Footcare and footwear

It is important to look after your feet.

Having an autoimmune condition can put you more at risk of developing problems in your feet. Getting into a good footcare routine can help reduce this risk and allow you to spot problems early on.

It gives you the opportunity to get to know your feet and spot any changes or wounds that could cause problems.

Wearing the right footwear also helps you look after your feet and can reduce the strain on other joints in your ankles, knees, hips and back.

As part of a good footcare habit you should:

• Wash your feet in warm water every day, using a mild soap, sponge, and nail brush.
• Gently pat your feet dry, especially between your toes. Avoid rubbing as it can make your feet sore.
• Dab surgical spirit on areas that are difficult to dry, particularly on the soles of your feet and between your toes – unless the skin is broken or sore.
• Treat any dry patches with an emollient, such as olive oil or lanolin, avoiding the area between your toes.
• Reduce patches of hard skin, calluses, or corns, using a foot file or pumice – never use a blade.
• Cut your toenails in line with the natural shape of your toe, every six to eight weeks. Do not cut down the sides of the nail, instead remove sharp edges with a nail file.
• Inspect each foot for sores, cuts, or blisters.
• Check for any areas that are warm, red, or swollen - this could be a sign of inflammation or infection.
• Wear clean socks, made of cotton or wool, each day.
• Exercise regularly, as it can improve the circulation in your feet and strengthen the soft tissue supporting your joints.

If you have trouble looking after your feet, ask a family member for assistance or ask your doctor how to get help from an NHS footcare specialist.

First aid for your feet

If you have arthritis it’s important to protect your feet and take care of any wound or pain before it becomes difficult to manage.

Padded dressings can protect areas that are painful, swollen or where the skin is broken.

You should pay particular attention to:

• sores
• calluses
• corns
• inflammation
• signs of infection.

Some people find wounds take a long time to heal, particularly if they are being treated for an autoimmune or inflammatory condition such as rheumatoid arthritis or psoriatic arthritis. This is because their condition and treatment can affect their immune system, increasing the risk of infection and reducing their ability to heal.

If your skin has trouble healing and you develop a new sore on your foot, cover the wound and take advice from a healthcare professional as soon as possible.

You should avoid using over-the-counter antiseptic or medicated treatments, such as corn plasters or anti-fungal creams, without talking to a healthcare professional.

Fungal infections, such as athlete’s foot, should improve if you thoroughly wash and dry the affected area.

Most healthcare professionals are trained to recognise common foot problems.

However, you may need to see your doctor before your problem can be treated, particularly if you have arthritis.

Your risk of developing infections and painful long-term problems in your feet can be increased if you have:

• inflammatory arthritis
• vasculitis
• systemic sclerosis or scleroderma
• lupus
• Raynaud’s phenomenon
• a condition that makes your skin heal slowly
• ongoing treatment with steroids
• treatment with biologics.

If you’re in any of these groups tell your doctor or rheumatology team about any changes to your feet as soon as possible.

Your doctor may recommend you see a podiatrist for specialist treatment. You may need to see a podiatrist once a year.

Podiatrists used to be known as chiropodists. They are qualified foot experts who can treat problems such as ingrown toenails, wounds, corns, or calluses.

They can also advise you on:

• padding or dressings
• specialist insoles, splints and supports
• footwear
• exercise
• medication.

A podiatrist can treat problems caused by the way the foot and ankle work, which could affect other weight bearing joints.

They can recommend orthotics, such as splints or insoles, which are designed to support and correct the position of your foot or ankle, reducing the risk of further damage to your joints.

Depending on the condition you have and where you live, you might be referred to an NHS podiatrist.

You can find a private podiatrist by visiting:

• the Institute of Chiropodists and Podiatrists website or calling 01704 546141
• the College of Podiatry website.

You can buy insoles and padding that offer generalised relief and some support, from a supermarket or pharmacy.

However, for specific long-term problems you are best to see your doctor or a podiatrist. They may recommend prescription orthotics, such as insoles, inserts, or specially made shoes.

Prescription orthotics are designed to relieve pain and help correct structural changes in the foot.

