I have been diagnosed with Parkinson’s disease since 2015. I have been experiencing severe pain in my foot on the ‘worst side’. It has been like this for three months now. I find it difficult to move my foot properly when I walk, and my fine motor skills have deteriorated, which affects my balance. I’m wondering if the pain could be nerve pain? Is this common with PD? What can be done about it?

It could be muscle spasms (dystonia) – typically, this occurs during an ‘off’ period (e.g. early in the morning, when the level of medication is at its lowest) and subsides once a dose of medication starts to take effect. Dystonia can cause the foot to twist, making it difficult to walk normally. It could be the same pattern of so-called thalamic symptoms, which vary with the effect of L-dopa (on/off fluctuations), but it is less common for this to cause severe pain and should not affect the movement of the foot.

If it is strictly related to strain, the foot and the bones of the foot should be examined to ensure there is no damage to the joints between the bones or to the bones themselves.

Dystonia is quite common and can be treated by optimising medication and, in some cases, with botulinum toxin (Botox) injections into the muscles.

/Håkan Widner