I will warn you now that this post may have a few bits that might make you squeamish if you aren’t too keen on feet! But just remember, they are the feet of a gorgeous two year old princess so they can’t be that bad!
Today I took Lucia for a podiatry appointment – and it was not a nice visit. It had a lot of screaming and a lot of tears – and a lot of chocolate buttons to calm Lucia down afterwards. Although it was a tough appointment for Lucia (and me – I am still a bit shaky this evening and have ate my own share of chocolate buttons!) it was well worth it for the results.
A little background
Someone suffering from Lymphoedema in the lower limbs and feet can have quite a bit of trouble with the toes as this is one area where it is extremely difficult to move the fluid from. Therefore there is constantly pressure on the toes from this fluid without much relief. Add to this that the toes have to take on the pressure of compression tights and shoes as well as carrying body weight throughout the day and you can start to see how problems can so easily arise.
All of Lucia’s toes are puffy but eight out of ten are perfectly beautiful and healthy! Her two big toes give her a bit of bother though mostly the big toe on her right foot – the foot with the most swelling. (Warning – gross description coming!)The pressure of the fluid in her toes has caused the skin on the corners of her big toe to start to grow over the nail in two big ‘lumps’ if you like. These two ‘lumps’ then tend to become red and inflamed regularly and also infected at times. Fortunately, so far, we have always been able to manage these infections and inflammation ourselves with our meticulous skincare regime, keeping them clean and dry, putting savlon antiseptic cream on and ensuring her compression tights aren’t too tight around the toe.
At these times she definitely feels some discomfort, but I don’t think any real pain – thankfully. She will say ‘sore toe’ and doesn’t like anyone looking at it never mind touching it but being the wee soldier she is she doesn’t let it stop her doing what she wants to do!
However, it does stop us doing what we NEED to do – mainly her lymphatic drainage massage. This would mean that as we helped to move the fluid through the body to encourage drainage we would also be helping the infection to spread through the lymph and this could make her ill. So when her infection clears up we try to do extra massage – which she now actually enjoys!
The foot lady
Over the last six months we started seeing a podiatrist regularly as these infections were occurring too often and the skin around the toe was growing so far over the nail we were having difficulty cutting it properly. And it really hasn’t been looking healthy. So the podiatrist has been treating it with silver nitrate – and it is amazing stuff!
For those of you who don’t know how it works the silver nitrate comes on the tip of a stick. A bit like a really long match stick. You dip the tip of it in water and this activates the silver nitrate and you then paint it onto the hard skin growing around the nail. In a day or two this skin then slowly turns black – our podiatrist kindly told us that this would happen as you can imagine how freaked out I would have been had I woke up the next day to find Lucia with a black toe!
Silver nitrate is corrosive and destroys the skin cells so after a couple of weeks these big lumps of skin fall off leaving Lucia with what looks like a brand new toe! Amazing!
But it isn’t long before the skin starts to grow over the nail again and so we go back to the magic matchstick. The other issue is the nail on that toe. It has got to the point where I can’t cut the nail because of the skin and today was the first time the podiatrist had to get her tools out, get under the skin and cut the toe nail to prevent it from becoming too embedded in the skin.
Now you can understand the screams. It took me and two podiatrists to hold her still while she screamed and cried until they finally managed to do the job. It was a very long half an hour and I felt so cruel. But when I saw how brilliant her toe looked and how neat the nail was I knew it was all worth it. And once the tools went away and the chocolate came out Lucia was back to her usual happy self.
Then came the suggestion that perhaps toeless compression tights would be an option as there would be less pressure on the toes. I have no idea how these could work though!
Lucia’s tights have extra layer of compression sewn into the right foot to try and squeeze the fluid up her leg – so how would this work if they were toeless? Would the compression work as well if they aren’t enclosed? As she has fluid in her toes surely she needs a closed toe to try and help this swelling rather than leaving them untreated? How would the tights stay in place and not move backwards up the foot? What kind of a sock would she then have to wear over her toes to keep them protected as we can’t find socks that she can wear without being too tight around the ankle.
I will of course be chatting all of this through with Lynne, our Lymphoedema Physio and I am sure she will have answers for them all but until then this is what is going through my head. I also know we are still very much in the trial and error phase. Our first trial was the tights which continue to help Lucia hugely – but maybe this is their one flaw. Maybe toeless tights will be just as good but give her toes a bit of relief. Maybe we could have a pair of each and depending on how her toes are that day decide whether she will have toes in or out!
As always I am just very thankful that we get such wonderful care and help from our health service and know we are very fortunate that Lucia is getting all the treatment she needs to ensure her Lymphoedema is managed well.