced to either give-up and "go down", limp moderately and have moderate severe pain on my left lateral toes using my "regular" walk or trying like hell to not oversupinate (after 50 years) with less local pain but a terrible limp.

After more research/observation and a phone conference with a podiatrist friend I made several interventions to try and break the cycle ( 1- I rested more during "off-periods" as I was experiencing painful cramping in "new" muscles of my left leg during these times, 2- I bought several different types of "protectors" e.g. gel rings or caps that covered the irritated areas of my claw toes and 3- began wearing a gel toe crest with a ring that slips over my 3rd or 4th toe and connects to a gel pad that fits comfortably under the end of my sole when I'm wearing shoes, elevating the toe tips and preventing the "crawling under" phenomenon, and 4- returning back to "basic training"- working on my foot tripod-medial arch and strengthening other intrinsic foot muscles leading to improved toe spreading.

So far- so good- irritation and pain are much less and my limp has mostly receded. As you all know- the work is never done. My gait degenerated into a classic PD-walk as I consciously and unconsciously tried to avoid excess pressure on my left, resulting in short ineffective steps and more 'tightness" as I was using my foot/ankle/and leg muscles differently. I'd love to know if anyone else has had aa similar experience or, if you take a look at your piggies, you think may have been occurring "silently"

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Daves1,

Welcome to this forum! Just curious but do you have a history of ankle injury and if so it it repetitive?

I had a foot drop condition that I was able to overcome doing a chi gong exercise called "Arrow and Bow Walking" - a slow mindful deliberate exercise.

Although her work and findings has now expanded Janice Walton-Hadllock, a 5 element Chinese medicine practitioner has worked with hundreds of PWP and found that they all had chi bockage in the feet She has written a lot about that...

Cheers, MD

I don't but a food thought

An easy, effective exercise is to dump a bunch of marbles on the rug and pick them up with your big toe and put them in a cup. Finish the marbles, do it again and again....