Podiatry for People with Epilepsy & Down Syndrome
My name is Dr. Todd Brennan1, and I am a board-certified Podiatrist2 from sunny Tampa, Florida3. I’m part of an incredible medical group known as Healthy Feet Podiatry4. You may have seen our videos online on platforms such as Facebook5, Instagram6 and YouTube7.
Favourite Sport: Soccer8
Hobby: Travelling
Favourite Food: Filet Mignon9
Over the past seven plus years I’ve been treating patients of all ages with variable medical histories including epilepsy. Not every patient I meet has epilepsy; however, when I do encounter patients with epilepsy in my office, each patient is treated on a case by case basis. Epilepsy is a diagnosis with uniquely differing characteristics in every patient.
As stated above, while each case is treated differently it is important to be cognizant of the etiology 10 of epilepsy in patients. I’d like to break it down simply into two categories: people that have epilepsy with no other medical manifestation versus people with Down Syndrome 11 who have epilepsy as an associated symptom. For people that have a history of epilepsy it is important to acknowledge the etiology prior to any treatments.
Healthy Feet Podiatry Team!
People that have epilepsy as an isolated neurological disease can present with a variety of issues including heel pain, arch pain or fungal nails. People with Down syndrome (who are more likely to have epilepsy as a comorbidity than those without 12 ), however, typically present with the similar foot complaints such as ingrown toenails and difficulty ambulating 13 (walking) due to flat foot pain.
Regardless of the etiology of epilepsy or the condition I’m treating, it is imperative to understand the seizure trigger(s) for people with epilepsy. This not only helps them feel more comfortable in the office, but it also allows me to properly devise a treatment plan that may usually include one of those triggers. In more complex cases of epilepsy something as simple as loud music (musicogenic epilepsy14 ) or flickering lights (photosensitive epilepsy15 ) may be a trigger; while unlikely to be a cause in our office, it is still worth noting to ensure that my office staff maintain a calm, peaceful space.
The two more common triggers I would encounter in the office would be pain and/or low oxygen. You may ask how would someone be affected by low oxygen in a podiatrist’s office? Well, if for instance, the person needed some type of procedure performed in the office (i.e. ingrown toenail removal) a lot of people respond to pain by holding their breath. Between the lack of oxygen and the pain associated with the injection to numb the area, these triggers could increase the risk of someone having a seizure in the office.
People with Down syndrome can be more challenging to treat due to the variations in their cognitive levels16 , communication abilities and family presence. As I stated previously; most people with Down syndrome who I have treated present with a similar grouping of issues: ingrown nails, warts, calluses or flat feet. The most important thing, from my standpoint, is to gain the trust and connection of my person along with his or her family member. If trust is not established with the person, it is extremely difficult to treat the issue they came in for. A condition such as painful flatfeet typically has an easy, non-painful treatment plan while other conditions that require an in-office procedure can cause stress and anxiety leading to an epileptic seizure. Reassuring the person that trimming his or her large callus won’t hurt is imperative. I will even occasionally use a separate scalpel blade on my hand to show the person what I’m going to do before I do it to help earn their trust. For warts and ingrown nails, I’ll always try to start conservatively to alleviate the problem, and this is always relayed to the care giver. Whether it is an ingrown nail removal or a wart excision I must consider the person’s pain tolerance and potential responses to pain. I’ve found for some people with epilepsy that even taking them to the operating room under light sedation is less stressful to them and their caretaker; which in turn allows me to provide the most successful care.
In conclusion, I think it is very important for podiatrists to understand the seizure triggers for people with epilepsy prior to beginning any treatment plan. This will not only make the treatment easier and safer for the person but will most importantly assist in earning the person’s trust. I take pride in my work to ensure that no matter what the condition is, every person is treated individually and to the highest standard.
Dr. Todd Brennan, DPM, FACFAS
Co-Owner Healthy Feet Podiatry
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