Barts-MS rose-tinted-odometer: ★★★ (Toenail yellow on a gloomy Monday morning #92825A)
As a result of my fractured pelvis, I have a very painful right hip with reduced movement; I have particular difficulty bending my hip and rotating my leg outwards at the same time. As a result of this, it has been very difficult to cut my own toenails. The good news is that seven months after my accident I can now manage to get my right leg into position so that I can cut my toenails with relative ease, albeit painfully. Another small win on my way back to a new normal. This small victory is something many of my patients will never be able to experience due to the progressive nature of MS.
In patients who I think are vulnerable, I always try to take the time to examine their exposed feet. Unfortunately, because of COVID-19-induced NHS service changes, this is very difficult to use telemedicine.
Poor foot hygiene and uncut toenails are in my experience an integrator of neglect. As the feet are generally hidden from view, people with MS who are neglecting themselves, or are being neglected, tend to neglect their foot hygiene more than other aspects of their grooming. Their poor foot hygiene is not intentional, but simply represents the reality of living with a disability. Poor eyesight, double vision, oscillopsia, weakness, tremor, loss of feeling in the hands, slow movement, incoordination, obesity, etc. are all more common in pwMS and make cutting your own toenails difficult.
If you are being cared for sometimes the family member or carer doesn’t take this and leave it up to the podiatry service. During the COVID-19 lockdown nail bars and podiatrists have been closed. Therefore I have little doubt that foot hygiene has deteriorated in many people with advanced MS.
So if you are a carer or a family member of someone with more advanced MS can I suggest you ask your family member if they need some assistance with their foot hygiene. Even better ask them if you can examine their feet. You may be in for a surprise.
I am convinced poor foot hygiene, similar to poor oral hygiene, is a social determinant of health. People with MS who have bad teeth, poor gum health and poor foot hygiene are more likely to have poorer outcomes. These should be red flags for putting pwMS on the ‘at risk’ register of closer medical and social interventions. Do you agree?
So if your family member or client with MS can’t manage to look after their own feet please get them down to the local nail bar or podiatrist for a pedicure.
General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.
