Perhaps I should be replying only to those persons who asked about
"curling toes," but since many more people may be interested, I will risk
replying to the entire list.
I believe this problem is really a dystonia, one of the sub-afflictions of
PD. I have read that it can occur as a result of levodopa excess ("peak
dose dystonia) OR when levodopa is at a low level ("off period dystonia),
such as during an "off" period or just before a new dose is needed. For
the former, treatment may consist in reducing each dose of Sinemet, with
or without adding a dopamine agonist to compensate for the lesser amount
of Sinemet. For the latter, various changes in medications (e.g.,
Sinemet-CR) may be needed to smooth out the therapeutic response to
Sinemet.
It is not clear to me that hammer toes result from this toe-curling
dystonia, but I could be wrong. The person who referred to thickened toe
nails in the context of hammer toes was probably talking about toe nail
fungus, not hammer toes.
Hope this helps.
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Ken Goodrich, Caregiver
Columbus, Ohio
