Feet are often neglected; many people don’t pay their feet and legs much attention until they notice something isn’t quite right. Many people simply don’t know whether they have a wart, a verruca, a corn, or even know the source of the pain at all, suggests foot care specialists Scholl.
As such, the pharmacist has a crucial role to play in helping the customer understand what the problem is and then working with the customer to provide guidance on the correct treatment solution. Pharmacies should ensure that they signpost the footcare section clearly within store and stock a comprehensive range of well-known products for customers to choose from.
With an ageing population, suffering from foot, knee and joint problems is seen as just part of getting older, but although to some extent that’s true, there are still warning signs that good pharmacists should take note of and refer on to a GP or podiatrist, along with effective support and treatment for feet and leg conditions.
Podiatrist and senior clinical specialist Paul Tennant sees patients of all ages and has some advice for pharmacy staff on treatments that work. ‘Many elderly people are told by their GP that their pain is simply an ageing process. While this in part is true, a whole host of options exist to treat conditions, particularly joint pain. Increasingly we come across patients who don’t want to give into old age and want to fight it and remain active.’
Plantar fasciitis is a mechanical problem with how the foot is functioning. Mr Tennant recommends an over-the-counter insole in the first instance, but if this doesn’t improve the situation within four weeks he suggests referring to a podiatrist for a bespoke orthotic.
‘Steroid injections are effective but do not solve the mechanical cause and should be a treatment used in conjunction with orthotics,’ he explains. ‘Heel pain can also be an early sign of far more serious conditions such as tibia is posterior dysfunction (old age flat foot), where the muscle is overused and the tendon connecting to the bone is strained, potentially snapping or giving way completely.’
As people age, feet can tend to over pronate, which can influence the onset of osteoarthritis, plantar fasciitis, achilles tendonitis and deformities such as bunions. A study carried out by Cuxson Gerrard recently revealed that as many as one in four people would consider wearing foot-shaped orthotics to help ease their foot, ankle, knee and back pain. It has launched the Pro-Nation orthotic - a cushioning insole that fits inside shoes to disperse impact forces and pressure.
Podiatrist, Michael Ratcliffe, explains, ‘If we are unable to absorb the forces that go through our feet and legs when we walk and run, this puts excessive stress on the joints involved. This overload can be substantially helped with a supportive, foot-shaped cushioning orthotic.’
For problems such as hard skin, calluses and corns, which can be very painful if left untreated, there are also devices such as the Pedi Pro Deluxe, the most recent upgrade to the JML Ped Egg. Launched recently, it’s now on sale at Boots and Superdrug and potentially an addition to spring/summer product ranges. The device is designed to buff hardened heels and bunions in a fraction of the time it normally takes, and also removes hardened skin, calluses and corns.
Fungal nail infections are estimated to affect 45 per cent of the population, particularly the elderly. Drugs aren’t always ideal, as terbinifin can cause liver-related side effects, and many topical medicines are prevented from working by the thickness of the nail plate. Mr Tennant suggests that an intervention from a podiatrist to thin the nails can help allow a topical treatment to soak through the nail plate, and adds, ‘Bear in mind that a fungal nail is a damaged nail and will grow slowly so treatment in severe cases can take 12 to 36 months with any treatment option.’
Annae Liu, Canespro brand manager, advises: ‘Fungal nail infections often co-exist with other fungal skin conditions, such as athlete’s foot, so that’s why we encourage pharmacists to maximise their merchandising by dual-siting Canespro alongside the Canesten topical athlete’s foot range. We recommend a ‘holistic approach to treatment’ by ensuring they advise customers to follow-up their treatment with a topical antifungal cream.’
ClearZal BAC is about to launch a press and TV advertising campaign designed to refresh the current image of the brand and increase awareness. The campaign will use the tag line ‘Don’t Let Your Nails Force You into Hiding’ and highlight the unique attributes of ClearZal BAC, which is designed to clear the germs that may cause nail infections along with the fungal infection. Social media activities and competitions will coincide with the launch, offering advice and tips on how best to avoid nail infections.
Mr Tennant believes that pharmacists and podiatrists should work together in helping customers of all ages deal with foot-related problems. ‘Find a good, competent podiatrist to recommend to patients and you will find they will recommend you, too, providing a symbiotic relationship.’
