It’s estimated that there are about 4.5 million people living with diabetes in the UK, and problems with their feet can be one of the first signs that the condition is developing.
Peripheral neuropathy and peripheral arterial disease affect people with type 1 and 2 diabetes. In peripheral neuropathy, sensation in the skin of the feet (and lower leg) may be reduced or completely absent, which means people might not be aware of minor injuries. Once the damage has been discovered, and dry skin and cracks in the skin on the feet have developed, people may come to the pharmacy for advice.
In more advanced cases, peripheral arterial or vascular disease can develop, reducing the ability of feet to heal after an injury, even a minor injury such as a blister, which may become infected. In some cases, this could lead to tissue death, ulceration and infection – and eventually to amputation.
Pharmacy staff are well placed to advise people with diabetes about their foot health, says Michael Ratcliffe, podiatrist at Carnation Footcare. “If someone with diabetes collects their medication or reports a problem with their feet, then the staff can ask about foot health and if they have a foot checking regime,” he says. “If they don’t have a routine, they can be advised on how to do this, and given informative and supportive literature.”
Pharmacy staff can also check for warning signs of a foot attack, such as:
Foot problems are often seen as cosmetic issues – hard skin that needs softening ready for summer, corns and bunions. But underneath common foot problems there could well be a more serious issue. Mr Ratcliffe says foot pain shouldn’t be ignored.
“One of the common problems patients put up with in their feet and legs is pain, and foot pain affects one in three people aged over 65,” he says. “This can be chronic, low-level pain or acute, sharp pain.
“Pain can be a result of callouses and corns from an underlying mechanical overload on feet due to poorly fitting footwear, joint pain from osteoarthritis (usually in multiple foot joints rather than in one joint) and, increasingly, oedema in legs from blood supply/return problems. Pain indicates that something is wrong. The source of the pain within the feet and legs should be investigated and the correct treatment applied, otherwise whatever is wrong will deteriorate.”
“It’s important to ensure all pharmacy staff are well educated on the types of common conditions that can cause aching legs and feet,” says Arnicare brand manager George Lellis. “Staff should also know where the relevant products are in store to ensure a smooth customer purchasing experience. During warmer weather, pharmacy staff should make sure cooling products are correctly signposted, with sub-categories created to ensure the customer can find exactly what they need.”
Aching feet and legs aren’t always a sign of underlying illness; sometimes it’s just down to being on your feet all day and warmer weather. A campaign for Nelsons Arnicare Arnica Cream and Arnicare Arnica Cooling Gel this summer will include opportunities for consumers to sample the Arnicare Arnica Cooling Gel first hand, adds Mr Lellis.
More than 1.7 million units of fungal nail products are sold every year in the UK, according to IRI data. It’s a common complaint – one in 10 people globally may be affected by contagious fungal nail infections. Fungal nail infections usually start as a white or yellow streak under the tip of the nail and the nail may change in appearance and become brittle, discoloured or crumbly.
The prevalence of fungal nail infection is rising. This is thought to be due to the increasing prevalence of diabetes, more frequent incidence of immunosuppression and an ageing population.
Nailner contains ethyl lactate, a substance that can saturate the nail and bring the other active ingredients through the keratin of the nail. The latest product from the Nailner brand is Nailner Treat & Colour, which launched in Boots last month. According to a brand manager at Nailner, “regular nail polish acts as a quick cover-up that makes matters worse. Fungi thrive in dark conditions and traditional nail polish forms a watertight seal that can trap the fungus.” Women especially may be concerned about the appearance of their nails, so the product is suitable for women who want to wear polish but need to treat a fungal nail.
Canespro Fungal Nail urea ointment is clinically proven to soften the infected part of the nail, leaving the healthy parts intact. The softened part of the nail can then be gradually removed, using the plastic tool provided in the set, in just two to three weeks. If a green-yellowish or black pigmentation appears on or underneath the nail, the customer should consult a doctor or healthcare professional. Pregnant women and people with diabetes should also seek advice from a healthcare professional before treatment.
