Taking Care of Your Lower Limbs: Precautionary measures for lymphatic patients

Taking care of your lower limbs

Precautionary measures for lymphatic patients

Putting your best foot forward

By Gurdish Sandhu

Many people are unaware of how hard their feet work for them until their independence is compromised. Each foot contains: 26 bones, 33 joints, and more than 100 muscles, tendons, ligaments, and nerves. Edema, neuropathy, infections, and circulatory disorders, like venous stasis and arteriosclerosis, are just some of the many ways in which the health of your feet and lower extremities could be compromised. Taking some time to care for your feet will maintain them and work to prevent long term injury so you can put ‘your best foot forward.’ Patients with lymphedema, diabetes, and peripheral and cardiovascular disorders should take extra precaution for optimal health and healing.

Basic care

Skin is the first line of defense against trauma, infections, and temperature fluctuation.1 Therefore, the best way to care for your feet is to inspect them daily for cracks, cuts, dry patches, hangnails, and fissures. It is important to note that patients should make an effort to keep the skin between their toes dry after daily baths or showers, with mild soap and water, and to check underneath their feet with a mirror for any injuries. If additional aid is needed, patients can seek help from their families to do their daily checks. Basic care entails the following:

1 Soak feet once a week in an acetic acid (eg. apple cider vinegar) and water solution. A dilution of at least 1:5 is

Gurdish Sandhu ORLPN, FCN is a perioperative nurse at St. Paul’s Hospital, and False Creek Surgical Center with over 22 years of experience working with Providence Health Care. Gurdish is also a Canadian Foot Care Nurse and owner of Vancouver Medical Footcare.

recommended, with the water at room temperature. People with neuropathy should test the water with a thermometer. Soaking should be no longer than five minutes. If soaking the feet cannot be tolerated for any reason, spray feet instead using a spray bottle and wait for five minutes before wiping dry.

2 Feet should be thoroughly dried afterward, especially between the toes. A clean dry washcloth is useful for this purpose. People with papillomatosis of the feet should ensure that all the cracks and crevices are dried. A hair dryer on low setting may be needed.

3 Moisturize feet with low pH emollients to keep feet supple. Do not put any emollients between toes as warm, dark, and moist environments encourage bacterial and fungal growth. Be sure to wipe away any excess emollients left on the feet.

4 Cut toenails across, following the contour of the nail, and filing the corners to prevent ingrown nails.2 To sanitize, boil

the clippers for at least one minute and allow them to dry for one hour before reuse, to prevent cross-contamination between family members or possible reinfection of oneself. Hydrogen peroxide (6%) is also a high level disinfectant that is quite economical to use.3

5 Once feet are cleaned, dry and moisturized, wear clean breathable socks or prescribed compression garments. It is imperative to change socks and garments daily. Avoid socks and garments with holes, repairs, or darnings; these can cause pressure zones on your foot that lead to dermal breakdown. Ensure the seams are not rough or irritating, and check both garments and socks and shoes for foreign objects before wearing.4 Thick socks of natural fiber are recommended to help absorb pressure and wick away moisture.5

6 See your doctor if you suspect a fungal infection or notice redness, blisters, itchy dry skin, or peeling. Early detection means early treatment.

Garments and the importance of shoe fittings

Swelling is a common symptom for patients dealing with lymphedema. To ease the discomfort of swelling, the easiest remedy is to elevate the patient’s feet. Sitting or standing for extended periods of time also intensifies swelling in lower extremities; therefore, the best course of action is to promote circulation by walking or moving around. If walking is restricted, circulation can be improved by doing one of the following actions: plantar and dorsiflexing,6 or curling and uncurling your toes; stretching; and/ or rolling a foam ball under feet. Avoid wearing tight fitting garments unless prescribed, measured, and fitted by a professional to ensure a proper fit and prevent nerve damage. Unless otherwise recommended by a practitioner, patients

should opt for open toed versions to allow for greater breathability when purchasing compression stockings.7 Bandaging and support garments should be reassessed routinely as sizing adjustments maximize effectiveness and decrease the potential for injury.

Avoid socks and garments with holes, repairs, or darnings.