If you need orthotics that are moulded or made specifically for your foot shape and problem your doctor or podiatrist may refer you to a specialist, known as an orthotist or orthopaedic shoemaker.

Each NHS trust has its own rules about which conditions qualify for free orthotics. If you cannot get a referral to this NHS service, you may need to pay to visit one privately.

Insoles and inserts, such as heel pads, can increase your shoe size, ask your orthotist or podiatrist for advice before they are fitted.

All orthotists, physiotherapists, and podiatrists must be registered with the Health and Care Professions Council (HCPC). You should check a practitioner’s credentials by visiting the Health and Care Professions Council website.

Your feet are weight-bearing joints and it’s important to look after them.

Wearing good, supportive, properly fitting footwear is an essential part of caring for your feet. It can improve your balance and posture, as well as reducing the strain on other key joints.

Your doctor or foot specialist should be able to advise you on the best type and shape of footwear for your needs.

Buying footwear

Your feet can change shape at any time throughout your life. It’s worth getting them measured each time you shop for new footwear.

It can help to have your feet measured while you are standing, as some people’s feet change shape when they are bearing weight.

Your foot shape can change throughout the day. You may be better trying on new shoes after you have been on your feet for some time.

Don’t forget to try new footwear on with any orthotics you use.

Finding the right footwear can take time and effort and you may need to visit different shops and look at a variety of brands, before you find the right fit and shape for your feet.

If you’re not sure which type of footwear would best suit your needs ask a healthcare professional, such as your doctor or a podiatrist, for advice.

Choosing the right footwear

Support, comfort, and protection should be your priorities when choosing new footwear.

Support

Your footwear needs to support the whole of your foot.

Good footwear should:

• not press or dig into any part of your foot
• gently hold your foot in a secure position
• be firm but comfortable around the heel
• have a 1 cm gap between the end of your longest toe and front of the shoe
• have a round front, deep enough for your toes to move
• have a broad heel, no higher than 3 cm on average
• have a thick, lightweight rubber or non-slip sole.

These specifications may differ slightly depending on your condition. If you are unsure speak to a foot specialist before you buy new footwear.

Fastenings

The shape of your feet can alter throughout the day because of changes in temperature, pressure, and arthritis. Footwear with an adjustable fastening can allow for these changes without reducing the support it offers.

If you have trouble tying and adjusting traditional shoelaces you could replace them with elasticated ones which should adjust with your feet and won’t need untying. Velcro and zip fastenings can be done up with one hand and should be less fiddly than buckles.

Comfort

Do not buy footwear thinking it will become comfortable over time. You should choose footwear that fits comfortably from the start. It should be deep and wide enough for your foot and any insoles or supports you use.

Shoes and boots that are too loose, pinch, rub, or put pressure on one part of the foot can increase the risk of structural changes, for instance bunions or hammer toes.

A cushioned sole, such as the type used in running shoes should reduce pressure on the bottom of your foot. Some shoes have soles designed for specific foot shapes, such as low arches.

Seams or ridges in the lining of a shoe can rub and make problems such as hammer toes, corns, or swollen joints more painful. Try to find footwear with a smooth lining.

Protection

Your footwear needs to protect your feet from getting damp, cold, or hot and sweaty, so a breathable material on the top of the shoe is important.

Shoes with a leather upper and lining are traditionally considered a good choice but there are various man-made materials designed to be breathable and water-resistant.

Your footwear needs to be:

• flexible so you can move your foot
• sturdy enough to support your foot structure and protect it from any knocks
• breathable so it allows air to circulate around the foot.

If you are having trouble finding the right footwear, look for recommendations or talk to your doctor or podiatrist.

Some high street footwear can be adapted by an orthotist to meet your needs.

Safety footwear

All safety shoes or boots should have a British Kitemark or CE mark to prove they are fit for purpose.

If your current safety footwear does not fit properly or makes your pain worse, you should ask about changing them for ones with greater depth and cushioning.

Indoor and outdoor shoes

If you have prescribed orthotics, make sure you transfer them to any shoes you change into.

Slippers with soft uppers can be more comfortable than shoes on painful feet. However, if you have been prescribed insoles or inserts you should limit the amount of time you wear slippers.