10 months ago

2017 HCHB_digital

Foot Care Common foot

Foot Care Common foot problems include athlete’s foot, smelly feet, fungal toenail infections, verrucae, corns and calluses, cracked heels, and blisters. Athlete’s foot Athlete’s foot is most frequently caused by a dermatophyte fungal infection which can infect the skin between the toes and the soles of the feet. The skin may look white and soggy or scaly, red and itchy. Cracks may be visible and there may be a slight odour. Dermatophyte fungi live in shed skin scales and are contagious via direct contact with wet floors and shared footwear or towels. Treatment is with topical antifungal preparations. Smelly feet Feet have more sweat glands than any other part of the body and feet can start to smell when the sweat cannot evaporate and becomes trapped inside footwear, providing a warm and moist environment for odour-producing fungi and bacteria to grow. Advise customers to avoid wearing the same pair of shoes every day, instead allow at least 24 hours for shoes to dry out. Socks should also be changed daily. People prone to more sweaty feet (see also Sweating, excessive [Hyperhidrosis]) may need to use a foot antiperspirant. Any athlete’s foot should be treated and shoe deodorisers can be used to treat shoes that are also smelly. Fungal toenail infections Infected toenails are common and difficult to treat. The nail looks thick and discoloured, white or yellowish. It may be brittle or crumbly and parts, or all of it, may fall off (see Fungal Nail Infections [Onychomycosis] for more extensive information). Verrucae Verrucae are warts that occur on the soles of the feet. They are typically grey or TREATMENT OPTIONS Category Examples Comments Topical antifungals (athlete’s foot) Antiperspirants and deodorants (for smelly feet) Topical nail preparations [GENERAL SALE] eg, zinc undecenoate (Mycota) [PHARMACY ONLY MEDICINE] eg, bifonazole (Canesten Bifonazole), clotrimazole (Canesten), econazole (Pevaryl), ketoconazole (Daktagold), miconazole (Resolve, Daktarin), terbinafine (Lamisil, SolvEasy Tinea Cream*) eg, aluminium chlorohydrate (Neat Feet Roll-On Foot Deodorant/Cool Foot Spray) eg, various ingredients (Actifresh Foot Spray, Gran’s Remedy Powder, Neat Feet Odour Guard insoles, NODOUR, Scholl range) See Fungal Nail Infections (Onychomycosis): Treatment options Terbinafine is fungicidal and can resolve athlete’s foot with once-daily applications. Most other antifungals are fungistatic and also effective, although more frequent application and longer treatment courses (continuing for one to two weeks after the infection has cleared) are required. Creams are easy to apply. They are good if the skin is moist, because they are water-soluble. Spray powders can give even cover over the sole and between the toes. Non-spray powders may clump, but are good for putting in shoes or socks to help reduce reinfection. Antifungal creams containing hydrocortisone (ie, Canesten Plus, Resolve Plus) also calm inflammation. A strong antiperspirant deodorant will stop feet sweating, reduce foot odour, soggy skin, and help prevent athlete’s foot from developing. If athlete’s foot is present, treat. Do not use the same container on feet and underarms because of the risk of cross-infection. Powders are long-lasting and may be used on the feet or put into socks. Cushioned inner soles that contain charcoal may also be effective. Products for corns, calluses, verrucae and warts [PHARMACY ONLY MEDICINE] eg, salicylic acid products (Carnation Corn Caps, Duofilm [+ lactic acid], Scholl range), dimethyl ether propane spray (Wartner) Do not use these products on moles or birthmarks. Soak corn or callus in warm water and remove dead skin with pumice. Protect unaffected skin around the corn, wart or verruca with Vaseline or a plaster before applying product. Some conditions may need four to 12 weeks’ treatment. Wartner is applied directly to the wart with a repeat treatment in 15 days if necessary. Cracked heels Blisters [GENERAL SALE] eg, DU’It Foot & Heel Balm, Ellgy Plus Cracked Heel Cream, Eulactol Heel Balm range, Neat Feat Foot & Heel, Scholl Express Pedi, Softening Socks [GENERAL SALE] eg, hydrocolloid (Compeed Blister Patch, Scholl range, Spenco range) Use heel balms regularly to treat or prevent cracked heels. Usually contain either urea, lactic acid or allantoin which are keratolytic, loosening surface skin cells. which then shed, exposing new skin. Electronic foot files make it easier to remove dead skin. Softening socks