Spotlight: Foot and leg care
Foot and leg problems can affect people’s daily lives if they are ignored. So where does community pharmacy come in? Victoria Goldman explains…
The most recent Active Lives adult survey by Sport England, published in October 2018, revealed that just over six in 10 adults now gain the health benefits from achieving 150-plus minutes of activity a week.
However, their feet could take a pounding if they don’t look after them. A survey of 2,000 people by the College of Podiatry, in December 2018, revealed that the most common complaints reported after starting a new exercise regime included calf pain (9%), foot pain (8%) and heel pain (7%).
Most people have regular check ups with a dentist or optician to ensure their teeth and eyes are in good health. But they wouldn’t think to do the same with their feet and legs. Another survey by the College of Podiatry in May 2018 found that despite feet being the most used part of the body, they are also the most neglected. Almost 60% of people are currently suffering from foot pain, but as many as half refuse to see a podiatrist or doctor about it.
The College of Podiatry is running this year’s Foot Health Month in April 2019, focusing on how to keep feet healthy and encouraging people to seek advice if they have a problem.
While the campaign is focusing on directing people to podiatrists, community pharmacists may find that they are the first port of call for some common foot complaints. Pharmacists, therefore, need to be aware of some common foot (and leg) conditions and how to treat them.
Foot ailments can affect people’s daily lives if they are ignored. Pain may also be a sign or symptom of a chronic medical condition. According to the National Rheumatoid Arthritis Society, up to 90 % of people with rheumatoid arthritis report associated foot problems. For some of these patients, foot pain is the first sign of the disease.
Dry and cracked heels are caused by a loss of elasticity in the skin and can lead to an infection if not treated. “Scrub heels on a daily basis and keep any hard skin filed down,” says podiatrist Emma Supple. “On particularly dry spots, use a heel balm that’s specially formulated with urea to treat dry, cracked heels.”
Athlete’s foot is usually easily recognised due to itchy white patches between the toes. It may be managed with over-the-counter anti-fungal creams, powders and sprays. Customers should be advised to wash their feet daily and to dry them thoroughly after washing, especially between the toes. If they are prone to fungal infections, they may find that dabbing surgical spirit between their toes will help.
“If a case of athlete’s foot (tinea pedis) doesn’t resolve within three rounds of treatment, or if it frequently recurs, then a podiatrist can assess the patient to determine if it is a fungal infection or if, for example, there is a secondary nail infection that’s causing the issue,” says Emma McConnachie, podiatrist for the College of Podiatry.
Verrucae often disappear without treatment within six to 12 months but can last for up to two years, especially in children. If these are causing pain, customers may wish to try OTC products, but they should be reminded that the products can take three months to work and may cause irritation. If the pain persists, customers should consult a podiatrist.
Over-the-counter products for corns and calluses are available, but persistent or severe cases should be seen by a podiatrist – this is particularly important if the customer has an underlying chronic condition such as diabetes, arthritis or circulatory problems.
“Calluses can be kept under control with a pumice stone or foot file, and the use of a foot cream regularly will help improve their condition,” says Emma McConnachie.
“In cases of a thicker build up, or for a longer lasting effect, a podiatrist can reduce the callus with a scalpel and advise on ways of minimising recurrence. Off-loading pads and hydrocolloid-based dressings can ease discomfort, but corns should only be removed by a trained podiatrist.
“In both cases, acid-based removal treatments (such as corn plasters) or knives shouldn’t be used for self-administered treatment. These can cause severe damage to the patient especially those with compromised skin, vascular supply and immune systems.”
Most heel pain is caused by plantar fasciitis, which is usually worse after waking in the morning or exercising.
“If a person has heel pain that lasts longer than three weeks, then they should seek the advice of a podiatrist or physiotherapist for diagnosis and treatment,” McConnachie says.
“In the early stages, though, the person should refrain from long periods of standing and long walks, wear supportive footwear and may find OTC supports to be of benefit along with anti-inflammatory medication.”
Tired, aching legs can be caused by sitting or standing for long periods, and may be associated with ankle swelling.
Maintaining a healthy weight, taking regular exercise and putting the feet up at the end of the day may help, as well as compression hosiery to improve blood flow.
However, legs and ankles can swell up for many different reasons and may be an early sign of poor circulation, so persistent problems should be assessed by a doctor or nurse.
Restless legs syndrome causes an overwhelming irresistible urge to move the legs, as well as an unpleasant crawling or creeping sensation. This is a common condition of the nervous system and may affect pregnant women, but there’s often no specific underlying cause.
The symptoms usually occur in the evening or at night, causing involuntary jerking of the limbs during sleep.
Severe problems need prescribed treatments, such as dopamine agonists, but lifestyle changes may help mild symptoms.