Determining a proper fit for shoes can be broken down into four aspects: support, warmth, breathability, and good soles. Shoes should be purchased in the evening while patients are wearing their prescribed compression garment. Purchasing shoes in the evening ensures a proper fit as feet often swell to their maximum by this time of day. Shoes should not pinch or feel tight. Patients should have shoes measured by a professional pedorthist each time they buy. These professionals can assist with shoe selection according to need and minimize pain associated with deformities, age related changes, and joint

LYMPHEDEMA

WOUND CARE

Lotions are primarily water based and as such are often drying to the skin. Emollients are preferred. They should be non-scented and free of sensitizing agents. They will contain some oil based components which are necessary to preserve the barrier function of the skin. They will not clog pores if applied correctly, very thinly.

inflammation. The insoles can be custommade for proper arch support and ultimate comfort. Patients with orthotic insoles should bring them to shoe fittings. Having corns, calluses, and gryphotic (thickened) nails reduced will help with comfort and fitting. However, the consistent use of adhesive tapes and medicated corn pads should be avoided as they can cause chemical burns in compromised individuals, especially those with neuropathy. While trying shoes on, patients should size the shoes for the larger foot by standing up to ensure that there is roughly ½ an inch between their big toe and the end of the shoe and that the heel is snug but not tight.8 Wearing shoes with a proper fit with breathability will allow for good air circulation and prevent calluses caused by repeated rubbing and friction.

Caring for footwear is an important part of maintaining optimal foot health. To disinfect, patients should spray footwear with Lysol once a week. If the shoes get wet, insoles should be pulled out and the rest of the shoe should be stuffed with either paper towels or newspapers to help absorb moisture. Furthermore, alternating footwear allows for complete drying and ventilation between uses.

Nutrition

Maintaining the overall well-being of a patient through a diet full of nutrition also improves the health of lower extremities. Enriching the health of an individual starts with a balanced diet and a good multivitamin. Most often, attaining a nutrient-loaded, well balanced diet means increasing the intake of a colourful variety of fruits and vegetables. Patients suffering from swelling would do well to incorporate anti-inflammatory foods such as: tomatoes, lemons, ginger, olive oil, leafy green

vegetables like spinach and collards, nuts, fatty fishes, broccoli, celery, and fruits like strawberries, blueberries, cherries, oranges, and pineapples. Anti-inflammatory foods assist in maintaining good circulation by preventing the engorgement of vessels.

A diet that lacks proper iron nutrient leads to anemia, which in turn can cause numbness, tingling, nerve pain and separation of the nail plate from its bed in patients’ feet. If the patient is a diabetic, good control of blood sugar levels will decrease the onset of neuropathy. Neuropathy, lymphedema, peripheral vascular and cardio vascular issues all decrease the patient’s ability to feel hot temperatures.9 Therefore it is not recommended that patients suffering from these illnesses use heating pads, hot water bottles, and chemical thermal warmers because they may not feel when blisters and burns occur.10

If patients smoke or drink alcohol, the limitation or removal of these substances from their lifestyle would greatly improve overall well-being. Smoking contributes to the gradual occlusion of arteries over time from plaque buildup, called arteriosclerosis, which leads to vascular constriction and poor circulation. Alcohol can cause dehydration, which leads to dry skin and a reduced ability to heal.

Exercise combined with good nutrition is essential in maintaining good health in patients. Exercise will help to keep weight in check, as well as increase the uptake and absorption of a nutrient-loaded diet. The best kind of exercise, to keep muscles and tendons of lower extremities healthy, is regular lowimpact exercises such as walking, stretching, swimming, and bicycling.11

Help and assessment

Mild injuries can lead to dangerous infections.

and symptoms of infection including, but not limited to, redness, warmth, swellings, and/ or pain. It is imperative that patients see their doctors if they suspect an infection or notice an injury that does not heal within a couple of days. Other symptoms to report to a health care practitioner are burning and tingling sensations, blisters, calluses, foot pain at night, and cramping in lower limbs. A physician will look into a patient’s medical history and lifestyle, review medications, and provide a physical exam. This physical exam will assess severity of pain, pedal pulses, nerve sensitivity, and level of edema present. With proper assessment, doctors can recommend tests, and provide patients with suggestions for a treatment plan tailored to a patient’s specific needs.

In conclusion

With aging and health related issues, proper care of lower extremities is essential as good quality care of feet decreases the risk of developing complications which can lead to disability, ulcers, amputation, chronic pain, and even death. Patients should seek out professional treatment from podiatrists or local foot care nurses if vision or mobility hinders them from routine basic care procedures. All individuals should remember to visit their family doctor routinely, as they effectively manage your overall care and coordinate your health care team. Good communication between you and your health care practitioners will help optimize the best care possible to take care of your lower limbs. LP

A full set of references can be found at www.lymphedemapathways.ca