REMEMBERING PROF. S. N. CHAKRABORTY BY HIS FOOT NOTES

 

 

Recently while going through my medical school class notes, I came across a very interesting lecture delivered by my late Guru and a wizard of Medicine, Prof. S.N. Chakraborty. He was a genius. He would walk inside a class early morning and ask “What do you want to study today?” and once we or his Medicine Senior Resident, Dr. Sumanta Chakraborty, who would take our attendance before his arrival, would express our choice of chapter, he would start extempore. No notes, no preparation Prof. Chakraborty was a walking talking encyclopedia of Medicine. We were mesmerized by his knowledge and were in love with his thunderous laughter.

On that day someone in our class asked him to teach us about diseases of the foot and in this blog I am trying to summarize his teachings from my lecture notes. The Professor said that although “my feet are killing me!” is one of the most overused exaggerations in the entire world, the truth is that the condition of your feet can say a lot about the overall state of your health, as well as indicate any underlying diseases you may have. Reflexologists and massage therapists have been proponents of manipulating points on the feet to improve the health of internal organs for a very long time. Although the evidence to prove this is somewhat scant, it's true that a person’s state of health can be expressed through their feet.

In addition to containing a quarter of the entire human body’s bones, the feet also bear its entire weight. There are no less than 33 joints, 100 tendons, muscles and ligaments in them, as well as countless nerves and blood vessels that link to the heart, spine and brain. Taking the above into account, it perhaps isn’t a surprise to know that if there is something wrong with someone’s feet, the likelihood is that their entire body will be affected as well. Let’s take a look at a few things about the human body that can be revealed by the condition of the feet:  

1. Foot Cramping and Spasms

If you happen to get cramps and spasms in your foot, it could be a sign of a deficiency in your body. Spasms can be caused by dehydration, which occurs as a result of the muscles not getting enough oxygen. Another reason for muscles spasms could be that there is a lack or imbalance of electrolytes or nutrients in your body. If you experience spasms specifically when walking, then this could indicate a circulatory problem. A further reason for spasms to occur is overexertion, or failing to stretch adequately prior to exercising. Last but not least, the type of shoe you’re wearing may be causing you discomfort. If you’re a lady who happens to enjoy wearing sky-high heels, for instance, you should look more closely at your choice of footwear to see if they’re to blame for the spasms.  

2. An Enlarged Big Toe

Gout is the most common type of inflammatory arthritis in men, and it can cause the big toe to become red, hot, swollen and extremely painful. Gout occurs as a result of too much uric acid building up in bodily tissues and fluids. Its normal blood level is between 3.5 to 7.2 mg%. It’s also to blame for an increased risk of developing kidney stones. This type of inflammatory arthritis usually manifests itself in the big toe because uric acid crystals tend to collect in the coolest part of the body. Overweight or obese people are more at risk of developing gout, as well as those who drink excessive amounts of alcohol and/or consume lots of meat. Furthermore, certain medication like diuretics can exacerbate the risk.

3. Cold Feet

 Do your feet to tend to be abnormally cold? If they do, it could indicate that you have poor circulation, diabetes, hypothyroidisim or anemia. In addition, if your feet change color from red, to white, to blue, it could be a sign of Raynaud’s disease, which is a narrowing of the blood vessels when nerves overreact to the cold. Primary Raynaud’s sufferers are advised to avoid the cold and smoking tobacco, however 20% of all cases stem from an underlying disease. These people tolerate the winter months poorly.

4. Swollen Feet (Pedal oedema)

Swollen feet can be indicative of numerous health problems. It could be simple nutritional deficiencies like hypo-proteinemia, anaemia and Beri-beri (Vitamin1 or Thiamine deficiency) or life-threatening like poor circulation and related heart failure, kidney or liver disease. It could also be because of deep vein thrombosis, filariasis,  a blood clot, lymphatic build-up and cellulitis, among others. Try raising your feet when sitting down, exercising your legs, reducing your salt intake and avoiding tight clothes, if you happen to have swollen feet. Investigations for the causative diseases are advisable. 

5. Spoon-Shaped Toenails

Concave-shaped toenails aren’t just unsightly – they could also be a sign of something underlying. The primary thing it’s associated with is nutritional deficiencies. They’re also associated with genetic disorders, circulatory problems, autoimmune diseases and musculoskeletal conditions.

6. Colored Toenails

Conditions such as tuberculosis, jaundice due to liver problems, thyroid gland involvement and even sinusitis could all cause the toenails to yellow. Yellowed toenails can also be symptomatic of bronchiectasis, an infective lung condition that causes breathing problems. Different nail colors and textures could also indicate a whole range of various systemic problems.  Vitamin B₁₂ deficiency present as hyperpigmentation of nails like bluish discoloration of nails, blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks.