Customers should be advised to avoid stimulants such as caffeine and alcohol in the evenings, stop smoking, take regular exercise (but not too close to bedtime) and establish a regular sleep routine.
Some affected people have iron deficiency, so dietary supplements may help. During an episode, it may help if they massage their legs, have a hot bath, apply hot or cold compresses and do relaxation exercises.
Varicose veins occur when valves in the leg veins stop working properly, meaning the blood falls down the veins when standing up.
Unless they’re causing discomfort, varicose veins don’t usually need to be treated, but compression stocking, regular exercise and avoiding standing for long periods may help to ease mild symptoms.
“There is a stereotype that it’s only the old and the overweight who will suffer from varicose veins,” says professor Mark Whiteley, venous expert and founder of The Whiteley Clinic.
“The truth is, 30% of all adults will be affected and, contrary to popular belief; the condition is familial and can strike at any time of life – although it does become more common with passing years.”
Deep vein thrombosis (DVT) doesn’t always cause symptoms, but warning signs include pain, swelling and tenderness in one leg (usually calf), a heavy aching feeling and warm red skin.
Anyone with suspected DVT should see their GP immediately for referral to a vascular specialist. Pharmacists should be aware of those at high risk and advise on preventative measures, especially before and after surgery or with long-distance travel.
“There has been much written in the past about what factors will make it more likely for someone to develop a clot,” says professor Whiteley, “for example, those who smoke, women taking oestrogen - either as the contraceptive pill or HRT - or if a person is dehydrated.
“There is also evidence to suggest that DVT is much more common in older people, with children carrying a very low risk.
“Despite this concerning a high percentage of people, many are still unsure how to prevent DVT from occurring, and are unaware of the importance of getting this uncomfortable condition treated should it occur.”
Diabetes and feet
Patients with diabetes are prone to foot and leg problems, often caused by poor circulation if their blood sugar isn’t well controlled.
“Every year, tens of thousands of people have a lower limb amputation related to their diabetes,” says Kathryn Kirchner, senior clinical advisor at Diabetes UK.
“Many of these amputations are avoidable. Community pharmacists can make people living with diabetes aware of the complications associated with the condition, and provide advice on how to look after their feet.
“Encouraging people with diabetes to attend their annual foot check, which is available for free on the NHS, is also important. This check can be the difference between keeping and losing a foot.
“Community pharmacists can also remind customers to check their own feet daily, and if they notice anything odd, including red spots, hard skin, bruises or cuts and sores that haven’t healed properly, they should have their feet checked immediately by a healthcare professional.”
It is estimated that around 10% of people with diabetes may develop a foot ulcer at some point. A recent survey of 200 chronic wound patients conducted by Mölnlycke revealed that patients with diabetic foot ulcers on average need their dressing to be changed five times a week.
Some 80% of these patients don’t change their dressing themselves and require a healthcare professional or family member to change it for them.
More than half of diabetic foot ulcer patients report that their wound has a high or very high impact on their life.
A common complaint with dressings for diabetic foot ulcer patients relates to comfort, as 76% of patients report that their dressing doesn’t move with their body or pulls on their skin uncomfortably.
“Foot and leg ulcers can require complex management from someone with training in tissue viability and wound care, which most community pharmacists won’t have,” McConnachie says.
“However, the pharmacist will be a regular point of contact for the patient as they have their dressing prescriptions filled and may be approached with questions that the patient may not have asked their nurse or podiatrist.”
The partnership between Scholl and The College of Podiatry was created to help improve the quality of educational materials available to healthcare providers and highlight the role of podiatrists and self-care in maintaining good foot health, says Sarah Mainland.
We see this as an unmatched opportunity to build on our shared passion to improve foot health education for the general public.
The main purpose behind the partnership is to ensure that the public have the information they need to make decisions about their foot health and care, through the pharmacists and healthcare professionals they seek advice from.
Through this partnership, Scholl and the College of Podiatry are in the process of creating an in-depth clinical professional development module to guide and inform healthcare professionals.
We are creating this in order to arm pharmacists and other key healthcare professionals with the information they require to confidently and efficiently keep their customers on their feet, and to know when and how to refer customers onto a podiatrist.
Further to this, at Scholl, we aim to create a suite of training materials designed to help improve knowledge about foot health including training tools which will be made available to pharmacy staff, covering common foot problems and how to recognise and treat them, and a consumer-facing website created with expert input from the college, covering self-care and general foot care advice.
The Scholl brand mission is to help the people of the UK maintain healthy foundations to keep them on their feet; by partnering with the College, we will move closer to ensuring that foot conditions don’t stand in the way of anyone achieving this.
Ultimately, this partnership will not only inspire the UK public to seek advice when a foot condition stands in the way of them getting back on their feet, but also empower the advice and support of community pharmacists and podiatrists.
Sarah Mainland is professional relations manager at Reckitt Benckiser UK.