Whether it is a diabetic foot, leprosy, lymphatic filariasis, Buruli ulcer, venous ulcer or an overgrown toe nail, the need for skin care is central to its management. Our legs are for standing and for access without assistance, we hardly comprehend their importance until they are compromised or damaged.
Warning! Simply put, not being able to walk threatens our very survival and not being able to stand makes our daily lives much harder to fulfil. From cutting toenails properly, with specific instruction on how best to manage them, to making clear that washing and emollients are key precautions to preventing infections in wounds and broken skin, basic care is an essential life enhancing skill.
Pressure over bony prominences such as the heel, hip, sacrum and elbow of those confined to bed by unconsciousness or paraplegia, or so ill that they are unaware of discomfort, is a major cause of ulceration. Feeling for foot pulses is an essential skill. Every fully equipped health centre claiming to be able to manage impaired blood supply should have the laser doppler equipment to measure foot blood pressure. Ulcer healing needs all the oxygen it can get from an effective blood supply. When it is noted that the surrounding skin is scaly and red extending up the leg, the skin will be in repair mode stealing oxygen from where it is most needed.
Action! Simply by washing and generously applying emollients this repair mode and demand for oxygen can be switched off. ‘Legs to Stand On’ is an impressive International initiative focused on developing community based approaches to improving lower limb care to preserve mobility and prevent disability in less resourced environments. Their promotion of clean water, safe driving, safe cooking fires, polio immunisation, folic acid in pregnancy, and plain decent footwear are actions we should all be extolling.