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Although people often neglect their legs and feet, they do so at their peril

Shoes: flat ones, high ones, strappy ones – whatever their style or purpose, we love them. But do they love us? Apparently not. Shoes can cause all sorts of problems – from sweaty feet to athlete’s foot, and from blisters to bunions, and even going without footwear has its risks. So how can you come to the rescue and save your customers’ soles?

Prevention is key

Women have a love-hate relationship with shoes – heels make 93 per cent of women feel sexier, but more than half experience pain and discomfort the next day, according to a recent survey by Carnation Footcare. Yet as many as one in five women fail to seek help if they have a problem with their feet because they don’t think it’s important, the College of Podiatry found when it polled 2,000 UK adults.

This is where pharmacy assistants can step in and provide valuable advice and information to their long-suffering customers. It is crucial that you are well informed about foot and leg care because pain in the legs and feet, particularly in older people, can impact on mobility, wellbeing and lifestyle, says Carnation Footcare podiatrist Dave Wain. “The importance of maintaining good foot health, especially as we get older, cannot be overstated,” he stresses.

Prevention is key, he adds: “Feet shouldn’t hurt, and customers should know that relief is available. Most of us are not born with foot problems; it’s shoes, overuse or foot mechanics that ultimately lead us to these issues. Prevention, therefore, is always better than cure.”

The College of Podiatry’s research found that around 90 per cent of women have at least one foot problem. Podiatrist and College spokeswoman Lorraine Jones says: “As a result of general wear and tear, most of us will suffer with some sort of foot complaint at some point in our lives, but we are seeing a lot of cases which could have been prevented – particularly amongst women. Conditions like blisters and cracked heels may sound like minor ailments, but they can cause a lot of discomfort and embarrassment.”

Emma Supple, consultant podiatrist and clinical director of Supplefeet, says pain in the feet and legs should always be taken seriously by pharmacy staff. “On a simple level,” she says, “pain restricts movement, which equates to wellbeing and weight management. And on a more serious note, it can be indicative of serious cardiovascular issues, rheumatology conditions and musculoskeletal issues.”

Dave Wain says that most footcare problems are caused by overuse and pressure from footwear, especially fashion shoes. Age also has an impact, as the health of the feet and the natural padding within the skin can break down over time.

So what are the foot and leg problems pharmacy assistants are most likely to be asked about? Let’s take a look...

Feet shouldn’t hurt, and customers should know that relief is available

Corns and calluses

Corns and calluses occur as a result of pressure on the foot, usually from wearing ill-fitting shoes. Corns appear over bony areas such as joints, while calluses usually occur on the soles of the feet. Both can cause pain and discomfort. The College of Podiatry says that customers should not cut corns themselves as this could lead to pain, bleeding and possibly infection. OTC corn treatments such as protective plasters, soft padding and foam insoles or wedges allow thick, hard skin to heal and excessive pressure to be redistributed.

Also available OTC are liquids or gels containing salicylic acid to help soften the top layer of dead skin so that it can be easily removed. These should only be used following professional advice, says the College. Calluses can usually be kept at bay by using a pumice stone or non-metallic foot file gently in the bath. Dr Tariq Khan, consultant podiatrist at Great Ormond Street Hospital for Sick Children, says: “There are very simple ways to prevent corns: wear properly fitted footwear with extra room in the toe area. Avoid shoes that are too tight or too loose. Use an orthotic or shoe insert made with materials that will absorb shock and shear forces. Also avoid tight socks and stockings to provide a healthier environment for the foot.”

 

Verrucas

A verruca is a wart that looks like a small, dark puncture mark in the early stages, but later turns grey or brown. Verrucas are usually found on the soles of the feet, although they can also appear around the toes. They are caused by a contagious virus, which is often picked up when people walk barefoot, especially on damp floors. The body’s immune system will fight verrucas off in time, but over-the-counter treatments will clear them more quickly. Customers should be advised to avoid touching or scratching verrrucas as they may spread into a cluster.

Bunions

A bunion is a condition where the big toe is angled excessively towards the second toe and a bony area develops on the side of the big toe. This may become inflamed and sore as it rubs on the inside of shoes. Bunions tend to be genetic and run in families, but footwear can also contribute to their development. Some OTC products, such as padding or shoe insoles, can ease the pressure on bunions, but only surgery can correct them fully. To avoid exacerbating bunions, customers should be advised not to wear narrow shoes with pointed toes. If they experience frequent pain, they should be referred to a podiatrist.

Blisters

Blisters are painful, fluid-filled lesions produced by friction and pressure. Ill-fitting or stiff shoes, wrinkled socks against the skin, excessive moisture and foot deformities can all cause blisters. Blisters should never be burst as they actually provide valuable protection for damaged tissue and the area may become infected if this protection is compromised. Advise customers to cover blisters with antiseptic ointment and a protective soft gel dressing or a blister pad/plaster.

