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Foot Care Q&A: Part 1

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

Some people who have poor vision or are obese can’t see their feet. In these cases I recommend that their caregiver (if they have one) perform the daily inspection, or I recommend they use a large mirror with handles. I also discuss the big three risk factors for amputations, which are neuropathy [nerve damage], peripheral arterial disease (PAD), and deformity [foot conditions such as bunions and hammertoes].

Dr. Beauchamp: Early on, most doctors test to see whether a person has feeling in his feet. They use a monofilament, which is like a piece of fishing line, to do this test. I also test for the ability to sense vibration. This has been shown to detect diabetic peripheral neuropathy earlier than the monofilament test. This helps me detect neuropathy and prevent related problems before it gets dangerous.

Dennis Janisse: For my patients who can walk, I recommend wearing a pedometer and getting 10,000 steps in a day.

2. What do you recommend for dry, cracked skin?

Dr. Scheffler: I first recommend using anything you have in the house. Most people have some kind of lotion or cream. If you are a man and live with a woman, she’s got some. Use hers. Then if what you are using doesn’t work, remember the purpose of these products: They hold moisture in. Put the product on after you have washed your feet, but don’t dry them completely before applying your lotion or cream. Do dry between your toes, and don’t apply your lotion or cream there. I usually prescribe Lactinol-E [a moisturizer containing lactic acid and vitamin E], or other, over-the-counter products with urea. You can gently use a pumice stone. Be careful not to rub hard or too long, and choose a pumice stone, not a metal [rasp or shaver]. Save metal for the Gouda cheese.

Dr. Smukler: It depends on how cracked the skin is. Usually a product with 12% ammonium lactate is where I start. The lotion is weaker than the cream. If that doesn’t work, I recommend a product with 40% to 50% urea.

Dr. Wu: Personally I like lactic acid 10% cream. Lactinol is an example. If a patient can’t afford to buy that, I recommend Eucerin cream. The cheaper lotions and creams smell and feel nice, but the majority of the content is water, which doesn’t do anything, and before long, it’s gone. I believe the key is to wear socks to bed after applying your cream of choice to facilitate better cream absorption. And, yes, you never want to put lotion or cream between your toes.

Dr. Beauchamp: I like to use an ammonium lactate type of lotion such as Lac-Hydrin or AmLactin. A 12% solution works well.

Dennis Janisse: I don’t recommend anything with alcohol in it. Alcohol is drying.

3. What can I do for my dry, discolored toenails?

Dr. Scheffler: First, find out why. Is it a fungus? I would ask your podiatrist to take a clipping and have it tested. Many times, I’m fooled. If it is a fungus, there is a topical product called Formula 3, and there’s laser treatment. Oral antifungal medicines can affect your liver. Some people try Vicks VapoRub. That will make the nails softer and easier to cut, but it doesn’t get to the nail bed to cure the problem. People with diabetes should not be self-treating.

Dr. Wu: Go see a foot doctor. Toenails can become thick and discolored from fungal infections, yeast infections, inadequate nutrition, poor health, genetics, other conditions such as psoriasis, or even poorly fitted shoes. While there are numerous home remedies and nail formulations available on the market that can help hide and mask the discolored nail, it’s best to determine and treat the underlying cause of the condition. 

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