may speed recovery of cracked heels, particularly if used with a heel balm. Protects blister from further rubbing, relieves pain and accelerates healing. Other Orthotic inserts (eg, Scholl range) Correcting poor foot posture and alignment can improve heel and knee pain. Natural / herbal / supplements Apricot kernel, Bitter orange, cider vinegar, garlic, Kolorex Horopito, tea-tree oil Various natural topical products have been used in the treatment of athlete’s foot and related fungal infections. Products with an asterisk have a detailed listing in the Foot Caresection of OTC Products, starting on page 238. @PharmacyToday. A part of your everyday. New Zealand’s only e-newsletter designed specifically to provide a news snack for pharmacy. With links to you’re only a click away from the full story. Page 72 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION brown and have a cauliflower-like appearance. Small black dots may be visible near the middle of the wart which is caused by bleeding. Verrucae are caused by the human papilloma virus which is contagious via wet floors. Although they can disappear spontaneously, this may take up to two years. Some people may require surgery to remove painful veruccae. Corns and calluses Corns and calluses are areas of hard, thickened skin which build up on areas of the feet subject to pressure and rubbing. Corns are smaller than calluses and develop on non-weight bearing parts of the foot, such as the tops of the toes. They have a hard centre and can be very painful. Calluses are flatter than corns and are often found on the heel or ball of the foot. Protect corns and calluses with moleskin or thin podiatry felt and advise customers to wear well-fitting shoes to reduce pressure and rubbing. A podiatrist may need to cut away the corn or callus to permanently remove it. Cracked heels Cracked heels are common in summer when people wear sandals or go barefoot and the feet dry out. Treat with a thick, oil-based moisturiser, applied twice daily, after using a pumice stone or foot file to remove any thickened skin. Blisters Blisters can form on the feet when the skin has been damaged (either by friction, rubbing or poor-fitting shoes), see Cuts, Abrasions and Blisters. Fluid collects between the upper skin layers and forms a small bubble or pocket. Most blisters will heal by themselves within three to seven days. Hydrocolloid dressings can be used to heal blisters, relieve pain and protect the area from further damage. Initial assessment If necessary, offer to take the customer into a private area where they can sit down and you can have a proper look at their feet. Wear gloves and examine the affected area, noting what symptoms correspond to the conditions above. Refer any customers with "yes" answers to the Refer to Pharmacist questions to a pharmacist. Also refer if you are unsure what the condition is, or do not know the appropriate treatment. Advice for customers Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes, is pregnant or breastfeeding)? • Is there any bleeding with the problem? • Has the condition persisted or recurred despite treatment? • Is a large area involved or are several nails infected? • Is the condition affecting other parts of the body (eg, face, scalp)? • Is the condition affecting the person’s ability to walk? • Is the corn soft and present between the person’s toes? • Are there any other symptoms (such as itching or a colour change in a suspected wart)? • Is the person aged over 50 and is this the first time they have experienced a wart? • Is the cracked heel severe or are there signs of infection? • Does the blister look inflamed or is there any sign of pus? • Does the person have any allergies to topical medicines? towels at a high temperature. • Wear leather shoes or open shoes, such as sandals, to reduce sweating. • Apply a foot antiperspirant daily if feet sweat a lot. Cracked heels • Inspect feet daily and apply a moisturising cream two to three times daily at the first signs of cracking. Athlete’s foot, infected nails, verrucae • Bleach the shower/bath area regularly to kill fungi and viruses. • Wash socks and towels in hot water and allow to dry in the sun. • Wear jandals in communal changing areas (ie, at public pools). Smelly feet • Wash feet twice daily with an antibacterial soap and dry thoroughly, particularly between the toes. Use a clean towel. • Change socks daily and wear cotton, not synthetic, socks. Wash socks and Page 73

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