Leg health is an important issue for Michelle Ellis, chair of the Lipoedema Ladies support group. The organisation is passionate about raising awareness of the condition, which affects 3.2 million women in the UK, but often remains undiagnosed. It is not to be confused with obesity or lymphoedema. Due to the condition often being misdiagnosed as obesity, patients often find themselves on a never-ending cycle of diets and exercise regimes, but with the correct treatment some of the symptoms can be relieved.
Lipoedema is a condition that often starts at puberty, pregnancy or menopause, and doesn’t just affect overweight women. Sufferers can be any size, but the defining factor is that their lower body is markedly larger than the upper body. The condition causes their legs to swell and to retain the lipoedemic fat, despite attempts at dieting and exercise.
Ms Ellis explains, ‘Pharmacies see ladies with lipoedema every day, but often don’t recognise the signs. Some will visit regularly for analgesics – it’s often called Painful Fat Syndrome. Some women return repeatedly for diet shakes – and don’t seem to lose weight from their lower body. Others will come in for water retention treatments which also
have little effect.’
Ms Ellis suggests that community pharmacists can help by suggesting that lipoedema as a possible cause of swollen aching legs and giving advice on alleviating symptoms. ‘If you think the customer might be suffering with lipoedema, try referring her to a lipoedema information website – and also suggest that she asks her GP for a referral to a Lymphedema Clinic, where she will get a diagnosis of lipoedema, lymphedema or lipo-lymphoedema.’ Many GPs aren’t aware of the condition. To help raise awareness, the RCGP has released a free 30-minute online CPD course to help health professionals find out more at http://elearning.rcgp.org.uk/course. There is a range of products that pharmacists can offer women with the problem.
Along with manual lymphatic drainage, compression hosiery is a standard treatment, and major suppliers are happy to train pharmacy staff on measuring properly for compression stockings. Supplements such as Butcher’s Broom and selenium are alsoIf a customer has joint pain, Michelle recommends joint care supplements, supports and advice to avoid high impact exercise. ‘Opt for activities that help boost the lymphatic system like Nordic walking or swimming. Exercise in water also brings hydrostatic pressure into play and this is highly recommended.’
‘Lipoedema is genetic and research is now taking place in St George’s Hospital in London and at The Freidman Centre in New York in the hope of finding a cure. Until that day comes, we rely on informed medics and pharmacists to help us take control of our chronic disease.’ For more information about lipoedema, go to: www.lipoedema.co.uk or www.lipoedemaladies.com suggested by lipoedema expert Dr Karen Herbst.
Many women report hot and painful feet, especially in summer, so cooling mists and gels, plus heel balms can be helpful. Skin care is also important, with good quality natural products that won’t affect hormonal balance.
‘Memory foam and gel insoles will help ensure feet are well supported, joints cushioned and comfortable, and cooling products help with the discomfort, as does keeping support garments in the fridge,’ says Ms Ellis.
Fiona McElrea, Whithorn Pharmacy, Whithorn ‘This time of year, we get plenty of queries from people who are concerned about dry, cracked skin on their feet, for which we suggest they use a heel balm. Ideally, they would apply an emollient cream to their feet in the evening and put socks on before going to bed to wear overnight, although this is too much hassle for many people. Corns is the other very common problem, mostly for older customers, and we should remember that corns can be extremely painful. A lot of people around here are in farming and wear wellies for work – and this can make their feet sweat more, making them prone to issues such as athlete’s foot. We get involved in doing the measurements for compression stockings prescribed by the GP, although some practices do this themselves, and advising people with diabetes about general foot health and prevention of foot problems.’
Shaheen Bahatia, Broadway Pharmacy, Bexleyheath ‘When the weather starts changing, people start to think about wearing sandals and getting ready to expose their feet, especially women thinking about their holidays. They want to be looking healthy, so they come to us for advice. We can treat things like athletes foot very easily through pharmacy, as well as fungal nail infections. People can leave fungal nail infections for a long time. They hide their feet in the winter and then suddenly look at them and worry about issues such as discoloured nails, and are not sure whether to go to the GP or not. Of course, pharmacy teams are there to help and advise on problems like this. I will always be passionate about people coming to use community pharmacy first.’
Jiten Shingdia, Berry Pharmacy, Portsmouth ‘Athlete’s foot is quite a common problem for customers, as well as other sweaty foot issues. For those, we tend to sell a lot of sprays and powders. We occasionally have people with fungal nail infections come in to buy products, but this community is situated in an area where most people will tend to visit the doctor to receive treatment on prescription. We do advise people that the products are available to buy there and then, but they’d usually rather stick to the prescription. We have a couple of posters in the pharmacy advising people about nail problems and treatments.’