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Baby steps to giant strides

Feet have a vital role to play in people’s lives – so it is important they are looked after from day one

Learning objectives

•  After reading this feature you should be able to:

•  Recognise common foot ailments

  Explain the treatment options for minor foot and leg problems.

Feet have a vital role to play in keeping us upright and moving but every step taken places a tremendous force on them – a force that is about 50 per cent greater than actual body weight when walking but can be as much as 300 per cent greater during exercise. It is no wonder, then, that problems can occur.

Complex

The foot is a complex structure, comprising 26 bones and an intricate structure of muscles and tendons. The muscles and joints of the leg interact closely with those in the foot – so any imbalance or inefficient movement in the lower limb can lead to pain in the muscles, tendons and ligaments or cause joint pain through excessive loading and give rise to accelerated wear and tear, or osteoarthritis.

If someone has a medical condition that causes them to alter the way they walk, this can contribute to foot pain. This may include conditions that cause numbness or pain in the feet, such as diabetes (an important cause of serious foot problems); leg and foot deformities; spinal problems; and neurological disorders such as cerebral palsy or Parkinson’s disease. Other conditions which can lead to foot pain include:

  • Arthritis, particularly osteoarthritis and gout
  • Obesity places added stress on feet and increases the risk of foot and ankle injury. The extra pressure on the joints and soft tissue increases the chance of developing plantar fasciitis tendinitis
  • Pregnancy: excess weight increases the stress on the feet, leading to fluid build-up and swollen feet
  • Some medications, such as calcitonin (used to treat post-menopausal osteoporosis and other problems) and drugs or treating high blood pressure, may cause the feet to swell.

Vigorous activities, such as jogging, running, strenuous aerobics or sports which involve short bursts of running and sudden changes of pace and direction, can lead to foot and leg problems such as corns, calluses, blisters, muscle cramps, sprains and strains.

Treatment

Many minor foot and leg problems can be treated with over-the- counter medicines and simple self-help advice.

Athlete’s foot

A fungal infection that usually develops between the toes, athlete’s foot is particularly common in teenagers and young adults. The affected skin may be red, moist, scaly or flaky. Mild cases can usually be treated with antifungal creams or gels and clear up after a few days or weeks.

Good foot hygiene can help to reduce the spread of an infection. Feet should be dried thoroughly after washing (particularly between the toes), clean cotton socks should be worn, and shoes and socks changed regularly, especially after exercising. Customers should be advised to not walk barefoot or share towels or clothes.

Blisters

Blisters can be painful and are more likely to occur in hot weather, when sandals or flip-flops rub against the skin. Anti-blister sticks and blister plasters can provide instant relief and prevent further damage. Customers should be advised not to pop blisters, as this increases the risk of infections, but to cover them with a protective gel dressing.

Verrucas

Most verrucas, which develop on the soles of the feet, are harmless and don’t cause any pain, unless they are on a weight- bearing part of the foot. The affected skin is usually white and may have a black spot in the centre. Verrucas are highly contagious and spread easily through contact with contaminated changing room floors or swimming pool areas. They usually disappear on their own, but this can take up to two years. Several treatment options are available OTC, including salicylic acid gels, creams, plasters and paints, and also cryotherapy products.

Cracked heels

Cracked heels are often caused by open-backed shoes, such as sandals or flip-flops, rubbing the skin. Applying a moisturising cream, or specially formulated proprietary foot cream, twice daily, will keep feet smooth and soft. Any hard skin can be removed with a pumice stone or non-metal foot file, which are most effective when used during a bath or shower.

Fungal nail infections

Fungal nail infections are commonest in people who wear shoes in hot, sweaty weather, regularly damage their nail or skin, or have certain health conditions such as diabetes or psoriasis. The infection usually develops slowly and causes the nail to become thickened and discoloured. The nail may turn white, black, yellow or green, but isn’t usually painful.

Mild fungal nail infections usually clear up on their own, although a GP may check for any underlying conditions. Antifungal nail paint may be effective if only the end of the nail is infected, but this needs to be used for up to six months or even a year. Antifungal tablets are up to 80 per cent effective, but again need to be taken for several months. Most treatment failure occurs because people stop using the medicines too early. In severe or painful cases, the nail may be removed with surgery.

Treating foot and leg pain

When foot or leg pain strikes it is important to use the right treatment at the right time. So when should cold therapy be used instead of heat therapy? And which conditions can be treated with topical NSAIDs?

Cold therapy

Cold products can be recommended for sprains and strains or sharp, shooting pain in joints or muscles. When cold is applied topically, it activates certain receptors in the skin, which send signals to the brain, combating the pain. It also helps the blood vessels in the affected area of soft tissue to constrict, which can help limit swelling and inflammation.

Heat therapy

Heat therapy can be recommended to help ease painful, stiff and aching muscles in the legs and for use before exercise to relieve any muscular aches and pains. Heat may also be used for problems such as sprains and strains once the initial cooling period of up to 72 hours is completed. Like cold, when heat is applied topically, it activates receptors in the skin, sending signals to the brain that helps to ameliorate the pain. Heat also increases blood flow to the affected area, bringing oxygen and nutrients to aid the healing process and help restore movement.

Tackling inflammation

Topical NSAIDs can be recommended for inflammatory pain in joints and muscles in the legs. Some topical anti-inflammatories can also be recommended to relieve pain associated with non-serious arthritic conditions. Topical anti-inflammatories can provide powerful, targeted pain relief at the site of the discomfort, helping to reduce swelling.

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