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Best foot forward

The foot health sector represents a significant part of a pharmacy’s retail offering, so it makes sense to ensure that the category is well represented – and that staff are well trained in how to approach foot health issues.

Taking the opportunity to support people with health conditions such as diabetes, who need to be aware of the importance of looking after their feet and treating minor ailments promptly, places community pharmacy at the forefront of healthcare at a time when people might be avoiding ‘troubling’ their GP.

While customer spend in the foot care category is just as likely to be affected by inflation as any other category this year (Mintel data from 2022 suggests consumers are considering lower cost versions of popular self care products), people still need good quality and effective foot care products that offer them value for money. 

Research shows that 62 per cent of UK consumers already purchase products that claim to treat dry skin, including foot care products. Premium products are likely to remain popular, as consumer interest remains high when it comes to ‘luxury’ products that make them feel cared for as well as performing a specific function. 

Making pharmacy fixtures appealing and segmenting well to differentiate between conditions, comfort and ‘pampering’ products can also help to drive sales. 

Common foot health conditions

Fungal nail infections of the toenails are very common, affecting one in four people during their lifetime, but figures suggest they are often left untreated. Fungal nail is especially common in elderly people, those with reduced immune system function and those with diabetes and poor circulation 

Athletes’ foot affects around one in four people, but is more likely to be treated than fungal nail as it can cause extreme discomfort. The condition can trigger intense itching, along with cracked, blistered or peeling and sore skin

Warts and verrucas are thought to affect up to 32 per cent of people, often children, teenagers and young adults. About one in 10 people of all ages in the UK are thought to have warts or verrucas at any one time, but this figure rises to almost one in three among children and young people.

Flexitol brand manager Leah Holden offers advice on supporting customers suffering from another common foot condition – cracked heels. She says: “Cracked heels are caused when the skin of the heels dries out, becoming stiff or chapped. This means that when we put our weight on them, the skin is pushed out sideways and because it’s fragile, it cracks under pressure.”

“Cracked heels are caused when the skin of the heels dries out, becoming stiff or chapped. This means that when we put our weight on them, the skin is pushed out sideways and because it's fragile, it cracks under pressure.”

Some people are more prone to developing cracked heels than others – especially those with eczema, diabetes or obesity. The condition can also affect people with jobs that require lots of standing, athletes and lovers of open-back shoes.

Products that contain urea may be worth considering, says Holden: “Urea is naturally produced as part of the skin’s natural moisturising factor (NMF), and can help the appearance of dry, rough skin by hydrating it to a smooth texture.

“Urea-containing foot care products may be helpful to people living with diabetes, as their feet are more likely to become dry or callused. Urea based emollient products have been shown to have distinct advantages beyond simple moisturisation, such as hyperkeratosis reduction, antimicrobial activity and improving skin barrier function.”

People with diabetes can be more susceptible to dry skin on the feet, which can quickly become more serious, so feet must be protected with a moisturiser. “Appropriate urea cream usage in people with diabetes can help to prevent foot ulcers,” says Holden.

Foot care in diabetes

Katie Bareford, senior clinical advisor at Diabetes UK, has some helpful tips about how to talk to people with diabetes about caring for their feet. 

She says: “If a customer appears to be moving uncomfortably, or if they are collecting prescriptions for diabetes medications or foot treatments of any kind, pharmacists could begin a conversation about neuropathy.

“It is important to check individuals’ diabetes status if they are purchasing over the counter foot remedies such as verruca creams or blades for hard skin, as these should not be used
by people living with diabetes. If the customer has diabetes, they should be signposted to their GP or foot protection
service instead.”

If a member of the pharmacy team suspects that a minor foot ailment, such as a blister, may not be healing due to diabetes, there are some key questions to ask:

  • Has the customer been diagnosed with diabetes?
  • If they don’t have a diagnosis, encourage them to complete the Diabetes UK Know Your Risk assessment at riskscore.diabetes.org.uk, and signpost accordingly
  • If a person with diabetes enquires about a minor foot ailment that is not healing, ask them if there has been:
    • Any change in colour or shape, or swelling to a toe or foot
    • Temperature change in their foot or lower limb
    • New or unexplained pain in their foot
    • Oozing or odour from a wound on a toe or foot
    • A wound or break in the skin on a toe or foot. 

If the answer to any of the above questions is yes, signpost them urgently to see their podiatrist (if they are already known to a service) or GP, or to attend A&E. People with any of these symptoms need to be seen within 24 hours. 

Pharmacy teams should advise people living with diabetes that common ailments such as corns and hard skin should be treated by a specialist and not self-managed.

General advice on foot care in people with diabetes

  • Inform people with diabetes about what care they are entitled to, including foot checks. Pharmacists should support people with diabetes to have these reviews
  • Explain why they are at risk of developing problems with their feet. Encourage them to check their feet daily and make sure they know what to look out for
  • Advise people to attend all of their diabetes appointments, including annual checks and regular appointments
  • Advise people to contact their healthcare specialist even if they have a minor ailment such as hard skin or a corn, as foot problems in people with diabetes require specialist care and should not be self-managed.

Provide general health advice, including help with stopping smoking, monitoring and managing blood sugar, blood pressure and cholesterol levels, healthy eating and physical activity.

The ACT NOW checklist to improve diabetes foot care and education is a valuable tool. It can be downloaded from the professional resources section of the Diabetes UK website

Annual foot checks 

A foot check is part of the annual review for people with diabetes, so should be booked in at their usual diabetes care provider. If someone has not had, or has not been invited for an annual review, they should contact their diabetes care provider or GP. NB: People living in Scotland may only be seen for a foot check once every two years if they are at low risk of foot disease.  

Views from the P3pharmacy panel

This is fairly important for us, so we do keep a good range of stock. The main queries we get are around athlete’s foot, but we also get questions about supports for sports injuries. Other areas we are asked about include minor injuries, varicose veins and compression hosiery. The products that do well for us include the Compeed range and also Carnation foot products. It’s not a category where we’ve seen much change in recent years, but it sells steadily for us throughout the year.

I see a lot of foot and leg issues. With increasing pressure on the NHS, patients are finding it challenging to get seen and are coming to their pharmacy first. The main queries are about warts, verrucas and pressure sores. Questions about corns are common too. Well own-brand corn blasters and toe wraps are really helpful, as is Salactol Wart Paint. More of these products are being sold to patients over the counter and fewer on prescription, which is great as we can solve many ailments in pharmacy, freeing up GP appointments.

Foot care is a minor category so it is important to stay focused and stock only products that have proven effectiveness and that our staff are trained on and happy to recommend. Verrucas are the number one request. Identification is always the first task. We are often sent CPCS referrals for verrucas. Bazuka is our best seller here. Lamisil cream sells well as does foot antiperspirant, which we try and link sell as way of preventing athlete’s foot. This section relies on recommendation and advice; staff training pays dividends.

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