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Why is kidney disease a risk to your feet?

Kidney disease is a lifelong condition which may cause foot problems. Some of these problems can occur because the nerves and blood vessels, including those supplying your legs and feet, are damaged.

This can affect:

-    the circulation in your feet (ischaemia); and

-    the feeling in your feet (peripheral neuropathy).

These changes can be very gradual and you may not notice them. This is why we recommend that you have your feet screened and assessed by a podiatrist every one to two months. You can then agree a treatment plan to suit your needs.

Your screening and assessment have shown that there is a high risk of developing wounds that won’t heal or amputation. Your health-care professional will tick which of the following risk factors you have.

o    You have reduced feeling in your feet

o    You have reduced circulation to your feet

o    You have hard skin on your feet

o    The shape of your feet has changed

o    Your vision is affected

o    You cannot look after your feet yourself

o    You have had foot ulcers before

o    You have had an amputation

o    You are on peritoneal dialysis or haemodialysis, or have an eGFR of less than 15mmol/l

Foot ulcers are breaks in the skin that struggle to heal. The development of foot ulcers in people with kidney disease may lead to serious complications and they are linked to an increased risk of heart attacks, strokes, amputations of the foot or leg and early death. Controlling your cholesterol and blood pressure, quitting smoking, increasing cardiovascular exercise, controlling weight and managing any other conditions you may have (such as diabetes) helps to reduce the risk of these life- and limb-threatening problems.  Managing any excess fluid is also important.

Note: You may be at further risk of cardiovascular problems if you have a family history of heart disease.

As your feet are at high risk of foot ulcers, you will need to take extra care of them. You will need regular treatment by a podiatrist.

If you follow the advice and information in this leaflet, it will help you take care of your feet between visits to your podiatrist. Hopefully this will help to reduce problems in the future.

Advice on keeping your feet healthy

Check your feet every day

You should check your feet every day for any blisters, breaks in the skin, pain or any signs of infection such as swelling, heat or redness.

If you cannot do this yourself, ask your partner or carer to help you.

If your skin is dry and cracks, use a 25% urea cream once a day until this improves, or consult your podiatrist who can make some recommendations to help.

Wash your feet every day

You should wash your feet every day in warm water and with a mild soap. Rinse them thoroughly and dry them carefully, especially between the toes. Do not soak your feet as this can damage your skin. Because of your condition, you may not be able to feel the difference between hot and cold very well. You should test the temperature of the water with your elbow, or ask someone else to test the temperature for you.

Moisturise your feet every day

If your skin is dry, apply a moisturising cream every day, avoiding the areas between your toes.

Toenails

Cut or file your toenails as advised by your podiatrist. If you have any concerns raise this with your podiatrist

Socks, stockings and tights

You should change your socks, stockings or tights every day. They should not have bulky seams and the tops should not be too tight and cause marks or indents into your skin.

Avoid walking barefoot

If you walk barefoot you risk injuring your feet by stubbing your toes and standing on sharp objects which can damage the skin. You should always wear footwear to protect your feet where possible.

Check your shoes

Check the bottom of your shoes before you put them on to make sure that nothing sharp such as a pin, nail or glass has pierced the outer sole. Also, run your hand inside each shoe to check that no small objects such as small stones have fallen in.

Badly-fitting shoes

Badly-fitting shoes are a common cause of irritation or damage to feet. The podiatrist who assessed your feet may give you advice about the shoes you already own and on buying new shoes. They may suggest that you are measured for prescribed footwear. 

Prescription shoes

If you have been supplied with shoes, they will have been made to a prescription. You should follow the instructions your orthotist or podiatrist with specialist training in prescribing footwear (the person who prescribed or designed your shoes) gives you. These should be the only shoes you wear. Shoes will normally be prescribed with insoles. These are an important part of your shoes and you should only remove them if your orthotist or podiatrist advises you to. Whoever provided your shoes will advise you about any repairs or alterations to make sure that they will match your prescription. Prescription footwear and insoles can reduce the risk of ulcers but cannot remove the risk altogether.

Minor cuts and blisters

If you check your feet and discover any breaks in the skin, or minor cuts or blisters, cover the area with a sterile dressing. Do not burst blisters. Contact your Podiatry department or GP immediately (their contact numbers are over the page). If these people are not available and there is no sign of healing after one day, go to your local accident and emergency department.

Minor cuts and blisters

If you check your feet and discover any breaks in the skin, or minor cuts or blisters, cover the area with a sterile dressing. Do not burst blisters. Contact your Podiatry department or GP immediately (their contact numbers are over the page). If these people are not available and there is no sign of healing after one day, go to your local accident and emergency department.

Hard skin and corns
Do not try to remove hard skin or corns yourself. Your podiatrist will provide treatment and advice where necessary.

Over-the-counter remedies

Never use over-the-counter corn remedies. They are not recommended for anyone with neuropathy as they can damage the skin and create ulcers. 

Avoid high or low temperatures

If your feet are cold, wear socks. Never sit with your feet in front of the fire to warm them up. Always remove hot-water bottles or heating pads from your bed before getting in

What should I do if I have a concern or problem with my feet?

If you develop any of the following problems, it is important that you contact your Multi-disciplinary Foot Care Team, local Podiatry Department of GP for advice as soon as possible (within 24 hours). 
 

A red/discoloured, hot, swollen toe or foot   

A break in the skin that doesn’t heal   

New redness or discolouration of your toe or foot  

New or unexplained pain in your foot

If they are not available, go to your nearest accident and emergency department. Remember, any delay in getting advice of treatment when you have a problem can lead to serious problems.

Appointments  

It is important that you attend all of your appointments with the Foot Protection Team or specialist podiatrist, as well as your other medical and renal review appointments. This will reduce the risk of problems developing.

Developed by the London Foot Care Strategic Clinical Network and the London Renal Strategic Clinical Network with help from service users
Based on the original leaflet produced by the Scottish Diabetes Group – Foot Action Group
Owned by the Royal College of Podiatry ©                       
Published date: Month,  May 2024         
Review date: Month, May 2027

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The National Kidney Federation cannot accept any responsibility for the information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.