A Medical Checklist for Assessing Changes in Your Feet

Did you know that the average person takes approximately 10,000 steps per day? That can add up to more than 3 million steps per year, with each step placing two to three times the force of your body weight on your feet, depending on whether you are walking or running. Over time, this can lead to changes in the look and feel of your feet and ankles.

Many of these changes are normal and associated with aging, such as:

  • Your foot becoming wider and longer, causing increase in your shoe size
  • Mild settling of your arch, seen as flattening of your foot
  • Thinning of the fat pad on the bottom of your foot
  • Loss of range of motion and increased stiffness in your feet and ankles

On the other hand, some foot changes can occur that are abnormal. These conditions can cause pain and discomfort, and may become serious if not treated.   

Bunion — A swollen, sore bump on your big toe, which starts to point toward the little toes. More than one-third of women in America suffer from bunions.

Hammertoe or claw toe — Curling of your toes, often paired with corns or calluses over the top of your toes or under the balls of your feet.

Tendonitis — Swelling, pain, and thickening of the Achilles tendon and other major tendons on the inner or outer sides of your foot or ankle

Arthritis — Nagging pain and stiffness in your feet and ankles. You may also experience inflammation, redness, and swelling in your joints.

Source: Jeffrey E. Johnson, M.D., President, American Orthopedic Foot and Ankle Society.

Perhaps the greatest challenge faced by podiatric physicians and surgeons is in the diagnosis and management of people with diabetes. In particular, patients with peripheral neuropathy who lose sensation in their feet as a result of diabetes are more likely to develop ulcers and limb-threatening infections that can lead to amputations. 

Pain as a warning

Patients with sensory neuropathy are said to lack “the gift of pain.”  Because they can’t feel injuries or blisters, they can develop an ulcer on the bottom of their feet in the same way that people without neuropathy might wear a hole in a pair of socks. It is critically important that we use advances in technology to diagnose, treat, and prevent lower extremity complications of diabetes. 

One of the ways in which we can do this is to monitor temperature changes, or asymmetry, between corresponding locations on patients’ feet. Previous studies have shown that increases in temperature may represent localized inflammation that can precede skin breakdown. In other words, the foot heats up before it breaks down.

Real-time intervention

In the past, we asked patients to monitor foot temperature at home using a hand-held thermometer.  The patient would then record the temperatures in much the same way as they might keep a log of blood sugars. However, this approach posed several challenges, including issues of compliance and communication between patient and doctor. What good would it be if a patient identified a “hot spot” on the bottom of their foot, but nothing further was done?  

Recently, I started work on a pilot study, in which patients receive a wireless mat, to use at home.  The mat measures foot temperature and connects to a cloud-based system that can analyze and detect temperature asymmetry. If a “hot spot” is detected, I receive an alert either via text or email, and I reach out to the patient directly to initiate a treatment plan. If we can prevent just one ulcer, infection, amputation, ER visit, hospitalization with this easy-to-use, smart mat technology, then we may be on to something big.