Q: Mildred Spickler would like to know if anyone has such sore foot soles that they can't walk on them.
Dr. Joan Dahmer points out that our feet often move in our shoes. The cutting action of anything rough can damage the skin on our feet and callouses which form to protect a pressure point are a common and often painful problem.
Several readers said that they soak their feet and remove callouses with a pumice stone, available at any drugstore. Dr. Scholl's has a large line of foot care products. "Once the callouses are removed," writes Nancy Covent, "the cracks heal more easily. Nancy uses gel from the aloe plant to help her cracked callouses heal and also mentions antibiotic ointment. She says that keeping the callouses filed down helps prevent cracking.
Another reader mentioned "The Foot Salon" by Clairol, which is a thermostatically controlled foot bath. It not only sounds good for softening callouses but heavenly for cold, tired feet.
Nancy Pinko writes that she has had success healing dry, cracked, painful callouses on feet with loss of sensitivity by using Dreft detergent with Borax. She soaks her foot 10 to 15 minutes, once a day, two or three days in a row and finds the cracks are healed. She says her orthopedic surgeon told her about this when her son developed infection after foot surgery.
Go slowly with this or any treatment, and don't forget that this is not a doctor speaking but other CMT people. We want to pass helpful hints on to you but advise that you use common sense and caution when treating yourself. All home remedies are tried at your own risk.
Another hint is to check your feet often, especially if you have a loss of sensation. It is so easy to step on something and damage the tissue which results in an infection before you know it. From what you've told us, and from personal experience, CMT feet heal very slowly and an infection is best avoided.
It seems many readers cannot bear to walk barefooted as the slightest stone, ridge or bump will cause severe pain. Some, however, prefer bare feet and, due to loss of feeling, their feet can't feel what is underfoot. These are the people who should definitely check their feet at least once a day for slivers, blisters or other wounds. One reader was prescribed vitamin B6 (check the drug list and other warnings about vit. B6) for soles and feet so sore she couldn't walk, and several mentioned that insoles made to alleviate particular pressure problems helped a great deal.
Sponge insoles may help. Wearing cushion-foot socks and never wearing soiled or sweat-soaked socks also helps. Nylons do not absorb sweat and some have a seam under the foot which irritates. Socks can make a difference, especially absorbent ones not made of synthetic materials.
Q: I can't bear to have my toenails clipped it hurts so much. Why?
A: Dr. Lowell Williams answers: Sensation in CMT feet is not always less than normal; it may be MORE than normal! There are some CMT patients who cannot walk on sand because the grains hurt them so much; maybe you have a similar problem. Cutting toenails moves the nail around a bit; the sensation that is normally not pain is MAGNIFIED to pain by the abnormal conduction of CMT nerves. It may be that because your body knows it is feeling less it takes any
information it gets (like the toenail being moved a little) and rushes it to your brain just in case it might be bad for you. Try soaking your feet in warm water before cutting and try to relax
while doing it.
Q: My feet are so cold in the winter inside or out of the house that they actually hurt. Why?
A: Dr. Lowell Williams answers: Studies now under way at Columbus, Ohio, show that the blood vessels of CMT feet are not responding normally to temperature. Normally the blood vessels close down to prevent heat loss when exposed to cold. In some CMT people they do
the opposite causing more heat loss; in other CMT people they close down too long so that there is a lack of circulation. It could be either of these in your feet. If too much heat is lost, the cold
will be painfully freezing some skin cells; if the blood vessels clamp down too long, the lack of oxygen from poor circulation will cause pain.
Q: I have been using a wheelchair during the day for my work now for several years because I fall so often that I'm afraid to stand to work. Recently I've been experiencing much pain and swelling in my feet and ankles. The swelling really has me worried. I walk a bit around the house but it is getting more difficult to stand. The doctors I've seen have no answers for me. One suggested support hose but that doesn't seem to be the answer. What should I do? Why are my feet and legs swelling? Have you ever seen or heard of anything like this?
A: Dr. Lowell Williams answers: Swelling of the feet and ankles can come from circulatory problems of those areas or possibly may be due to other body disorders. If your doctor has checked out your heart, blood pressure and kidney functions and found them to be alright, swelling may be due to poor local circulation. Both support hose and exercise may help improve the blood flow to lessen fluid leaking out of the blood vessels. Sometimes a prescription for water pills or medicine to cause diuresis may help. Keeping your feet elevated while in your chair may help. Although it is not common in CMT, some CMT people have this problem. We are hoping to
study the nerve's control of CMT circulation to understand this complication.
Q: I had a fall nearly four months ago and injured my ankle. X-rays showed no broken bones. Verdict - torn ligaments. However, the ankle continued to be very painful and second X-rays looked at by a specialist caused his comment..."lack of calcium" and "nothing can be done." Have you had experience with this?
A: Dr. Robert Sampson answers: The pain which one suffers from a chronic sprain of the ankle can be severe and long-lived. Depending on the nature of the injury and upon the health of the person who sustained it, it is not unusual for a sprained ankle to be painful for six to nine months. I think people are frequently lulled into a false sense of security when they are told that they "just have a sprained ankle." Quite often that means that things should be well in a few days but this is not always the situation.
A person who suffers the discomfort of a chronically sprained ankle, in my opinion, should be treated with an air stirrup or similar type of ankle brace for up to a year after the original injury. Occasionally, the use of anti-inflammatory medication, such as Ibuprofen which is available over the counter in the United States (and Canada), is also helpful. Another thing that we have found helpful here is that on rare occasions injection into the painful ligament of a cortisone/local anesthetic combination may be of some help.
If your discomfort persists, even after the above measures, then one must consider that there may have been an injury to the bone which did not show early on. There are some rare conditions that show up six to nine months later, and repeat X-rays should be taken. At the same time, I would advise that a "stress X-ray" be taken to make sure that the ligaments have not been damaged beyond the point of normal healing. If this were the situation, further remedies, such as a surgical procedure or prolonged casting, might be necessary.
The comment "lack of calcium" is a difficult one to analyze. It probably doesn't have a lot to do with the sprained ankle at all.It may be that you have some osteoporosis of the bones, but even that wouldn't affect the healing of the ankle sprain. It could, however, mask a small crack or fracture in the bone, and a repeat X-ray might be necessary.