There are more than 20 leg, foot or toe amputations every day due to diabetes, yet four out of five of those are preventable. Kathryn Kirchner, senior clinical advisor at Diabetes UK, believes awareness needs to be raised around footcare, because taking care of what may at first appear to be minor issues could prevent them from becoming serious health concerns.
“Every year, tens of thousands of people have a lower-limb amputation related to their diabetes,” she says. “Community pharmacists can make people living with diabetes aware of the complications and provide advice on how to look after their feet.” Ms Kirchner also suggests that pharmacy teams play a role in getting people with diabetes to think more about their feet, by signposting them to regular foot heath checks.
“Encouraging people with diabetes to attend their annual foot check, which is available for free on the NHS, is very important,” she says. “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.”
Diabetes UK has a helpful video on its website (diabetes.org.uk) that customers with diabetes can use to check their feet for problems. There is also a guide that can be download and printed off for customers, and leaflets for healthcare professionals to order via the ‘Putting Feet First’ campaign page.
The experts at Flexitol agree. “Pharmacy teams could suggest customers consider booking an annual foot check with a healthcare professional, rather than just if they notice a problem, and making footcare a daily priority, including checking for changes, wounds, redness or swelling,” says Flexitol. “Customers should also be advised to make caring for feet part of their regular daily routine, including a daily application of a urea-based moisturiser for healthier, softer skin.”
Carnation Footcare has recently expanded its range with a spray emollient, Foot Mousse Intensive Hydration, which is designed to maintain epidermal and dermal skin layer hydration, and the skin’s natural protective barrier function. Suitable for people with diabetes, Foot Mousse delivers a therapeutic concentration of urea (12.5 per cent) as a humectant, while the consistency enables the emollient component to be rapidly absorbed without surface residue.
“An independent trial, commissioned by Carnation Footcare in 2018 followed 53 people – 27 men and 26 women – who have type 2 diabetes over a two-week period, charting the appearance of the skin on their feet with daily use of Foot Mousse,” says Michael Ratcliffe, sales training manager at Cuxson Gerrard & Co. “Eighty-one per cent of the participants reported that ‘my skin felt healthier after using the mousse’.”
Avoca is one of the few verruca treatments suitable for people with diabetes. “It’s speculated that the HPV virus, which resides in all of us, activates at times of hormonal change, such as puberty. The hormonal changes in diabetes are also thought to cause the HPV to activate, which can lead to more outbreaks of verrucae,” says Andy Christie, sales and marketing director of Bray Healthcare. “Traditionally, people with diabetes were advised not to treat warts or verrucae topically, but because Avoca penetrates only to a few cells’ depth, it’s safe to use.”
Scholl has partnered with the College of Podiatry to create a suite of training materials designed to help improve knowledge about foot health. “Both the College and Scholl are passionate about foot health and we want to help keep the UK on its feet,” says Sarah Mainland, professional relations manager for Scholl. “Consumers will be given initial advice on self-care, which is where the pharmacy team can advise on the Scholl portfolio of products. For foot and lower-limb problems, they may also be advised to seek help from their GP or a private podiatrist.”
The training from Scholl, available soon, will include a consumer-facing website covering self-care and general footcare advice, and online CPD modules for pharmacy teams.
The College of Podiatry will be helping to draft the training materials to ensure all advice is relevant and up to date, although Ms Mainland is keen to emphasise that the College does not specifically endorse the Scholl product range. “We simply want to provide clear footcare advice and, with help from the College of Podiatry, we can ensure that the pharmacy team can be confident in the information Scholl provides to them,” she says.
Emma Supple, clinical director of Supplefeet, also suggests customers are advised on footcare and ways to prevent common issues such as cracked heels and calluses. “It is important to address heel beating, a phrase I use to describe one of the ways chronic heel callus forms,” she says. “To avoid heel beating, stretch out the calf muscles, including the soleus, then elevate heels in shoes to bring the ground up to meet the foot. Ensure the heel of the shoe matches the anatomical heel placement and there are no odd angles of heels on boots and shoes. I also recommend scrubbing heels and feet daily with a bristle brush before applying a heel balm.”
The College of Podiatry has some advice for pharmacy teams who want to refer customers for professional help. “NHS podiatry services are available nationwide,” says podiatrist Emma McConnachie. “However, access criteria and level of service will vary, so we would suggest pharmacy staff refer customers to their GP or check their local NHS trust website first for details.” The best way to find a private podiatrist is via the College of Podiatry website (cop.org.uk), but there will also be listings in popular directory services.
“Some podiatrists choose to specialise in certain areas of podiatry, such as musculoskeletal conditions or diabetes,” says Ms McConnachie. “Remind customers to let the podiatrist know about any specific problems when they first contact them. This will ensure they book the correct type of appointment.”
She also suggests that recommendation is a reliable way to find a good podiatrist. She advises that in the case of older people, or people who may not be well enough to visit a podiatrist, there are podiatrists who will do home visits if pharmacy staff think a referral is appropriate.
“Many private podiatrists will offer a home-visiting service within a few miles’ radius of their location,” says Ms McConnachie. “The NHS may offer a service for housebound patients, but check with your local trust for details.”
Podiatrists are required to be registered with the Health and Care Professions Council (HCPC). Customers looking for a referral can check if a podiatrist is registered by checking on the HCPC website (hcpc-uk.org).
Shaftesbury Pharmacy, Harrow
Ellacombe Pharmacy, South Gloucestershire
Well Pharmacy, Hartlepool
|“This is a popular category all year round. We get lots of customers who’ve been referred by a podiatrist or their GP. Common foot problems include corns, calluses and hard skin. If they need a diagnosis for a foot or leg problem, they tend to see their GP as people are not comfortable taking shoes/socks/tights off in a pharmacy, even though we have a private consultation room. Scholl and Fortuna sell well and we get lots of requests for insoles to make shoes more comfortable. Compression hosiery is popular during the holiday season.”||“We tend to forget about our feet during winter and problems can gradually develop without us noticing. Pharmacy can play a crucial role in helping customers understand their feet or leg problems and provide guidance on the treatments. The choice can sometimes be overwhelming for them. The most common foot problems we come across are athlete’s foot, fungal nail infections, verrucas, calluses and corns. We also stock a good range of foot, knee and joint supports and foot orthotics and insoles to help with foot and heel pain.”||“This category grows in popularity as the weather gets better. Typical queries include heel pain, athlete’s foot, hard skin, warts, corns and fungal nail infections. Daktacort, Lamisil, corn plasters, Loceryl and Canestan are our top sellers. More customers are asking for OTC products and we stock a variety of products, which allows us to create a personalised treatment plan. I recommend always stocking at least the basic products to treat common ailments. Foot and leg care should have its own section with clear sub-sections.”|