Kathy Oxtoby looks at the care and support pharmacies can provide people with common feet and leg conditions…

Taking care of our feet and legs is as vital as looking after any other part of the body. But we tend to take them for granted until something goes wrong.

Pharmacy is increasingly the first place people experiencing health issues now visit for help and advice. So, it is important pharmacy teams are up to speed on how to treat common foot and leg conditions.

People with diabetes, pregnant customers, patients with sprained ankles, and those with varicose veins or poor circulation – each of these groups will require specific care, advice, and treatments, which pharmacy teams are well placed to provide.

People with diabetes

A major complication of diabetes is foot and leg problems. The condition causes more than 180 amputations in the UK every week, according to Diabetes UK.¹

For people with diabetes, foot problems can escalate quickly, so it is vital they take care of their feet.” “Pharmacists need to make sure they give the correct advice to anyone with diabetes,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow. She says feet should be kept clean to avoid infection, going barefoot should be avoided, and shoes should fit well. If there are any changes to their feet, people with diabetes should see their GP, and they should have an annual foot check as part of diabetes NHS care.

It is important not to offer products to people with diabetes that are caustic in nature, such as those containing salicylic acid to treat verrucas. Patients with these kinds of foot problems should be referred to a podiatrist, says Eoghan O’Brien, superintendent pharmacist at Bannside Pharmacy, County Antrim.

Many products are available to keep feet moisturised and prevent dry, cracked skin. Mr O’Brien recommends gentle products for people with diabetes who have dry skin on their legs and feet, such as Pedi Salve, which combines shea butter, argan oil and vitamin E.

Pregnant customers

A common issue for pregnant customers is swollen ankles and calves and the discomfort that might bring, says Brendon Jiang, vice chair of the Royal Pharmaceutical Society (RPS) England Pharmacy Board, and superintendent pharmacist at Wychwood Pharmacy in Shipton-under-Wychwood, Oxfordshire.

Pharmacists can advise to elevate the feet, to do simple gentle exercises such as rotating the feet in circles, and to have comfortable footwear, says Mr Jiang. 

Pregnant customers could consider ice packs to reduce the swelling on their calves and ankles, or wearing compression stockings, provided they have been recommended and fitted properly by, say, a GP or nurse, says Ms Thakerar.

If the skin is uncomfortable and stretched from swelling, emollients and soothing creams can help. Venagel, a horse chestnut gel, can be used for the relief of tired, aching legs, says Mr O’Brien.

A ‘red flag’ is if the pregnant customer is retaining a lot of fluid on their legs and feet, and the swelling is not easing, and they should be referred to a GP, he says.

A patient with a sprained ankle

Symptoms of a sprained ankle can include pain, swelling, bruising, and a loss of movement and strength around the ankle and foot.²

For the first few days, patients can be advised to follow the steps known as ‘RICE therapy’ to help bring down swelling and support the injury. This involves rest, applying an ice pack to the injury for up to 20 minutes every few hours, compression – wrapping a bandage around the injury to support it – and keeping the ankle elevated, raised on a pillow, as much as possible.³

Patients can take OTC anti-inflammatory medications - available in tablet form, or creams and gels - to take away pain and discomfort and reduce swelling, advises Ms Thakerar.

Customers looking for alternatives to traditional pain relief medication, could be offered creams and gels containing arnica, or Pernaton – a herbal gel for sprains and inflammation, says Mr O’Brien.

A customer with varicose veins

While varicose veins are not regarded as a particularly serious condition, they can be painful.  Symptoms include a feeling of heaviness, burning or throbbing in the legs, muscle cramp, and dry, itchy and thin skin over the affected vein. Symptoms are usually worse during warm weather or if the person has been standing for long periods.⁴

Lifestyle advice for customers includes avoiding prolonged sitting or standing, and regular exercise, says Mr Jiang. Properly fitted compression stockings could be worn to help improve blood flow and reduce discomfort, he says. These are available in a range of different sizes and pressures.

If an individual is experiencing pain and discomfort, their skin is sore, and their sleep disturbed, they should be referred to a GP, says Ms Thakerar.

A customer with poor circulation

“If customers say they have poor sensation down to their feet, my initial advice is to check their shoes are comfortable and the right size,” says Ms Thakerar. Compression stockings can also be helpful, she advises.

Asking lifestyle questions are important to understand why patients have circulation problems. Lifestyle can contribute to poor circulation, such as smoking, being overweight and lack of exercise, says Mr Jiang. Pharmacists can offer support, such as advice and help to quit smoking, he says. 

Pharmacists should also make sure the patient’s skin is intact, and if there is blanching, for example, a moisturiser could help.

He says it can be useful to ask patients about their symptoms. If someone finds that on movement they get pain, that could be a sign of intermittent claudication, and would require further investigation and referral, he says.

Pharmacists can also assess patients for any red flags. For example, signs of a potential deep vein thrombosis (DVT) include issues with one leg rather than both, pain, and redness or swelling that does not go down, and may require a referral to the patient’s GP, or to hospital, says Mr Jiang.

These common foot and leg conditions “offer an opportunity under the Minor Illness part of Pharmacy First Service, for pharmacists to use their expertise, to make the public aware of the new service, and to be reimbursed and recognised for their skills. Referrals would be required for the Minor Illness aspect of the service,” says Ms Thakerar.

There are many different treatment options for common foot and leg conditions, and pharmacists can consider stocking natural remedies, which can be safe to use where conventional treatments may not be so suitable, says Mr O’Brien. However, when offering natural remedies for foot and leg care “you need to know about, and be confident in the product and stick to well established companies”, he advises. 

“It’s about understanding patients might neglect their feet, but those problems can compound,” says Mr Jiang. He says pharmacists need to highlight to patients the importance of leg and foot care, and “provide tailored solutions to help them.”

References

1 Diabetes UK (n.d.) Research on preventing amputations. https://www.diabetes.org.uk/our-research/about-our-research/our-impact/preventing-amputations

2 NHS Inform (2024) Ankle sprain. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/ankle-sprain/

3 NHS (2021) Sprains and strains. https://www.nhs.uk/conditions/sprains-and-strains/

4 NHS (2020) Varicose veins. https://www.nhs.uk/conditions/varicose-veins/