The Five Stages in Parkinson’s disease

  1. According to, the 1st stage is hardly noticing the symptoms at all. They won’t interfere with daily tasks. One might have a one-sided tremor, controllable with medications.
  2. The 2nd stage is more moderate. Symptoms of stiffness, tremors/ trembling & changes in fascial expressions are much more noticeable. At this stage there is no impairment of balance. Speech can be affected, & symptoms may occur on both sides of the body. Progression from stages can take months, even years without any way to predict.
  3. Stage 3 is “Mid-Stage”. Add loss of balance to all stage two symptoms, & falls can be common, as “reaction time” is delayed . The disease can effect daily tasks, once taken for granted.
  4. This stage robes the person of much of their independence. Walkers & other “gait aids” are needed. Living alone may be threatened, since daily tasks are difficult , if not impossible.
  5. This advanced stage is most debilitating. Stiffness in the legs can cause “freezing” upon rising. Wheelchairs are required. Patients have been known to become delusional with hallucinations. Some of the medications at this stage have more considerable side effects & they may outweigh the usefulness.

Most doctors treating these stages rely on the Hoehn & Yahr rating scales. Main symptoms include; stiffness, out of control tremors. Slowing of moving body. Standing & balance is difficult.

Foot Care in Parkinson’s

Anyone can have hereditary or historical traumatic foot problems, that have nothing to do with the simultaneous diagnosis of the neurological disease, Parkinson’s. Having a poorly functioning foot/ feet, can additional impact balance & gait characteristics. Being a neuromuscular disorder, this diagnosis make use of the limbs more difficult. In later stages of the disease, freezing, shuffling, tremors & imbalance makes gait a challenge. Heel to toe contact with the ground can be difficult. Abnormal gait can adversely affect shoe ware & making balance even more troubling. Alternating different foot gear resolves this issue. Toes may curl ( Dystonia) under in spasm, reducing the feeling of propulsion. Lower leg muscles may not “cooperate in a coordinated manner” ( excess of Inversion or Eversion) to accomplish propulsion. Since there is less movement , fluids can collect at the ankles. Ankle range of motion is the key for “pumping” of fluids in the limbs ( sit in a recliner) , back up to the heart for recirculation. Stagnation can occur & make more work on the heart .

Podiatric Medicine can help

The Doctor of Podiatric Medicine ( DPM) can help in the can of the Parkinson’s patients. They can coordinate a plan for issues encountered in the lower extremities. Don’t wait for problems to develop. Be proactive & take advantage of what the professional has to offer.

Hygiene for life ( nail & skin care) is needed so that the patient does not become a victim of neglect. There are many items on the market for making hygiene easy & independent. Advice on what types/ styles & tasks of quality foot gear. Exercise programs to encourage range of movement as in Water Aerobics can be valuable. Benefits are multiple, to include; 1) doing an activity that gives a feeling of self-accomplishment & satisfaction of finding a task that can be valuable & ongoing. 2) lowering A1C in Diabetic patients. 3) burning fat ( lose weight) & sugar. This may reduce intake of some medications. 4) Lower blood pressure, always a good thing . 5) toning muscles that can be spastic outside the pool.

Foot gear should be chosen carefully. Flat bottoms, non-skidding sloes/ heels, that provides a “secure perimeter”. If patients are “freezing” on the carpet, application of Duct Tape across the tip of the toe of the sole can help movement begin. Falling is the leading cause of injuries in Parkinson’s. Billions are spent yearly on folks falling & getting injured sometimes because of the foot gear. It is difficult in today’s market place, to go by the size of the shoe looking at the “numbers” in the shoe. The “rule of Thumb” , your thumb’s width, between the longest toe & the end of the shoe when standing, is a better way to decide what shoe to purchase. Sometimes an insole, customized for the individual, can “Off-Load” a hot spot ( callus) . It is difficult for the Parkinson’s patient , to try to avoid stepping down on a callus, & not losing balance from the disease. The DPM can also suggest multiple style of “pads” that can redirect energy away from areas of stress ( corn on a hammertoe). Surgery is not always the available , or recommended solution. Patients with Neurologic diseases are not always the best surgical candidates.

Patients with Parkinson’s disease can function well if given every advantage, in hygiene , in gait, & leading a full & productive life as long as possible.

Dr. Tim Byron, Foot Surgeon
Dept. of Surgery.