Monday, January 7, 2013

Caring for the lymphedema foot

Caring for the lymphedema foot

January 2013

Most people who have leg lymphedema also will have foot involvment. Thus, taking care of our feet becomes even more critical for lymphedema patients.
Feet that have damaged skin, cuts, scrapes or any open areas become entry foci for bacterial infections associated with lymphedema infections. Feet with unhealthy skin can become an open door for foot fungal infections. Both can cause further complications and worsening of our lymphedema.
Keith Smiley
The National Lymphedema Network (NLN) has been flooded with questions regarding foot and ankle care for patients with lower extremity lymphedema. Dr. Joseph Hewitson, a San Francisco Podiatrist, who has worked with many lymphedema patients, provided NLN a list of guidelines and suggestions for proper foot care for people suffering from lower extremity lymphedema. These guidlelines are excerpted from The July NLN newsletter.
Wear shoes.  
I love going barefoot, but with lymphedema, this can be downright dangerous and can give bacteria a splendid opening for an infection.  Resist that temptation to go barefoot.
Make sure you don't provide an opportunity in your shoes for bacteria or fungus spores to hide and grow.  I personally use an antifungal powder in even my street shoes.
Nail Care

Be sure to trim your toenails, but not necessarily straight across. If the corners have grown into the skin, trim the offending border.
If you get an infection, you should remove that side of the nail to resolve the infection. Antibiotics often will not work because an abscess (walled off infection) has occurred. Soaking may only provide temporary relief.
A lymphedema patient should never undergo a chemical matrisectomy (destroying root growth matrix with a chemical to permanently remove nail).
Fungal nails are common in lymphedema patients and should be soaked in 1:1 vinegar/water solution for 20 minutes, with antifungal solution applied afterwards.
Routine foot care every three months with a podiatrist if possible or your physician.
Meticulous nail care decreases the chance for inflammation and infection.
Taking Care of your Toes
The inner spaces between your toes need to be kept clean and dry.
Soaking in a 1:1 vinegar/water solution for 20 minutes at least once a week and running a piece of gauze between your toes to remove any debris will help keep your web spaces clean.
Using a drying agent/antifungal solution like Castelani's Paint decrease chances of irritation and infection.
Applying lambs wool (see your pharmacist) between the toes allows the web greater breathability.
Open toed compression garments will also allow greater breathability, as will breathable footwear that is fitted correctly.
Dr. Hewitson says that proper footwear is very important. He says always buy your shoes at the time of day when your foot is most swollen (usually the end of the day). If you wear a compression garment, make sure you fit your shoes to accommodate this. Good athletic shoes are excellent to wear because they are more supportive, and more breathable. For very large feet, a Velcro strap shoe is usually more accommodating.
If you have painful corns and calluses, they should be routinely trimmed by a podiatrist or practitioner. Never use any callous removal pads, because they can cause burns and infections.
Dr. Hewitson also says to always work with reputable practitioners who are willing to further educate themselves on lymphedema. He adds, you may be their best and only teacher.
Simple measures which will promote healthy skin:
1. Inspect the skin daily for any crack, cuts or dry areas. Check carefully areas with reduced sensation or where there are skin folds.
2. Clean skin daily with non-perfumed soap
3. Dry skin completely, especially the area between the toes
4. Keep skin supple. Use a Iow pH lotion as Eucerin to keep the skin moist and pliable.
5. Check fingernails and toenails for any signs of infection, cracks, fungus, or hangnails. Do not cut nails or cuticles. Use an emery board.
6. Call your doctor at the first signs of any infection, redness or high temperature.
For Further Information on the skin, skin care, foot care, possible complications and infections, please see the below listed pages:
Wrapping Lymphedema Toes - illustrated

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