Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, muscle tone, balance and coordination. Although its most recognised symptoms include tremor, rigidity and slowness of movement, the disease can have a substantial impact on foot health and the ability to perform routine foot care. Changes in gait, reduced dexterity, dystonia, swelling, altered sensation and difficulty managing footwear may increase the risk of pain, skin injury and falls. Effective foot care should therefore be regarded as an important component of multidisciplinary Parkinson’s management rather than as a minor hygiene issue.
Effects on gait and foot function
Parkinson’s disease commonly alters the normal walking cycle. People may develop shorter steps, shuffling, reduced foot clearance and difficulty initiating movement. Some experience “freezing of gait”, in which the feet appear to become temporarily stuck to the floor, particularly when turning, approaching a doorway or moving in a confined space. Festination may also occur, with increasingly rapid but short steps as the person’s centre of mass moves forward. These changes reduce stability and increase the likelihood of catching the toes on rugs, thresholds or uneven ground. Foot-health problems can further worsen postural instability and walking difficulty, creating a cycle in which painful or poorly functioning feet increase fall risk.
Rigidity may restrict movement at the ankle and foot. A person may have difficulty achieving normal heel strike, ankle dorsiflexion and toe-off, and may instead walk with a flat-footed or forefoot-loading pattern. Reduced ankle movement can increase pressure beneath the forefoot or heel and may contribute to callus formation. Stiffness in the calf and ankle can also make a heel-to-toe pattern difficult to maintain. Consequently, routine walking may cause fatigue, discomfort and compensatory loading elsewhere in the lower limb.
Dystonia, deformity and pressure
Some people with Parkinson’s develop foot dystonia, an involuntary and often painful muscle contraction. The toes may curl underneath, the great toe may extend, or the foot may turn inward. The ankle can adopt an inverted or equinovarus position, causing pressure on areas that would not normally bear substantial load. Dystonia may be more pronounced during walking or at particular times in relation to medication. It can make the foot difficult to place inside a shoe and may produce pressure over the dorsum, sides or tips of the toes.
Persistent abnormal postures may contribute to claw or hammer toes, contractures and focal areas of callus. A shoe that previously fitted comfortably may become restrictive as the position of the toes or ankle changes. Pressure from footwear can result in blisters, corns, nail trauma or breaks in the skin. Where circulation, sensation or general health is compromised, even a small lesion may take longer to resolve. Foot deformity can also increase pain and further disturb gait, making mobility and balance more difficult.
Difficulty with self-care
Bradykinesia, tremor, rigidity and impaired coordination can make ordinary foot-care tasks challenging. Cutting toenails requires adequate hip and spinal mobility, visual control, hand strength and precision. A person with Parkinson’s may struggle to reach the feet, hold nail clippers steadily or judge how much nail to remove. This creates risks of cutting the skin, leaving sharp nail edges or cutting too deeply at the corners, which can contribute to ingrown nails.
Applying moisturiser, checking the soles and removing hard skin can also be difficult. Some individuals may not notice a blister, fissure or area of redness until it becomes painful or infected. Reduced activity, fatigue, cognitive changes or depression may further reduce motivation to maintain regular foot inspection. For these reasons, assistance from a family member, carer, podiatrist or other health professional may be necessary. Regular professional care is particularly valuable when self-treatment is unsafe or when there is a history of recurrent lesions.
Skin, circulation and swelling
Reduced mobility can contribute to dependent swelling in the feet, ankles and lower legs. Oedema may make shoes tighter and increase friction against the skin. It may also fluctuate during the day, meaning that footwear comfortable in the morning becomes restrictive later. Elevating the legs when appropriate, maintaining safe levels of movement and obtaining medical assessment for persistent or asymmetrical swelling may help identify contributing factors.
Dry skin and fissures are additional concerns. Feet should generally be washed in warm, not hot, water and dried carefully, especially between the toes. Harsh soaps and prolonged soaking can remove natural oils and worsen dryness. A suitable emollient may be applied to dry skin, but it should not be placed between the toes if moisture retention increases the risk of maceration. Any cut, burn, ulcer, unexplained colour change, discharge, odour or rapidly increasing swelling warrants prompt clinical assessment.
Footwear and fall prevention
Appropriate footwear is central to foot care in Parkinson’s disease. Shoes should fit the current shape of the feet, provide adequate toe space and avoid pressure over prominent areas or dystonic toes. A firm heel counter, a secure fastening system and a stable, non-slip sole may improve security during walking. Velcro or elastic closures can be easier to manage than laces when dexterity is limited. Slippers, loose backless shoes and walking barefoot may increase the risk of slipping or losing balance.
Footwear should be checked regularly because changes in deformity, swelling and gait may alter its suitability. Insoles or orthoses may be considered where there is a specific mechanical problem, although they require individual assessment. Evidence regarding orthoses and specialised footwear in Parkinson’s disease remains variable, and devices should be introduced cautiously so that they do not destabilise the person or interfere with foot placement.
Multidisciplinary management
Foot care is most effective when integrated into broader Parkinson’s management. A podiatrist can assess skin and nail health, pressure distribution, deformity, footwear and the need for professional treatment. A physiotherapist can address strength, balance, gait retraining and cueing strategies for freezing. An occupational therapist may recommend equipment or environmental adaptations that make bathing, dressing and nail care safer. The neurologist or prescribing clinician should review motor fluctuations, medication timing and painful dystonia when these affect foot function.
Education should include daily visual inspection, safe nail-care practices, appropriate footwear and advice about fall hazards within the home. Foot care plans should be reviewed as Parkinson’s disease progresses because symptoms, medication effects and mobility can change over time.
Parkinson’s disease can affect foot care through altered gait, rigidity, dystonia, deformity, swelling, reduced dexterity and increased fall risk. These problems may cause calluses, corns, nail trauma, pain, skin breakdown and difficulty wearing shoes. Regular inspection, safe hygiene, professional nail and skin care, appropriate footwear and coordinated multidisciplinary management can help preserve mobility and independence. In clinical practice, early recognition of foot problems is important because improving foot comfort and stability may reduce avoidable disability and support safer walking for people living with Parkinson’s disease.