The pharmacy has become the first line in the treatment of common foot problems
Over the years, the community pharmacy has become the go-to option for patients seeking advice and treatment for their foot problems. The community pharmacy has become the best-placed and most cost-effective option for foot health in primary care, and the article below focuses on two of the most common foot problems: Fungal nail infections, and athlete’s foot (Tinea pedis).
Athlete’s foot
Tinea pedis belongs to a family of ringworms that invade different areas of the skin, in this case, the feet. As always, prevention is better than cure, so patients can be advised on some steps they can take to avoid athlete’s foot and to prevent it spreading to others. Feet should be washed daily in warm, soapy water and dried thoroughly, especially between the toes. If a patient is prone to athlete’s foot, they should be recommended a medicated powder. Socks should be changed once a day and patients should alternate the shoes they wear and feet should be protected in public places, with the added benefit of preventing the spread of the infection.
Patients with diabetes require special attention and should be advised to seek medical attention immediately if the foot is hot, red and painful, as this may indicate a more serious infection. Patients with a weakened immune system can also be susceptible to more serious infections, and all patients should also be advised to see their GP if they do not respond to treatment.
Early treatment is key to dealing with athlete’s foot, and it is unlikely that the condition will resolve on its own. The HSE advises people with athlete’s foot to consult their pharmacist as a first-line option for advice and treatment.
If standard treatments do not work, patients need to be referred to their GP, as they may need a prescription-strength cream or ointment to resolve a stubborn infection. More serious infections may require a combination of topical and oral treatments, which should be combined with the self-care measures outlined above.
When trying to establish if the infection is indeed athlete’s foot, it is often useful to ask if the patient regularly visits swimming pools or gyms, or if any other family member has the same symptoms.
Nail infections
Fungal nail infections sometimes arise due to athlete’s foot. To avoid this, patients should be advised to keep the feet clean and dry and to change their socks every day. Old shoes should be discarded and sandals should be worn at the pool or in the gym. Nail-clippers or scissors should not be shared with other people, and it is also best to use personal towels and avoid footwear that makes the feet hot and sweaty.
If athlete’s foot is not treated quickly and effectively, it can result in a fungal nail infection. This usually affects the toenails, but can also affect the fingernails. This type of infection can make the nails brittle and painful, with thickening, and the nails can turn yellow.
The infection sometimes starts at the edge of the nail and spreads to the middle of the nail and when it becomes yellow, the nail can often be lifted off the toe. Nails with a fungal infection can also crack and fragment and the tissue around the nail becomes swollen and painful.
Treatment
The HSE recommends that people consult their pharmacist for advice and treatment in the form of antifungal creams, powders or sprays. These can include antifungal nail medications or nail-softening cream, and sometimes oral antifungal medication is required to deal with a persistent infection. Newer treatments have the added benefit of a once-off application, although these products are restricted to patients aged over 18 years.
Even with an effective antifungal treatment, it can take one-to-two weeks for any improvement to be seen with a fungal infection. Fungal nail infections can take longer to respond, sometimes 12 weeks or more, while an antifungal gel, cream or spray usually start to work within seven days. Oral prescription antifungals can take from two weeks to several months to show benefits. Patients taking the oral medication should be advised not to give blood for at least seven days after finishing their course.
If patients with diabetes have a fungal nail infection, they should be referred to their GP for further investigations. A foot injury can also make a fungal infection more likely.
