This summer recess I am trying to visit all the sheltered housing and homes for the elderly in my Hornsey & Wood Green constituency. It looks like the visits will spill over into the autumn, but the reason for making such a concentrated set of visits is that I want to reach out to people who often find it hard to come and see me in person to raise their concerns – and to hear at first hand what the issues are that matter the most in their day-to-day lives.

One issue coming up time and time again is foot care. It’s an issue that barely gets a mention in my normal post bag or in the media (even though NHS stories are not exactly rare) – but when getting out and talking to people, it’s clear there’s a massive issue here for so many people.

At heart is the stupidity of the NHS spending zillions on new knees and hips, or straightening out arthritic toes – but not similarly providing foot care for older people. Hard skin on your feet may not sound too bad if you haven’t suffered it, but my goodness if you or someone you know has – you’ll know how it can be just as immobilising as knee or hop or arthritic toe problems. But when it comes to hard skin – if you’ve not got the money to go private, you’re usually stuck.

After mentioning the issue on a radio program, I got an email from an expert who was listening. She said:

“I heard you briefly on the radio this lunchtime. Don’t know what the programme was – my husband was listening to music as we drove across town and I tuned in to the talky bit. What I did hear and wanted to applaud loudly was your bit about foot care for the elderly.

“I’m a physiotherapist, have worked in palliative care since 1991 … Many elderly people cannot reach down to their feet, cannot cut their own toenails (and carers and District Nurses, if they are lucky enough to have one, aren’t allowed to) apply cream or dry between their toes, so in growing toe nails and fungal infections are a huge problem. This often leads to a nasty skin infection called cellulitis, which causes further damage to the lymphatic system as well as making the sufferer systemically unwell. Foot washing, when you can’t get in and out of a bath, becomes a major operation and if you have been fastidiously clean all your life, as most people have, if you choose to seek help, you have to suffer the shame and indignity of revealing to a healthcare professional that this part of your personal hygiene has become too much for you. I suspect that a lot of people choose not to and suffer in silence.

“In our area the waiting lists for podiatry are huge and for many the effort of getting to an outpatient clinic is prohibitive. Taxi drivers have been instructed not to help to lift legs into vehicles in case they catch the skin and litigation ensues! So if there is no friendly relative available to provide transport, folk, who can’t manage to lift their heavy, swollen legs in and out of cars, become prisoners in their own homes.

“Feet become increasingly swollen (due to immobility), itchy (due to dry stretched and cracking/flaking skin), painful (‘bursting feeling’ and pressure from footwear), shoes become unwearable or dangerously boat-like – causing damage to the feet or leading to falls, and legs are heavy (try walking about with a litre bottle of water strapped to your lower leg – and many of our patients are carrying up to 6 litres of extra fluid in each leg!!!, causing muscle fatigue, joint strain and imbalance).

“So much of the above could be avoided by care and attention at an early stage, by the education of carers in sheltered accommodation about the need to look after the largest organ of the body -the skin, and encouragement and help with basic foot care and mobility issues for our elderly citizens, many of whom live alone and struggle on.”

I rest my case!

(c) Lynne Featherstone, 2008