When last did you cut your toenails?
In patients who I think are vulnerable, I always try to take the time to look at their feet. Unfortunately, because of COVID-19-induced NHS service changes, this is very difficult using 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 often neglect their foot hygiene more than other aspects of their grooming. 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.
During COVID-19 lockdown nail bars have been closed and podiatrists have not been seeing patients; therefore, I suspect general foot hygiene may have deteriorated in many people with more advanced MS.
There is little doubt that MS or physical disability is a risk factor for onychogryphosis; in plain English overgrown and neglected toenails. Onychogryphosis makes it difficult to wear shoes, causes pain and may even put mobile patients at risk of falls. So if you can’t manage to look after your own feet I suggest post-lockdown setting-up regular appointments to have your toenails cut and your feet examined by a podiatrist. Please note in the UK podiatry is an NHS service.
Marginal gains, i.e. focusing on small differences which add up can make big differences to the quality of life and health outcome for people with MS, and this should include foot hygiene and taking care of your toenails. This is just another factor that HCPs need to consider if they want to manage MS holistically.
#T4TD = Thought for the Day
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