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Cauda Equina Syndrome

Feetproblems

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Many people who have cauda equina-syndrome, have problems with their feet. That is because the nerves, that control the skin and muscles of the feet, are not functioning well anymore. Doctors and caregivers often pay little attention to problems with the feet. That's a pity. Only until you encounter problems with your feet, you realize how important they are.
Below you find - in alphabetical order - more information about the various feetproblems that may occur with the caudasyndrome. Also you can read what can be done about it.

• Athlete's foot
• Clawtoes
• Cold / warm feet (chillblains)
• Footdrop
• Foot sole, hypersensitive
• Nails, fragile
• Shoes, no longer fitting
• Standing is tiresome
• Wounds, small
• Exercises

ATHLETE'S FOOT

Occasionally, people with the caudasyndrome suddenly suffer (more) from athlete's foot.
What can be done about it?

• After showering/bathing, dry your feet thoroughly with a towel that you use just for your toes.
• If necessary, ask your GP for a special cream for athlete's foot.

CLAWTOES

Because some feetmuscles have become weaker or fail completely, the foot gets concave at the bottom, the arch of the foot gets high and the toes start clawing. At the beginning, it is still possible to get the toes in the right position by pushing under the foot. Over time, the clawposition gets permanent. It results in friction with the shoe on top of the toes, which is painful. Also callus or a corn can get on the tops of the toes or on the knuckles. When there is failure of the sensitive function, small wounds can easily emerge.
What can be done about it?

• Wear well-fitting shoes, with enough space at the toes.
• Get - if possible - insoles fitted.
• To prevent clawtoes from getting hammertoes (when they grow together in that position), you have to move, bend and stretch your feet and toes regularly. For this, you can also use a foot massage roller or for example a rolling pin.
• If the symptoms are very serious, an operation can be considered.

COLD / WARM FEET (CHILLBLAINS)

Disorders in the sensory nerves disrupt the regulation of the temperature of the skin. That is why someone with the cauda equina syndrome often suffers from - alternately - extremely cold or overheated, itching (chillblain) feet. The skin usually feels cold while you feel your feet are glowing. The transition from cold to heat can cause itching. The feet, especially the toes, show all kinds of shades of pink, blue and purple. All this is a result of an impaired bloodflow which is caused by the damaged nerves in the feet.
What can be done about it?

• Wear woolen socks in winter.
• If possible, take a walk before going to bed or do exercises with your feet, move them energetically for a while.
• Let your feet get warm slowly with an electric blanket or a lukewarm hot water bottle. It is important that your feet don't get warm too fast. That way you can prevent chillblains. Don't make a hot water bottle too hot and turn off the electric blanket in time. Beware of burns: you won't feel them if your feet are numb.

FOOTDROP

The so-called footdrop is caused by weakness or failure of the muscles that lift the feet and toes up and turn them outward. The foot can not be put down on the floor in a normal way and often flops audibly. During walking is it not possible to take off well. When no aid is used, the foot drops in the swinging phase of walking inwards and downwards. Often a dropfoot results in an inward and downward twisted resting position because there is no counterbalance to the functioning calfmuscles and deep flexors. Walking without aid is very awkward and walking well is impossible, even with a good walking-aid.
What can be done about it?

• A brace (ankle-foot orthosis) can help improve the gait and prevent struggling.
• Wearing high orthopedic shoes contributes to stability and makes you walk distances.
• The most serious symptoms of footdrop can often be corrected by one or more tendon transfers. In this operation, functioning muscles are connected with tendons of paralyzed muscles. This way, the functioning muscles (partly) take over the function of the paralyzed musles.
• It is important to keep moving in order to maintain the existing strength of the muscles and to strengthen the weak muscles where possible. A physiotherapist can give the right exercises for this.

FOOT SOLE, hypersensitive

The big muscle in the middle under the foot often is cramped as a result from problems with the muscles. As a result, even the tiniest stone in the shoe or, walking on bear feet, on the ground, hurts. What can be done about it?
Nothing can be done about this, except for watching your step carefully.

NAILS, fragile

Because of the damage of the sensory nerves, the toe nails get less ‘nutrition’ and will get thinner and more fragile in time.
What can be done about it?

• Pay extra attention to a good and regular care of your toe nails.
• If necessary, go to a pedicure (preferably one that is specialised in ‘diabetical foot’).

SHOES, no longer fitting

A lot of people who have caudasyndrome get an unpleasant surprise: their shoes suddenly do not fit properly anymore. Because some muscles or groups of muscles in the feet have become weaker or fail completely, the form of the foot changes. The instep is higher and the foot gets concave at the bottom.
What can be done about it?

• It is very important to wear properly fitting shoes which suppport the feet well and have a sole that is as flat as possible.
• You can have shoe insoles fitted, for example by a podiatrist or an orthopedic shoemaker.
• If necessary, ask your (rehabilitation)doctor for a referral to an orthopedic shoemaker to have custom made shoes.

STANDING is tiresome

Normally one needs relatively little musclepower to keep in balance while standing. The skin plays an important role. Your toes, that get pushed to the ground, provide information about the position of your feet, so the feet- and legmuscles can provide for balance.
People with the caudasyndrome, already have less musclepower in legs and feet. That makes it harder for them to keep their balance. But the numbness or the loss of sensitivity of the skin in especially the outerside and the underside of the feet and toes makes it even harder. The various muscles must work harder to keep the body in balance, they need to correct more often and intense. That is why standing upright is relatively tiring for people who have the caudasyndrome.
What can be done about it?
By training and doing exercises the leg- and feetmuscles can get stronger. It is best to turn to a physiotherapist for this.

WOUNDS, small

The caudasyndrome makes the skin of the feet more vulnerable. The skin dries out, gets flaky and cracks easily. The skin is thinner, so small wounds appear more quickly and heal slower. On top of that: because the skin is numb or less sensitive, painsignals are not passed on (well). As a result, small wounds or blisters don't get noticed (on time), with all its consequences.
What can be done about it?

• Check your feet regularly on strange spots and beginning wounds and go to your GP if you find such spots or wounds.
• Small wounds occur if you wear shoes which are too tight and your toes/feet rub along the inside of your shoes. Because of this it is important that you wear well fitting shoes. If necessary, ask your (rehabilitation)doctor for a referral to an orthopedic shoemaker for custom made shoes.
• Ask a pedicure, who is specialised in ‘diabetic foot’, for advice in taking care of your feet.

EXERCISES

There are exercises you can do to make your feet stronger:

• Exercise for the hollow foot, to strengthen the muscles on the bottom of the foot and to make the arch of the foot stronger:
  Take a rolling pin, a special footmassage roller or another rolling object and put that on the ground. Hold one foot on the ground and put the other one on the roller. If you have difficulty keeping your balance, you can hold on to something; if standing upright is difficult for you, you can sit on a chair. Put some weight on the roller and roll it backwards and forwards under your foot. In the beginning, don't push too hard and slowly build up the pressure and the amount of repetitions.
• Exercise for the muscles of the toes and of the arch of the foot:
  Lay a towel, another cloth or paper napkin on the floor. Stand on bear feet, with your toes over the edge of the towel and try to pull it under your feet, holding your heels still. Repeat a few times. To make this exercise more difficult, you can take a longer towel. If balance and/or standing upright is a problem, you can either hold on to something or sit on a chair.