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Community pharmacists have a role in helping to prevent and manage foot and lower leg conditions that can significantly impact people’s health and quality of life, says Steve Titmarsh…

People with diabetes, for example, are at risk of diabetic foot problems that can lead in some cases to amputation. The Legs Matter campaign underlines the importance of preventing and treating foot and lower leg conditions, pointing out that they are often forgotten in health policy and not managed effectively.

The Campaign also says foot and lower leg conditions can have a significant effect on people’s quality of life resulting in months and sometimes years of potentially unnecessary pain and suffering.¹  

Problems range from relatively minor issues such as blisters and athlete’s foot to more serious conditions such as leg ulcers, peripheral arterial disease and diabetic foot ulcers.

Each year about 73,000 people in the UK develop a leg ulcer. However, almost a third (30%) do not receive a correct diagnosis and therefore are not treated optimally. Untreated, leg ulcers can result in a range of problems. 

For example, they can be very painful, smelly and can leak fluid. As a result people’s sleep is affected, they may find mobility difficult and their work and ability to socialise are impaired. Peripheral arterial disease affects about 20% of people over 60 years old in the UK. 

People with the disease are at a higher risk of lower limb amputation and are prone to cardiovascular diseases such as stroke and heart attack even though around three in four people with the disease have no symptoms.

Diabetic foot ulcers affect people with diabetes as well as individuals with neuropathy and/or reduced arterial blood flow. There are about 169,000 cases a year in the UK (equivalent to around 5% of adults with diabetes). The condition results in some 6,000 people with diabetes having leg, foot or toe amputations each year.¹  

A wound that does not heal may be an indication that a person has a diabetic foot ulcer. However, as a result of neuropathy that people with diabetes can develop, they may not experience any pain from a foot ulcer.

Instead they may feel generally unwell with flu-like symptoms, fever, chills or nausea, for example. Signs of red, hot, swollen feet in a person with diabetes should be checked as the progression from a minor injury to irreversible tissue damage and possibly gangrene can happen in a couple of days.

Dinah Kheder, Clinical Pharmacist, South Southwark Primary Care, Network in London, writing in the journal Wounds, recently said that pharmacists are ideally placed to have a role in wound care, including diabetic foot ulcers, pressure wounds from long periods of disability or immobility or blood vessel diseases that can cause venous and arterial wounds.

For example, medication reviews provide ‘a golden opportunity to assess any risk factors for wounds and early signs of venous insufficiency, such as swelling, pain or discoloured skin’ and determine if any medicines a patient is taking may be contributing to or making the situation worse.

From this, pharmacists can then ‘work with the multidisciplinary team to ensure it is investigated. This is especially important in those with uncontrolled diabetes, hypertension or obesity’.

Ms Kheder adds that: ‘Community pharmacies can also cover wound issues, for example, as part of the community pharmacist consultation service or the service for the treatment of skin infections associated with injection site complications.’²  

Although not many community pharmacies may be offering diabetic foot or related services currently, because they see the same patients regularly and build up good relationships with them ‘they are well placed to notice risk factors for pressure ulcers such as a decline in mobility, weight changes, or repeatedly asking for wound care products, such gauze or bandages,’ says Ms Kheder.

And ‘pharmacists have a key role in health promotion – a healthy diet (e.g. high in vitamin C, zinc and protein), regular exercise, stopping smoking (which has been proven to affect the healing rate of chronic wounds), limiting alcohol and managing stress are all factors that will promote healing,’ she adds.² 

In Southwark, there is a new lower limb clinic where, says Ms Kheder, the primary care network (PCN) team is trying to get pharmacists involved. 

The clinic has a multidisciplinary team (MDT) to treat lower limb wounds to help patients to recover faster. The MDT includes staff from hospitals, community settings and GP practices. The clinic is already having very positive results, and is hoping to provide wider access across south east London.²  

Elsewhere, community pharmacy services for people with diabetic foot problems are emerging. Community Pharmacy England records in its services database that a community pharmacy diabetic foot care awareness initiative was run in West Hampshire. 

The aims of the service were to raise awareness of diabetic foot problems, empower patients to be in control of their foot health and thereby reduce the prevalence of diabetic foot ulcers and amputation across the region.³ 

The objectives of the initiative were to:

• identify West Hampshire CCG patients with diabetes at the point of prescription collection

• deliver a brief intervention on diabetic foot problems

• provide information on daily diabetic foot hygiene

• provide information on potential foot problems and avoidance; and

• signpost routes to foot care services if required.

The Wessex Pharmacy Local Professional Network has developed a framework for pharmacy teams to work through to become a Diabetes Focus Pharmacy.

The framework is categorised into six elements: the pharmacy team; prevention and lifestyle; complications of diabetes; education programmes; medicines adherence, and signposting.⁴ 

Some community pharmacies are not providing diabetic foot services directly but offer podiatry services run by professionally qualified podiatry specialists in-house to patients instead. Details of the services can be found on community pharmacy websites.^5–9

References

1. Legs Matter! Legs matter consensus document (https://legsmatter.org/resources/legs-matter-consensus-document; accessed October 2025).

2. Kheder D. How pharmacists could play a key role in wound care. Wounds UK 2025;21:142–4 (https://wounds-uk.com/journal-articles/how-pharmacists-could-play-a-key-role-in-wound-care; accessed September 2025).

3. Community Pharmacy England. Services Database: Community Pharmacy Diabetic Foot Care Awareness (West Hampshire Area) (https://cpe.org.uk/?our-services=community-pharmacy-diabetic-foot-care-awareness-west-hampshire-area; accessed September 2025).

4. Royal Pharmaceutical Society. Good Practice Examples: Community pharmacies, Wessex LPN (www.rpharms.com/recognition/all-our-campaigns/policy-a-z/diabetes/diabetes-good-practice-examples; accessed September 2025).

5. Market Street Pharmacy. Pharmacy services – Podiatry (chiropody) (www.lincolnshire.coop/branches/pharmacies/market-street-pharmacy; accessed October 2025).

6. Temple Pharmacy. Private services – Podiatry clinic (www.templepharmacy.co.uk/private-services/podiatry-clinic; accessed October 2025).

7. Hillcrest Pharmacy. Podiatry – Hillcrest Pharmacy (https://hillcrestpharmacy.co.uk/hillcrest-pharmacy-podiatry; accessed October 2025).

8. Prestwich Pharmacy & Care Clinics. Foot Clinic (www.prestwichpharmacy.co.uk/wellbeing-services; accessed October 2025).

9. Malcolm’s. Podiatrist (https://malcolmspharmacy.co.uk/product/podiatrist; accessed October 2025).