Back on your feet

OTC

Back on your feet

Conditions that affect the feet and legs, which have been impacted by stress, anxiety and the reduction in activity imposed by lockdown rules. Here's a rundown of the more common problems pharmacy customers may be experiencing.

Restless Legs Syndrome (RLS), otherwise known as Willis-Ekbom disease, is a neurological disorder that affects around 10 per cent of the population. It is characterised by an irresistible urge to move, and many people also experience pain and discomfort, usually during the evening or at night when they are trying to sleep. Symptoms can be relieved temporarily by moving, massaging or stretching affected limbs, but they usually return after resting. RLS is most likely to affect the legs, but it can also move to the arms and, in extreme cases, the whole body.

Studies have found that metabolic changes, mood disorders and antidepressants can increase the chances of developing RLS, but that light or moderate intensity exercise can reduce symptoms. Lack of movement in recent months may well be a factor in RLS. A study carried out during the pandemic revealed that physical activity had reduced by around 38 per cent. Physical inactivity is well documented to be implicated in cardiovascular disease, hypertension and diabetes. Epidemiological studies also suggest that there may be a relationship between cardiovascular disease, hypertension and RLS, and that there is a high prevalence of RLS in people with type 2 diabetes. Anxiety and depression can also exacerbate the problem.

RLS can be either primary or secondary. With primary RLS, there is no recognised cause. It usually begins slowly, before the age of 40–45, and there is often a genetic connection. Symptoms tend to come and go and worsen over time. 

Secondary RLS occurs suddenly and is usually associated with a medical condition such as iron deficiency anaemia. It can also be caused by medication. About one in five pregnant women also develop RLS, usually in the third trimester, and it can carry on post-birth.

It is important to recognise that in some people with RLS, the antihistamines contained in OTC treatments for sleeplessness, colds and allergies can make symptoms worse. If a customer presents with RLS symptoms, it’s advisable to ask them if they are taking any medications, either OTC or prescribed. Other medications known to exacerbate the condition include some SSRI anti-depressants.

Although there is no known cure for RLS, some people find that implementing a good sleep hygiene routine helps. This includes:

  • Maintaining a consistent bedtime and waking time
  • Avoiding nicotine, alcohol, refined sugar and caffeine – especially close to bedtime
  • Not eating for at least three hours before bedtime
  • Avoiding brightly lit environments for at least three hours before bedtime
  • Avoiding daytime napping. 

The severity of primary RLS symptoms can be improved with exercise, compression devices and acupuncture. The Charity RLS-UK also recommends magnesium oil spray, iron, vitamin B complex, folic acid and calcium. If symptoms are causing distress, the patient should be referred to their GP. Primary RLS can be treated with medications such as iron sulphate or iron gluconate and if that doesn’t help, a doctor may suggest trying dopamine agonists, alpha 2 delta ligands such as gabapentin, or opioid medication.

Alex Clark, physiotherapist for orthopaedic supports manufacturer Neo-G, advises that using compression or massaging affected limbs can help to ease RLS symptoms. She says: “Compression socks can be particularly useful as they can help aid circulation too – and some research has found a link between restless legs syndrome and developing cardiovascular diseases. 

“If wearing compression socks is not ideal, we also offer a variety of one size compression supports in our variable compression range.”

VARICOSE VEINS

Compression therapy is often prescribed alongside exercise therapy to improve venous health. Compression hosiery works by squeezing distended veins so that the valves are able to close effectively. This stops blood from flowing away from the heart and can help to prevent the formation of new varicose veins as well as keeping existing veins from getting worse. 

LYMPHOEDEMA AND LIPOEDEMA

Compression therapy can also help with the symptoms of lymphoedema and lipoedema. Lymphoedema occurs when there has been damage to the lymphatic system, such as following cancer treatment. The lymph fluid cannot drain effectively, so it builds up in the body tissue, leading to swelling. Using a well-fitted compression garment can help to increase the pressure within the tissues and encourage the drainage of excess lymph fluid. In the case of lymphoedema, long term use is recommended to maintain reductions in limb volume.

For lipoedema, compression therapy can help to reduce the discomfort of swollen limbs, along with the associated aches and pains, by supporting the tissues. It also helps aesthetically, by streamlining and supporting the limb. As with lymphoedema, compression also helps to reduce swelling by moving blood and lymph fluid away from the affected tissues, and can help prevent worsening of symptoms when worn long term.

BLISTERS 

Foot blisters are usually caused by irritation from continuous friction or pressure, and experts suggest that early treatment can avoid complications later on. 

