If You Notice This With Your Toes, Get Checked for Parkinson's
It's often one of the first symptoms in Parkinson's patients under 50.
Parkinson's disease (PD) is a progressive disorder that causes the brain's dopamine levels to drop, triggering a range of motor and non-motor symptoms. Though Parkinson's often begins with a minor tremor, it can sometimes escalate to affect muscles throughout the body, causing stiffness, slowness of movement, involuntary motions, and balance problems—all resulting in impaired mobility. Among these motor complications is one that experts warn can affect the toes—and they say it often appears at the first motor symptom among those under the age of 50. Read on to find out which symptom in your toes may be an early warning sign for PD.
If you notice your big toe flexing upward uncontrollably, it could be a sign of Parkinson's.
One little known symptom of Parkinson's can appear in the toes, in a condition known as striatal toes. "A striatal toe has been defined as an apparent extensor plantar response, without fanning of the toes, in the absence of any other signs suggesting dysfunction of the cortico-spinal tract," explains a 2002 study in the journal Parkinsonism and Related Disorders. In other words, the big toe becomes rigid and flexes upward toward the body, while the other four toes on the affected foot remain straight or curl under. Roughly 10 percent of people with Parkinson's experience this symptom, estimates a 2013 study published in the journal Annals of Indian Academy of Neurology.
Experts say that this condition is a form of dystonia, a movement disorder in which the muscles contract involuntarily. "Dystonia is a continuous or repetitive muscle twisting, spasm or cramp that can happen at different times of day. Curled, clenched toes or a painful, cramped foot are telltale signs of dystonia," explains the Parkinson's Foundation. In fact, the organization says that foot dystonia is the most common type of dystonic pain among Parkinson's patients.
It's more likely to happen while you're using your feet.
According to the Parkinson's Foundation, dystonia is more likely to occur in a body part while that particular area is in use. "Dystonia often happens when the person with PD tries to perform an action with the affected body part," the health organization explains. "For example, if you have dystonia of the foot, you may feel fine when sitting, but you may develop toe curling [a similar condition in which the toes curl under] or foot inversion (turning in of the foot or ankle) when trying to walk or stand."
Less frequently, the same phenomenon can occur when the foot or affected body part is at rest. "Some dystonia happens unrelated to an action or movement—like toe curling while sitting," the foundation's experts say.
It may occur early in the disease's progression.
The American Parkinson's Disease Foundation points out that foot dystonia is commonly considered an early symptom of Parkinson's disease. "Particularly in young onset PD [in which the onset of symptoms begins before age 50], foot dystonia may appear as the first motor symptom that is experienced. If dystonia occurs in isolation, the diagnosis of PD may only become clear as other symptoms appear," their experts write. However, the Parkinson's Foundation adds that it "can also appear in middle to advanced stages of Parkinson's."
This can make diagnosing striatal toes difficult, says a 2005 study published in The Lancet. This is especially true when more traditional Parkinson's symptoms such as tremor, bradykinesia, and rigidity aren't yet present. Specifically, they say it's often mistaken for the Babinski reflex, a normal reflex in which the big toe flexes upward and the other toes fan out when the sole of the foot is stimulated.
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Treatment may be available.
If you notice striatal toes after already being treated for Parkinson's disease with dopaminergic medication, your doctor may first try adjusting your dosage. If you are not currently being treated for Parkinson's, there may still be several treatment options available to you, says APDA. According to a 2016 study published in the Journal of Rehabilitation Medicine, "Botox injection is effective and safe to treat FD [foot dystonia] such as striatal toe and remains the treatment of choice for limb dystonia." Additionally, muscle relaxants and physical therapy may help prevent spasms and muscle twisting in the toes and feet.
If no other treatments are successful, some people find relief with the help of deep brain stimulation surgery. This has been shown to reduce a range of Parkinson's-related motor symptoms, not limited to dystonia. Speak with your doctor to find out if this course of treatment may be right for you.