By Harry Jackson Jr.
ST. LOUIS POST-DISPATCH
Monday, Apr. 23 2007

Although the feet may seem like the stepchild of the human body, you may want to pay more attention to them.

Authorities on foot health say that keeping an eye on your feet is just as important as keeping an eye on your overall health.

Your feet can signal problems with undiagnosed diabetes, cardiovascular disease, kidney disease and even cancer, they say. That means that watching your foot health can help you catch undiagnosed conditions before they do permanent damage. “I teach my patients daily foot inspections,” says Dr. Christopher Sloan, a podiatrist practicing at the Desloge Foot Care Center in Desloge, Mo. “By doing that, you know what you have, and you know what it looks like.”

Sharon Plummer, a nurse practitioner with the Endocrinology Foot Clinic at the St. Louis University School of Medicine, explained that feet have the longest nerves and arteries in the body and that they’re at the lowest part of the body. That makes them the body’s early warning system.

Gravity is the reason, says Dr. Johnny Benjamin, director of the Joint Implant Center and Medical Specialty Procedures Surgery Center in Vero Beach, Fla. Disease can be detected because as your blood circulates to the lowest part of your body, if your heart isn’t strong enough to pump it back efficiently, problems arise. If you have diabetes, the extra sugar damages the nerves and other tissues.

If your heart is weak or you have high blood pressure or other cardiovascular problems, your feet may swell. If vessels clog with impurities, tissues die and must be amputated. “When the heart can’t pump the fluid correctly, gravity pulls that fluid down into your feet,” Benjamin says. “You end up thinking it’s a problem with your foot or your leg when it’s a problem with your heart.

Kidney disease also can cause swelling.” People need to watch for changes in color and feeling, Benjamin says. “If there’s a darkening or discoloration of their toes that happens fairly suddenly, that can be an indication there’s a blood flow problem.” Unexplained sores and lacerations signal loss of feeling in the feet, and that signals diabetes.

In the case of swelling, “If you press on the swelling and you leave a divot, that can mean that your heart is not functioning correctly, even congestive heart failure,” Benjamin says. And, he says, “… a little blue or reddish, that could be vascular problems.”

Finding a problem can give doctors a head start on treating it, he says. “When you find one of these symptoms, you work backward to find out what’s causing the problem that’s manifesting itself in your feet,” Benjamin says. “Swelling doesn’t come from a problem with the feet. It comes from a problem with the heart.”

What The Feet Reflect

For people with or without health problems, look for signs that can signal impending problems. Experts say all of these problems can be magnified for smokers. Plummer says, “When someone smokes and looks at their toes and they’re darker and blue-red, you wonder if smoking is giving you vascular disease, and the answer is yes.”

Smoking causes circulation problems in healthy people. So if you smoke, expect your toes and feet to darken. Experts say that’s caused when poor circulation causes the veins to back up like a clogged drain. Otherwise, here are some problems that can be detected by just looking at your feet.

Diabetes

This is the disease that most shows itself in your feet. And undiagnosed or ignored diabetes can lead to foot amputation. “I diagnose 30 to 40 cases of diabetes a year for people who didn’t know they were diabetic,” Sloan says. The American Diabetes Association reports that in 2002, more than 60 percent of lower-limb amputations not because of an accident were for people with diabetes. That adds up to 82,000 people. A major symptom is numbing in the feet and toes. Formally known as neuropathy, numbing is the primary predecessor to amputations. It means tissues and nerves aren’t getting a good blood supply. When that happens, they die. The surplus blood sugar stream damages the walls of blood vessels and nerve endings. The result can be so severe that people find wounds on their feet and don’t know what caused them.

Stroke

If you’re older and you suddenly start tripping a lot, you could have had a mild stroke. “Nerves automatically lift the feet when they walk,” Plummer says. “You don’t have to think about it.” A foot not lifting properly is called “foot drop.” Something is inhibiting the nerves. A mild stroke, a back injury or diabetes can cause foot drop. Smoking enhances these effects.

The Wrong Shoes

Although poor-fitting shoes aren’t classified as a disease — although podiatrists believe they should be — corns, calluses, hammertoes and ingrown toenails are problems for millions of people. The key is to take care of problems as soon as you see them. Don’t wait for pain to become unbearable. Then invest in a couple of pairs of shoes that fit right.

Cardiovascular Disease

Swelling often is a sign that your heart isn’t pumping fluids through your body with enough force. Fluids settle in lower legs, ankles and feet. Press on a spot on a swollen foot and if it leaves an indentation and the color lightens drastically for a few seconds, you need to report that to your doctor quickly. The diseases could be hypertension, congestive heart failure, hardened arteries, kidney problems or other vascular problems. Smoking enhances this problem.

Obesity

Doctors say the most common groups of people complaining about foot problems are obese and elderly people. Obesity can cause any of the above problems as well as arthritis. “The feet can tell when you’re carrying too much weight, and that’s a common cause of pain,” Plummer says. “Your feet were designed to carry a certain amount of weight. So people who are obese will complain of pain.”

Skin Cancer

Your toes beneath the nails can indicate a very rare but dangerous form of skin cancer. Beneath the toe, a bruise will appear for no reason, then it won’t grow or shrink, and it doesn’t grow out with the nail as a bruise would. The vast majority of the time, toe discoloration is because of fungus or a bruise.

Thyroid Gland Problems

Brittle nails can mean problems with the thyroid gland. See your doctor.

All of the experts agree: Don’t self-diagnose. But experts also agree that educating yourself on the possibilities is vital. Research your condition, says Plummer, and compare symptoms with your family history and other risk factors. “Doctors love informed patients,” Plummer says.

Keep An Eye on Your Feet

Mary Doerr, foot-care nurse with the Diabetes Center at Barnes-Jewish Hospital, teaches people how to keep an eye on their feet. Doerr and other foot-care experts offered these tips on keeping your feet problem-free.

Keep them clean. Wash your feet every day with mild soap and warm water. Especially if you’re older, test the water with your hand. This is important because if you’re suffering from a loss of feeling you won’t scald your feet. Dry your feet completely, making sure you get between your toes. Damp toes become bacteria motels. Drying powders help.

During your inspection, look for changes: redness, cracks in skin, sores, color changes. If you have a blister, cut or sore, watch how quickly it heals. If it takes more than a few days, see your doctor. Slow-healing sores are a sign of diabetes, and long-lasting sores have a better chance of becoming infected. Do not endure foot pain.

Wear healthy socks. That means no cotton. Cotton traps moisture inside the shoe, and that creates a welcome home for germs. Wear shoes that fit. Shoe manufacturers have made orthopedic shoes almost unnecessary. Shoes come in every width, stiffness and size.