Most people don’t take much notice of their feet and legs until something goes wrong, such as a skincare complaint, pain or mobility issues. When they do seek help, community pharmacies are often the first port of call. Yet while foot care is an important category, not all community pharmacists are discussing the topic with customers on a regular basis.
In July 2017, a survey of Royal Pharmaceutical Society (RPS) members, in association with RB and published in The Pharmaceutical Journal, revealed that about 30 per cent of community and hospital pharmacists encounter a foot condition more than once a week. However, 84 per cent of respondents said they only discuss foot care with customers or patients if they are specifically asked about it or if the person has diabetes, and seven per cent said they never mention foot care at all.
Foot and leg health advice may mean different things to different customers, depending on their age and state of health.
Some customers may seek advice on a general foot care regime before they put their feet and legs out on display in the spring and summer months. Others may ask for products and advice on minor ailments, such as athlete’s foot, verrucas, dry legs and cracked heels. Then there are customers with chronic conditions, such as diabetes, arthritis or poor circulation, who may need specific one-to-one advice and possible referral to a podiatrist or other healthcare specialist.
So pharmacy teams will want to make sure they understand, and can cater for, customers’ varied needs.
For this year’s Foot Health Month in June, the College of Podiatry aims to educate people about the importance of making foot health part of an overall health routine, and encourage them to visit a podiatrist when they need to.
According to the RPS survey, athlete’s foot, verrucas, corns and calluses and sweaty/smelly feet are the conditions most frequently seen by pharmacists on a daily basis. A regular foot care regime may pick up on minor ailments before these become long-term problems, or even keep them at bay.
“Foot pain can be debilitating. As we only have one pair of feet, it’s important to take good care of them,” says the College of Podiatry.
Matt Clegg, associate director skincare at O’Keefe’s, suggests that pharmacy teams actively promote the benefits of an ongoing healthy foot care regime, including moisturising products. “The most common trend in the foot care category over recent years is the number of new mechanical tools that claim to remove hard skin on the feet,” he says. “However, we are finding that consumers are looking for an effective foot cream that, with regular use, will provide continued relief from dry and cracked skin.”
"I find that customers are happy to show their feet to a pharmacist without any embarrassment, so we can check their symptoms and explain how we can help without the need for a GP appointment"
Providing the right information is key to making sure minor ailments don’t develop or return. “Many customers coming into a pharmacy are looking for medicated foot care products or P medicines,” says Bolton pharmacist Thorrun Govind.
“But some also come in for practical tips and advice that they wouldn’t get elsewhere. As well as recommending creams, sprays and powders for fungal infections such as athlete’s foot, I suggest drying their feet thoroughly, taking off their shoes regularly and not walking around barefoot. I find that customers are happy to show their feet to a pharmacist without any embarrassment, so we can check their symptoms and explain how we can help without the need for a GP appointment.”
Some customers buy foot and leg products straight off the pharmacy shelf, especially if they have common ailments such as athlete’s foot, cracked heels or verrucas, so pharmacy teams should make sure that their display is wellstocked and easy to navigate.
According to Well pharmacist Sadik Al-Hassan, while it’s important to display value and luxury ranges in one space to offer customers a choice, it’s also important not to give too much variety, as this may cause confusion.
“There are two main types of product performing well in this category – the £1 or value lines and luxury products,” he says. “Both sell well, but unlike luxury products in other categories, it’s not impressive packaging that makes the sale. It’s the products that look more medicinal, such as the CSS and Flexitol brands, that are strong sellers. Single-application antifungal products are increasingly popular, so this is something to brief your team about for future sales. Although these products are more expensive, the shorter treatment length is favoured by most patients.”
Foot care is an all-year-round pharmacy category, but sales often spike in the spring and summer months, when people are looking to get their feet flip-flop ready. “This is a prime time to create a feature in the store, promoting a healthy foot care regime,” says Mr Clegg.
“By creating stand-out fixtures that are bold, bright and fresh, pharmacists can increase sales and encourage trials of seasonal products.”
Certain customers are at a high risk of foot and leg issues and will need specifi c pharmacy advice and possibly a referral elsewhere. These include customers with diabetes, poor circulation, arthritis and any other long-term health issues that can affect their mobility.
According to Diabetes UK, there are more than 20 leg, foot or toe amputations each day due to diabetes, yet four out of five of these are preventable. Pharmacy teams can discuss diabetic foot disease with relevant customers and hand out leaflets or display them in the pharmacy. According to Mr Clegg, the diabetes foot care category is expected to show significant growth in the next five years, so pharmacists should aim to stock foot care products that are clearly labelled as being medically safe for people with diabetes.
Regular checks – at least annually – are important if customers have long-term health conditions that can affect their feet. They may also benefit from lifestyle advice, such as weight management, healthy eating, wearing the right footwear and regular physical activity.
“There is good evidence for the use of insoles and specialist footwear for helping people with rheumatoid arthritis, particularly in the early years soon after diagnosis,” says Emma McConnachie, a podiatrist from the College of Podiatry.
“People with diabetes are at greater risk of developing loss of sensation (peripheral neuropathy) and reduced circulation (peripheral arterial disease), which can lead to foot ulceration, infection and, in some cases, lower-limb amputation. Preventing foot problems involves managing diabetes well by controlling blood-glucose levels, along with cholesterol and blood pressure, and leading a healthy, active lifestyle.”
“We receive a lot of queries from people with diabetes. Foot problems are a common concern in this group – things like dry, cracked skin on the feet and corns. We recommend products such as Flexitol Heel Balm. For customers with diabetes, we give them advice on prevention and treatment, and refer them to a podiatrist if we feel that the products we stock will not be suffi cient to treat the problem. Athlete’s foot is a big area for us. Where we’re located, a lot of the surgeries don’t measure patients up for compression hosiery, so when we get someone in with a prescription we have to measure them here. We explain to the patient how to put them on, how to wear them and how important they are. We stock a lot of Active Class 1 and Class 2.”
Sadik Al Hassan
“You do tend to get a lot of regular business around foot care and many people would think of us as the fi rst place to go. Also, GPs are referring some people to pharmacy rather than prescribing treatments for foot and leg problems. We see a lot of dry skin complaints with leg health, which are more common in winter. There is a good range of moisturisers, with Aveeno being incredibly popular for use on dry skin. Athlete’s foot is a profi table area for us due to the link sales associated with it. The best advice for athlete’s foot treatment is to use a product and continue using it for two days after it’s better, but also, to practise good foot hygiene: spraying shoes or sandals once a day with a shoe spray, and drying feet well after baths or showers.”
“Athlete’s foot and other fungal infections are important for us, and we see a lot of children with verrucas, too. In terms of diabetes, foot checks are normally done by the patient’s GP, but as part of an MUR we would make sure they are having regular blood tests, getting their sugar levels checked and having their feet checked annually as well. With compression hosiery, we do measure our customers when doctors or nurses prescribe it if it’s not a standard size that they need. There have been a few occasions where I felt the patient should have hosiery but have not been advised that by a GP, so I might refer them back with a recommendation and sizes and so on, and then the practice would normally prescribe.”