Sweaty feet

Sweaty feet can be a persistent and embarrassing problem for some people. Feet have 250,000 sweat glands, so they tend to sweat more than other parts of the body. A cheesy odour develops when bacteria on the skin breaks the sweat down. Advise customers to wash their feet at least once a day with antibacterial soap, and to dry carefully between their toes. They should also wear clean socks made from at least 70 per cent cotton or wool, and alternate their shoes daily to allow them to dry out.

Athlete’s foot

Athlete’s foot is a fungal infection that can cause intensely itchy, cracked, blistered or peeling areas of skin, as well as redness and scaling. It can be picked up anywhere, but is typically found in warm and humid places, such as swimming pools, showers and changing rooms where people walk around barefoot. If left untreated, the fungus can spread to the toenails and cause a fungal nail infection. Athlete’s foot can be treated with OTC antifungal or fungicidal treatments. Topical treatments for fungal nail infections are also available OTC (see page 16 for more details).

Cracked heels

Cracked heels can be extremely painful. They occur when the skin becomes dry and splits under pressure. If the fissures are deep, they may bleed, and walking may increase the pain and worsen the cracking. The problem can be prevented by moisturising regularly with a specially formulated OTC cracked heel cream or foot balm, and by using a pumice stone or non-metallic file in the bath or shower.

Plantar fasciitis

Plantar fasciitis is caused when a band of tissue in the foot, known as the plantar fascia, becomes damaged and thickened. It causes pain deep in the heel, which can be severe and is usually worse on standing. The complaint is relatively common, although it usually occurs in people over the age of 40. The recommended treatment is rest, wearing good footwear, heel pads and pressure relief insoles, as well as taking painkillers and exercise. A GP or podiatrist may offer a steroid injection and even surgery to release the plantar fascia.

A podiatrist may prescribe strapping or special supportive insoles to help the feet function more effectively, thereby reducing strain on the ligaments. (See page 31 for more on this condition.)

Arch pain

Plantar fasciitis is a common cause of arch pain, which can also be brought on by wearing flat shoes, sandals or flip flops that lack support. Wearing these types of shoes all day can cause tired legs, a sore back, arch cramps and general muscle fatigue. Massaging the feet and wearing shoes with proper support will help to resolve this problem, and walking properly can also help. Varicose veins

Varicose veins

develop when blood vessels in the legs become enlarged as the small valves inside them stop working properly. This prevents blood flowing back to the heart efficiently and results in blood flowing in the wrong direction. Up to a third of the UK adult population are affected by varicose veins. They become more common as people get older and women are more likely to develop them than men. Pregnancy and being overweight can increase the chance of developing varicose veins.

Many people will not show any symptoms, but for those who do, these can include heaviness, aching, throbbing, itching, cramps, or tiredness in the legs. Varicose veins can worsen over time and some people will go on to develop leg ulcers, which can be difficult to heal and significantly affect quality of life. Self-help advice should include avoiding prolonged periods of standing or sitting still; putting feet up (above the level of the hips) regularly to help prevent blood pooling in the veins, and using a moisturising cream or ointment to protect the skin if it is dry, flaky or itchy. If varicose veins are problematic, customers should be referred to the pharmacist.

Deep vein thrombosis

(DVT) Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein in the leg. It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism. Symptoms include pain, swelling and redness, usually in the lower leg. Anyone can develop DVT, but it becomes more common with age and in people who are immobile, for example following an operation. Other risk factors include previous venous thromboembolism, a family history of blood clots, medical conditions such as cancer and heart failure, and inactivity.

The main treatment for DVT is anticoagulant medicines. Customers can reduce their risk of DVT by stopping smoking, losing excess weight and walking regularly to improve circulation in the legs. Undertaking long journeys by air, bus, car or train can slightly increase the risk of developing DVT. Any customer at risk of DVT should be advised to talk to their GP before travelling for four hours or more. Compression stockings can help to prevent DVT. These are worn around the feet, lower legs and thighs, and fit tightly to encourage the blood to flow more quickly around the body.

Tired and aching legs

Tired and aching legs can be caused by long periods of standing or poor circulation in the legs. The problem tends to affect people as they get older – half of women over the age of 45 are estimated to have tired, aching legs, and seven out of 10 of those who are affected say the pain is so severe that it interferes with their daily lives. If this condition goes untreated, the small valves in the veins of the legs may stop working properly, leading to swollen ankles, varicose veins, itchy skin and possibly DVT. 

Over-the-counter health supplements, cooling gels, analgesics and wearing support hosiery may be recommended. If symptoms persist, refer customers to the pharmacist.