FFE Magazine

When did you last check your feet?


Many people don’t visit a podiatrist unless they have a foot problem, but did you know that your primary care doctor should take a look at your feet, too? “Just from an exam of the feet you can tell a lot about the overall health and wellness of the patient,” says Anthony Weinert, DPM, a double board certified Michigan podiatrist. Seems the feet are windows into what’s happening in the rest of the body. Here’s what your dogs can reveal:

Disappearing hair on toes

What could be wrong: Poor circulation

Hair follicles don’t have enough circulation to remain intact so they slough off. Often it’s accompanied by a cool foot temperature. It’s typical of vascular disease, most commonly arterial sclerosis, which is a hardening of the arteries that brings blood from the heart to the extremities. Poor circulation can also be heart related; a weak heart-pumping mechanism can cause circulatory issues. Patients must see a vascular surgeon for evaluation.

Toes that tip up

What could be wrong: Lung, heart or gastrointestinal issues

“On exam, patients will have the distal end of their toe bump upwards at the end; it sort of looks like a weird-angled toe. We call it digital clubbing,” says Weinert. It can be one toe or multiple and is usually a red flag for a pulmonary or lung disease, even lung cancer. It can also be a gastro issue, like Crohn's disease or heart disease. A primary care doctor needs to hone in on what’s going on with additional testing.

Burning feet

What could be wrong: Neuropathy (numbness)

“The sensation of burning in the feet is usually caused by some type of problem with the nerves,” says Dr. John Scheffel, DPM, founder of the Scheffel Foot Center in Worcester, Mass. Neuropathy is a general term meaning nerve dysfunction. Causes include diabetes, vitamin deficiency, and side effects from medications. The first step is to determine the cause of the neuropathy. If no cause can be identified, this is called idiopathic peripheral neuropathy. Medications can be prescribed to decrease neuropathic pain and burning sensation.


What could be wrong: Diabetes

Podiatrists perform various types of nerve testing to check a patient’s sharp and dull sensations. People with decreased sensation have a peripheral neuropathy, which may signal diabetes because high sugar impacts the nerves so they don’t function well. “Someone with neuropathy can have a rock in their shoe and they won’t know,” says Weinert.  If you have neuropathy but good blood sugar checks levels, you may have a misaligned position of the foot where when weight is placed on the foot, it collapses. A nerve that runs along the side of the foot becomes stretched and eventually compressed and leads to losing nerve sensation there. Custom orthotics, little inserts in shoes, helps correct the alignment.

Brittle toenails

What could be wrong: Vitamin deficiency

Brittle toenails can signify a lack of vitamin A and D since vitamin D, along with calcium and magnesium, are the foundation for healthy nails. “Sufficient amounts of vitamin D obtained either by casual exposure to sunlight daily or by taking supplements can enhance the absorption of calcium and increase the level of magnesium in the body,” says Afsaneh Latifi, a Manhattan podiatrist. Lack of essential fatty acids can also cause inflammatory conditions around the nails, which in turn render nails weak and brittle. Some medical conditions responsible for causing nails to become weak and brittle also include Raynaud's disease, hypothyroidism, lung conditions, tuberculosis, and Sjogren's syndrome.

Painful, red, swollen big toe

What could be wrong: Gout

Gout develops when there is a high amount of uric acid, usually from diet, whether it’s from drinking a lot of wine, or from cheeses, or red meat. “It’s a red, hot, swollen big toe joint and it’s so painful where patients can’t even have a sheet touching it,” says Weinert. It’s like a severe toothache in the big toe. Patients with gout are either overproducing or under-excreting uric acid. Weinert injects the toe with cortisone to get the acute swelling down. Patients then eat a low-purine diet and take preventative medication.


Cramps or charley horse

What could be wrong: Dehydration, low potassium
Foot cramps and charley horses in the calf are usually a result of low potassium or dehydration. If you have an issue with cramping of feet or legs, eat a banana before vigorous exercise and drink plenty of water before and after. Try stretching feet before sleeping.

Pitted toenails

What could be wrong: Psoriasis

In about half of all people with psoriasis, finger and toenails have tiny little holes like pits. More than three-fourths of those with psoriatic arthritis, a type of arthritis related to psoriasis that affects joints, also have pock-marked nails. Nails may also be thick, yellow or brownish. Your doctor can diagnose and treat psoriasis and psoriatic arthritis with medication, diet and lifestyle changes. Nails can sometimes be restored to normal if treatment is sought early.


Jennifer Nelson




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