Athlete’s foot is a foot condition that is best treated as soon as customers detect symptoms.
Annaë Liu, Canesten brand manager at Bayer advises that “a topical anti-fungal treatment containing bifonazole or clotrimazole will attack the main types of fungi that cause the infection, including dermatophytes. Hydrocortisone, a mild corticosteroid, will treat symptoms of inflamed athlete’s foot when combined with clotrimazole.
“Consider recommending Canesten Hydrocortisone Cream, which is formulated with a combination of clotrimazole and hydrocortisone for treatment of inflamed athlete’s foot.” Ms Liu also suggests that pharmacy teams should advise consumers to consult a doctor if they are uncertain about diagnosis and if symptoms persist after treatment, and reminds that pregnant or elderly sufferers may not be able to use antifungal medication and should also seek advice from a doctor on the best way to treat their athlete’s foot.
Also for foot problems, Footner CoolActive Massager, for tired feet, combines a cooling foam and a ball massager with phytonine for reducing swelling and improving circulation.
As many as 90 per cent of women have suffered a foot problem, with one in five saying that they are embarrassed about their feet, according to the College of Podiatry.
The top foot problems suffered by women are blisters (55 per cent), cracked heels (45 per cent), veruccas (28 per cent), corns (24 per cent) and ingrown toenails (20 per cent), as reported in a survey. More than twice the number of women to men report suffering from corns, cracked heels and bunions, yet despite these problems, 19 per cent of women haven’t sought help because they didn’t think their foot complaint was important.
Advice for customers to help sore or uncomfortable feet includes:
Conditions such as blisters and cracked heels may appear minor, but can cause a great deal of discomfort and embarrassment, comments a College spokesperson.
For corns and hard skin, the College recommends the regular use of a foot file, emery board or pumice stone to keep the problem under control – and advise that customers should never cut corns off their feet themselves or use over the counter products without first consulting a podiatrist or healthcare practitioner, such as a pharmacist.
Bina Patel, Kalsons Chemist, Westcliff-on-Sea “We have a full display for this category now and our staff are trained to give advice on foot care – they do a lot of that. We’ve seen our sales go up considerably around foot conditions because of the attention we’ve put on it. We feel that we’ve done well. We try to keep a good selection of products in the category – footcare products and supports and so on – and Scholl is a popular range. Often people will come in with a particular product in mind because they have seen an advert somewhere, so that’s useful to keep an eye on what’s being advertised. This category seems to be improving – I’m pleased with how it’s doing in our pharmacy and with the service our team provides to people with foot health questions.”
James Tapiwanashe Masamha, Morrill Pharmacy, Hull “We don’t have many queries to do with foot and leg conditions, and I wouldn’t say it’s one of the most important areas for our business as a whole. The most common thing would be people who present with athlete’s foot. I would usually recommend clotrimazole to treat the infection, but it’s also very important to share hygiene advice with them to prevent them from getting the infection again. This includes advice such as wearing open shoes, not sharing towels and keeping the feet clean and dry. You do need to cover these points thoroughly with customers. Queries around more serious issues such as peripheral neuropathy are less common, probably because people are more inclined to discuss something like this with their GP.”
Jiten Shingdia, RJ Berry Pharmacy, Portsmouth “This is not that an important category for us. We do occasionally have athlete’s foot queries, but I’ve only had one fungal nail infection query in the past four or five months. I think sometimes people ignore these infections, or they think they’ll get better on their own – which is definitely not the case. Alternatively, these problems might just not be as common in this local area as in others. The main products are athlete’s foot sprays, miconazole powders to put in socks and shoes and Lamisil cream. We don’t have many people discussing more serious foot and leg conditions such as neuropathy. We do have a lot of diabetic patients in the pharmacy, but that’s probably something they discuss with their GP or specialist.”