Podiatry Advice

If you have poor circulation in your legs (Peripheral Arterial Disease)

Your circulatory system to your lower limb has an arterial supply that takes warm blood containing all the nutrients and oxygen to keep skin and muscles working well out to all the cells that need it. You also have a venous part of your circulatory system to remove waste and the de-oxygenated blood from the lower limb. To find out more about your venous system click on ‘if you have trouble with your veins’

Your arterial supply is important because it will keep your skin, muscle and other tissues working properly. If you have a good arterial supply then you should heal quite quickly if you injure your skin. Healing quickly will reduce the chance of a cut or wound getting infected. If a cut or wound does get infected then a good arterial supply can help limit and fight off an infection.

If you have not got a good arterial flow this may contribute to developing wounds because the quality of your skin is altered which can leave it at a higher risk of injury, poor healing and a higher risk of infection if it takes a long time to heal. Reduced arterial flow can be caused by changes taking place in the arteries due to limited physical activity, your diet, conditions such as high blood pressure or diabetes, or activities such as smoking.

For some advice on how to help improve your circulation and reduce the chances of some of the unpleasant complications, please read our Peripheral Arterial Disease leaflet.

If you have problems with your veins

Part of your circulatory system in your lower limb, the venous supply, takes the blood that travelled to your arms, legs and organs through your arterial blood supply, back to the heart. This is the way that the used blood that has delivered the oxygen and nutrients is taken away be cleaned by your kidneys and liver and made ready to pick up oxygen and nutrients to take through the arterial system to ‘feed’ your skin, muscles and other tissues.

Your heart helps pump arterial blood out around your body, but your venous supply relies on muscle contractions and valves in the veins to move blood along and keep it there. If you are not moving around much or your veins have had some changes that prevent the valves working properly, then you can get swollen discoloured ankles and legs where the venous blood is not being removed efficiently. This can also be complicated where some medical conditions like heart failure, kidney disease or poor lymphatic drainage cause fluid to retained in the body and can cause swelling in the legs and feet. This can cause the skin to stretch and breakdown resulting in venous ulcers; these typically appear on the legs but can appear on the feet in some cases. For more information on how to reduce swelling in the lower limb, prevent venous ulcers or help manage them please visit NHS Leg Ulcer information.

If the sensation in your feet has changed (neuropathy)

Nerves in the body conduct messages to give the brain feedback about the position of your body and how it is interacting with the environment. Sensors in the joints and muscles can tell you whether your joint is straight or bent, like if you move your toes or ankle. Sensors in the muscles tell you if they need to work harder or if another set of muscles needs to help control a movement. Pressure on your skin can tell you if you are in contact with a surface like the ground and how stable it is; think of the difference between walking on sand, cobbles or a flat pavement.

The feedback you get from the sensors in your muscles, joints and skin are very important in telling you when something is not right and alerting you that you are at risk of harm from things like falls, burns, cuts or ulcers.

This loss of feedback sensation is called neuropathy. The loss of sensation through your skin is called sensory neuropathy. This can be a normal part of aging but can be accelerated where there is reduced blood circulation, lifestyle choices such as smoking and high alcohol consumption, or medical conditions such as diabetes or lupus, or treatments like chemotherapy.

Ideally it is best to prevent developing neuropathy by avoiding causes where possible and looking after yourself.

If you have been diagnosed with neuropathy, the key measures are to take precautions to prevent harm to yourself such as making sure shoes fit correctly, not walking barefoot and also to check your feet daily so you notice any problems that you may not realise have occurred – remember you are not getting the feedback to warn you if you have an injury.

For more advice on what you can do please read these leaflets:

If you are having problems with the skin on your feet

Skin is the protective outer layer of the body. It is designed to be a barrier to fluids and germs and to protect the body from damage. Where there are changes in the condition of your skin it can affect how well it is able to act as a barrier.