According to Michael Ratcliffe, sales training manager for Carnation: “Preventing blisters involves either avoiding the build-up of the friction that leads to their formation or intervening once they have formed. Generally, when a ‘hot spot’ arises, such as an area of friction or pressure, then it is important to begin treatment. One form of treatment is the timely application of hydrocolloid plasters, which are widely used in blister management.” As well as preventing friction damage to the skin and treating existing blisters, hydrocolloids such as Carnation Footcare Hydro Blister Care can help to relieve pain.

PLANTAR FASCIITIS

Plantar fasciitis is one of the most common causes of heel pain. The condition occurs when the plantar fascia is overloaded and excess stress in the tissue results in heel pain and inflammation. The main cause of plantar fasciitis is lack of support in the foot arch. Insoles or heel pads can provide relief, and it is important that shoes are comfortable, with a low heel and soft sole.

FUNGAL NAIL

With summer approaching and the hope that lockdown is over, people may be planning outings and even holidays – which means that feet will come into focus, says Andrew Clark, sales and marketing director for Excilor. Customers may therefore be more likely to seek help for unsightly conditions, such as fungal nail infection. 

According to Trimb Healthcare, owner of the Nailner brand, research has found that the look of their nails is the main reason why 67 per cent of sufferers seek help for the condition. “Most people do not realise discoloured nails are a sign of fungal nail infections,” says the brand. Infection normally starts at the edge of the nail before spreading to the centre, causing discolouration, pain and swelling.

VERRUCAS

Verrucas are easily caught and can spread quickly, so it is important that they are treated effectively. Treatment gels have traditionally been the first port of call, although stronger, freezing treatments generally work more quickly. “Cryotherapy (or freeze therapy) involves applying liquid nitrogen,” explains Trimb Healthcare, which also owns the Wartie brand. “It used to be performed only by doctors but now easy-to-use and safe home freezing cryotherapy products are readily available.”

Brand news

• Compression products supplier L&R Medical has launched a new initiative. Headed up by ambassador Johnny Vegas, Squeeze In aims to support patients and clinicians in managing leg health. Patients can sign up for newsletters and advice, while healthcare professionals can access a self-care resource pack, healthy living booklet, and clinical newsletter at www.lrselfcare.co.uk/squeezein 

• Neo-G has launched a range of slimline Active supports. Described as lightweight and breathable, they allow movement during activity, and can be worn all day. Physiotherapist Alex Clark explains: “Featuring multi-zone compression for best fit and performance, they protect and support, reducing the likelihood of injury and providing support for sprains and instabilities. We have also given them a fashionable, vibrant design.”

• Neo-G has also developed a Plantar Fasciitis Everyday Support compression sock, specifically designed to relieve the symptoms of plantar fasciitis and heel and arch pain. The anatomical silicone insert can be worn with most footwear.

Excilor Nail Fungus Treatment is being promoted in key pharmacy media and via a multi-media consumer campaign to raise awareness of fungal nail. The product uses trademarked TransActive+ technology to relieve the problem by penetrating nails and creating an environment that is hostile to fungi.

Views from the P3category panel

“We always have customers asking for help with verrucas and corns. Freeze pens have proven really popular. As there’s no air travel, we’re not selling many flight socks. However, we’re doing well with blister and corn plasters, with people doing lots of walking instead. We’ve had more queries about leg and foot injuries, due to people either exercising at home or doing lots of walking. Lots of the products for foot and leg care need to be hung up, so we site them next to our first aid sector, which works well.”

Lindsey Fairbrother, Goodlife Pharmacy, Hatton, Derbyshire

“This is a massive category for us and has become increasingly important during the pandemic. We have a lot of farmers in our community who wear wellies all day and often come in with foot problems. Corns and calluses are very common, also verrucas, plantar fasciitis, Achilles problems, dry skin and cracked heels. The Profoot range does well for us, plus Compeed blister plasters and the Scholl range. People are coming to pharmacy more now they’ve realised how accessible we are.”

Fiona McElrea, Whithorn Pharmacy, Dumfries & Galloway

“This is a popular category for the pharmacies I work at. However, queries have reduced in the last year due to Covid-19 restrictions. Customers typically attend for treatment for blisters, verrucas and athlete’s foot. For athletes’ foot, Scholl, Canesten and Mycota are the most popular brands. For blisters, Compeed sells well and for verrucas, products containing salicylic acid and lactic acid, sell very well. I think sales will go up again when sports and leisure return to normality.”

Jaimini Modi, locum pharmacist, Harrow

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