Key message
Foot problems that appear minor can deteriorate rapidly if mechanical stress or infection develops.
Pharmacists are often the first point of contact and play a critical role in early risk identification, protective advice, and timely referral.
Foot problems are a frequent reason for consultation in community pharmacy. Patients often present at an early stage with symptoms that appear minor, such as blisters, cracked skin, dry and hard skin, calluses, localised discomfort, or early signs of fungal infection. However, when management is delayed or inappropriate, seemingly simple issues can progress to infection, ulceration, or prolonged disability.
Pharmacists are therefore well positioned to support early recognition, provide safe and practical advice, and ensure timely referral, helping to prevent avoidable complications.
Why early foot problems should not be ignored
The skin of the foot is exposed to repeated pressure, friction, and moisture, making it particularly vulnerable to breakdown. In addition, peripheral circulation in the lower extremities may be less efficient, which can compromise tissue perfusion and slow healing. Even small lesions can deteriorate if mechanical stress persists or if infection develops 1.
In some populations, such as the elderly or people with peripheral neuropathy, pain may be reduced or absent, leading to delayed presentation and underestimation of severity 2, 3. Age-related changes in skin, circulation, and vision can make deterioration harder to detect, while reduced mobility and difficulty reaching the feet may limit routine self-examination, particularly in older adults. Furthermore, foot health is frequently deprioritised by patients, despite the feet often providing early signs of broader health issues 2, 4-6.
Foot problems commonly seen early in pharmacy:
In daily practice, pharmacists commonly encounter patients presenting with:
- Dry skin and fissures, particularly on the heels
- Blisters, corns and friction lesions related to footwear
- Calluses and localised pressure points
- Nail problems, including thickened or ingrown nails
- Fungal infections of the skin and nails
- Foot pain associated with load, footwear, or prolonged standing
These conditions often present before medical consultation, positioning pharmacists as an important first point of contact for early advice and risk identification.
What “early care” means in pharmacy practice
From a pharmacy perspective, early care involves three key steps.
Identify risk:
Pharmacists should be alert to broken skin, redness, swelling, discharge, colour changes, recurrent lesions, or delayed healing. Poor footwear, prolonged standing, and difficulty with self-care further increase risk 3, 4, 6.
Protect and support:
Early advice should focus on improving skin integrity and protecting from mechanical stress. This includes optimizing footwear, reducing friction and pressure, and addressing dry and hyperkeratotic skin through appropriate management, maintaining skin hydration with suitable emollients, and encouraging regular monitoring.
Know when to refer:
Any deterioration, lack of improvement, or signs of infection should prompt a low threshold for referral. Early referral is an integral part of early care, not a failure of self-management.
Role of cushioning and orthotic insoles in early care
In pharmacy practice, these measures can be considered as preventive support, but they do not replace medical assessment when red flags are present.
Red flags requiring prompt referral:
- Open wounds or non-healing skin breaks
- Increasing redness, warmth, swelling, hot spots, or discharge
- Blackened or discoloured skin
- Severe or worsening pain
- Sudden deformity or inability to bear weight
- Systemic symptoms, such as fever
In conclusion, as a first point of contact, pharmacists have a unique opportunity to act early and help prevent avoidable foot complications!
