Understanding what to expect and how to best manage the side effects of chemotherapy can be an important asset in staying positive during cancer treatment. One area of the body that people don't often consider with respect to chemotherapy and its impacts is their feet. However, there are some real concerns that can be addressed with the right help. For this reason, the American Cancer Society specifically recommends that cancer patients seek the assistance of a chiropodist/podiatrist, ideally, before beginning a course of chemotherapy.
Chemical Induced Peripheral Neuropathy
Chemotherapy can result in a condition affecting extremities including the feet called chemical induced peripheral neuropathy (CIPN). There are many types of neuropathy caused by things like diabetes, alcoholism, and some types of medications to name a few. What all neuropathies have in common – including CIPN – is that they typically result in pain or tingling, a loss of sensation, and muscle weakness.
The loss of sensation caused by CIPN is particularly troubling in that people undergoing cancer treatment already suffer from a weakened immune system caused by the chemo drugs and often from radiation therapy. If a person is unable to feel a cut, blister, abrasion, or the temperature of a bath that's too hot, there is a serious risk of a dangerous infection developing. This risk is dramatically increased if the cancer patient also suffers from conditions such as diabetes or circulatory impairments, since these problems further affect the immune system and the body's ability to heal.
Some Ways Your Chiropodist Can Help
It's important for your chiropodist to treat ingrown nails before beginning chemotherapy to eliminate the serious risk from infection posed by the intruding nail. Nails can become brittle, and growth can be interrupted with chemotherapy treatment An impaired ability to heal and fight infection along with slow/lack of nail growth makes treating an ingrown nail very difficult during cancer treatment. Eliminating problems before treatment begins combined with preventative care during cancer treatment are essential.
Fungal & Viral Infections
A weakened immune system caused by chemotherapy will leave patients more prone to fungal infections of the nails and skin as well as viral infections such as plantar warts. Your chiropodist can begin treatment for these problems if present before chemotherapy begins and can help prevent them afterward through preventative education and ongoing care.
Corns and calluses are a sign of friction. The friction can be caused from a variety of things from improper footwear to structural foot problems. If not managed, the corns, calluses and the underlying friction can lead to skin breakdown and a serious wound on the foot called an ulcer. Reduced sensation caused by CIPN may cause a developing ulcer to go unnoticed until it is too late. An ulcer is an open invitation to serious bacterial, fungal, and viral invaders, and the body's reduced healing ability during cancer treatment makes them difficult to heal. Dry skin is also a common problem during chemotherapy, one that your chiropodist can treat and help prevent.
Custom orthotics and off-the-shelf arch supports
If you experience foot pain, plantar fasciitis, corns/calluses on the feet, it is recommended that you see your chiropodist to address the biomechanical abnormality that is leading to the pain or pressure spots. Custom orthotics may be necessary for more serious problems. If the pain and biomechanical abnormalities are not too severe, high-quality off-the-shelf insoles can be used. CIPN can exacerbate pre-existing foot pain beyond a person's ability to tolerate the condition. It is important to deal with any foot pain to ensure that the cancer therapy does not make it worse.
Swelling of the lower extremities is another potential side effect of chemotherapy. Your chiropodist can help address this in a number of ways, including through prescription compression therapy such as compression stockings.
Many patients are unable to find suitable footwear to accommodate their swelling during chemotherapy due to lack of knowledge of how to buy a proper shoe, or where to buy anything suitable. Depending on the extent of swelling and the requirements of the shoe, the chiropodist can give constructive advice or even order something appropriate.
Footwear must fit properly and provide adequate support and protection from injury. It is recommended that you wear protective foot gear even around the house. You should always have closed toes, and sandals are not recommended as foreign objects between the sandal and the foot can cause damage to the skin – damage that you may not feel due to lost sensation caused by CIPN.
Poor posture or existing biomechanical conditions may worsen swelling often associated with cancer treatment. Proper foot control (such as through orthotics, muscle strengthening, and stretching) can help. It is easier that start this program before patients are too advanced in chemotherapy and have little energy. Reduced strength in the hands caused by CIPN can also make even basic self foot care difficult.
Education and ongoing care
Your chiropodist will be able to help with all aspects of preventative foot health during your cancer treatment. This includes education and prevention at home. For example, due to the loss of sensation caused by CIPN, he or she will want to ensure that you protect your feet from extreme cold by dressing appropriately for winter as well as from extreme hot such as in a bathtub. Falls prevention is another important facet of CIPN, again due to the sensation loss. Also, dry skin and other dermatological and nail problems are common problem during chemotherapy; your chiropodist can treat and help prevent these as well as part of an ongoing care routine.
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