When skin becomes dry it is less able to stretch and can become prone to splitting. Often splits can occur around the heels and where they are deep enough to cause bleeding they can become infected if not cared for properly. Dry skin is easily prevented by applying cream to the dry areas (not around or between toes) daily.

Sometimes skin can get sore or thicken where it rubs against the tops and sides of shoes or because of the way you walk. A good tip is to check the fit and condition of your shoes. The size of your feet can change as they swell during the day or if you wear thicker socks. If the painful area is on the tops of your toes then it is often the shoes rubbing and you may need to get a bigger size. Your feet can also rub on seams or splits, or become painful if the cushioning inside has worn out, so it is worth checking your shoes and thinking about if there is a particular pair that causes problems, which you can then stop using. To help soften the thickened skin and keep it flexible and less painful you can apply cream daily, but this should not be between the toes as this can cause them to become too damp.

If the skin between your toes looks white and soggy (macerated) then it has become too damp. After washing your feet it is a good idea to dry between your toes as this will help prevent this problem and also clean out any trapped sock fluff etc This can be done with a dry flannel if your toes are packed tightly together and helpful aids can be purchased to assist with this if you have trouble bending over. Sometimes in-between the toes can get very damp if you have sweaty feet and wear closed-in, plastic shoes or polyester socks a lot. This can be helped by changing to more natural fibres such as cotton, wool or leather so that moisture is not trapped in as much. A daily application of surgical spirit with a cotton bud can help dry out the area and discourage infection, but also spending some time resting without shoes and socks may help.

If the skin between your toes looks white, soggy and is itching a lot, you may have got a fungal infection. The advice above will still work but you may also find using an anti-fungal spray helpful. Creams are not recommended for between the toes as this can add to the moisture levels and keep allow the problem to re-occur. Fungal infections can occur on other parts of the foot and may appear as patches of dry skin, sometimes with what appears to be dry blisters of skin. This may or may not itch. These can be treated with an anti-fungal preparations that can be purchased from a pharmacy or on prescription. You may need to also treat shoes and wash socks on a high temperature to kill fungal spores which may re-infect your skin and nails

Thickened skin (callus or callous) can sometimes become very sore. This often occurs because there is no rest from the cause of the friction or pressure over the area. Where possible the cause needs to be identified so it can be avoided or addressed such as shoes with more cushioning or better fit of shoe for your foot shape. Sometimes it is because the callus has become thick enough to cause the pressure or is affecting the skin around it causing pain. Regular use of a foot file and application of cream can reduce the thickness of the existing callus and the continued regular application of cream can prevent it getting thick again. Continued use of the foot file should not be as frequent in case this causes callus to form. When checking your feet, dry skin will appear normal when wet but callus will appear more yellow, both will respond well to regular application of cream. If you notice that your skin or callus under your feet appears white and soggy then you may have the beginnings of an ulcer. It will be painful if you have good sensation, but if you have neuropathy (loss of sensation) then you may not notice any pain. If you suspect it is an ulcer (a wound where the skin is broken due to pressure) you should contact a medical professional for help and a referral to the Podiatry Service.

You may find these leaflets helpful:

Basic Footcare Leaflet
First Aid for Feet

Advice about managing your nailcare or hard skin

For advice on basic nail care please read this leaflet <here>

If you have trouble reaching your feet you may find this information useful to share with someone who is able to help you. Long-handled aids can also be purchased to help reach your feet and manage your nails and hard skin.

We suggest that filing your nails can often be safer than cutting them as there is less chance of accidentally cutting skin or going too far down at the sides and possibly causing an in-growing nail. A file does not require as much force as trying to cut nails and can also be used to reduce thick nails if filed across the top.

Performing weekly filing can keep on top of nail growth and give you a chance to check your feet for any breaks in the skin, signs of rubbing or other skin changes, to provide first aid and monitor them on a weekly basis.

Foot checks you can do at home yourself – YouTube