7. Deformed, infected and destroyed toe nails

Fungal infection of the toe nails or Onychomycosis, usually seen in diabetics are a common cause of deformed nails.  If the nails are peeling, brittle, or have vertical ridges, this may be vitamin D deficiency should be considered. Recurrent nail bed infections – paronechoea should always be investigated for diabetes. Brittle nail that chip and break easily is associated with iron deficiency anaemia. White spots on the nails - sometimes called Beau's lines - are one of the important signs of a zinc deficiency.

8. Pins and Needles Sensation

Circulatory problems, peripheral nervous system damage, a trapped nerve and a range of other ailments can lead to numbness or tingling in the feet. Diabetics who are exposed high blood glucose for an extended period can also experience nerve damage, which in turn leads to tingling in the feet, which is called Peripheral Neuritis. Pins and needles in the extremities can also be one of the first symptoms of multiple sclerosis.

9. Aching Toe Joints

Some 90% of people who have rheumatoid arthritis will experience aching toe joints. The disease makes the lining of the joints swollen and inflamed. As a result, the joints and supporting ligaments and tissues are damaged, which ultimately leads to decreased mobility. Antiinflammatory drugs relieve these symptoms, but have their own side effects like gastritis. Furthermore, shoe inserts can help minimize pressure and correct the shape of the foot. Some people also have braces that they wear on their feet. Gout too is a cause of painful and swollen great toe joints.  

10. Hallux valgus and Bunion

This condition is characterized by misalignment of the big toe. This leads to the big toe pushing and exerting pressure on the surrounding toes making the big toe MCP joint to stick out and point outward. Bunions at this projected site are more common in women who have diabetes and are overweight.  

11. Corns and Calluses

Corns and calluses are thick, hardened layers of skin that develop when the skin tries to protect itself against friction or pressure. They often form on feet and toes or hands and fingers. If you're healthy, you don't need treatment for corns and calluses unless they cause pain. Offloading footwear can help patients who are severely distresses. Corn caps, which have salicylic acid can be used for a long time to get rid of them. Offloading footwear can help patients who are severely distresses. 

12. Planter fasciitis

Plantar fasciitis can cause pain in the bottom of your heel or in the lower part of your middle foot. This happens when the plantar fascia becomes strained because of soft-soled footwear with poor arch support, frequent standing, long-distance running, weight gain, or other foot conditions. Stretching exercises, alternate hot and cold foot bath and corrective footwear can effectively treat this condition.

13. Foot Drop

If you have difficulty lifting the front part of your foot, this could be a sign that you have drop foot, which is normally indicative of an underlying muscular, neurological or anatomical problem. The resultant gait is called ‘steppage gait’. Foot drop can occur as a result of a leg injury, faulty plaster immobilization damaging the lateral popleteal nerve or Sciatic nerve damage during a hip operation. It can also be the result of a neurological disease such as polio, as well as a brain or spinal cord disorder. A brace or splint can be used to help maintain a normal foot position, whereas nerve stimulation can also alleviate drop foot to a certain extent. Surgery can also be undertaken to treat nerves, fuse bones or transfer tendons.

14. Persistent Sores

If you have diabetes, it’s possible that you have experience nerve damage to some extent. Nerve damage, or neuropathy, results in people being unable to feel or notice injuries such as blisters and decreased vascularity prevents early healing. Diabetics are prone to foot ulcers both because of loss of sensation and because of decreased blood flow. Nerve damage can also cause feet and toes to change shape – Charcot foot. Dry, cracked and peeling skin on the feet can also be a sign of diabetes, as can calluses and poor circulation.

15. Madura foot

Madura foot, or mycetoma, is a chronic granulomatous infection characterized by subcutaneous masses, draining sinuses, and the presence of grains or granules in exudates. This condition is caused by either fungi or aerobic filamentous bacteria.  Surgical debridement, followed by prolonged appropriate antibiotic and antifungal therapy for several months is required to save the foot.

16. Deformed foot

Deformities can be since birth like Club foot, Syndactyly of toes, Hemimelia or shortening of lower limb. Acquired deformities can be because of trauma or because of chronic diseases like diabetes and Rheumatoid Arthritis. Diabetes is the commonest cause of amputation of foot or its digits is you take trauma out of the consideration.

 

The Professor concluded with the advice that if you miss to examine the feet of your patients, you may miss the diagnosis! The feet warrant more attention than you imagined. If you are a diabetic then take care of your feet more than your face.

Friends, this was one of Prof. Chakraborty’s many extempore lectures which we have enjoyed in our college days. Always smiling, with a twinkle in his eyes he not only knew the subject thoroughly but could organize it into a captivating lecture and could convey his message almost effortlessly. With no notes, no power point presentations, the sagacious grand old man was effervescent with knowledge and his love for teaching could only be matched by his wisdom. Remembering him today with great reverence and respect!