Five conditions in feet caused by cancer treatment

Introducing Podiatrist, Afni Shah-Hamilton

ConsultingFootPain is delighted to introduce a clinical colleague who has dedicated part of her career to looking after feet following cancer treatment. This is a poorly recognised area of podiatry, which is vital for patients affected by some of the toxic drugs required.

This article will highlight five conditions directly associated with chemotherapy. Although written for professionals, it is also of value to the lay reader.

Chemotherapy

We know that certain chemotherapies can affect the feet by preventing us from carrying out normal routines, especially after having surgery for cancer. Some of these side effects exhibited can be painful. Clinicians supporting patients with cancer aim to minimise such complications from therapy.  Being aware of what could occur is the secondary aim and relates to good education.  Assisting those with depression associated with enduring pain and loss of mobility, together with minimising any risk from infection, are the main aims. 

Being aware of how to tackle problems can prevent patients from interrupting their cancer treatment prematurely when a complication does arise.

Cancer and Feet

While cancer may not be curable, those suffering foot-related complications may benefit from podiatric care.

Numbness

This symptom is associated with the condition ‘peripheral neuropathy’ and can present as numbness or tingling,

Reduction in certain sensations. The altered ability to determine temperature leads to blistering and burns, loss of sharpness and bluntness, and deeper damage if not responded to—reduced light touch awareness and vibration. 

In addition, any altered muscle strength can lead to walking imbalances and increase the risk of falls due to loss of ground awareness, affecting walking.

Key anticancer drugs that can cause chemotherapy-induced peripheral neuropathy

• Biological agents  ge bortezomib (Velcade)

• Platinum-based drugs, eg cisplatin, carboplatin, oxaliplatin

• Vinco-alkaloids eg vinblastine, vincristine, vinorelbine

• Procarbazine

• Ifosfamide

• Thalidomide

• Taxane drugs eg paclitaxel, docetaxel

• Antimetabolites, eg cladribine, cytosine, fludarabine, methotrexate

• Etopside

• Thiotepa

Nails

This hard structure may thicken further, separate, and develop fungal infections or ingrown toenails.

Approximately 35% of patients suffered from nail problems when undergoing treatments, particularly those receiving epidermal growth factor receptor inhibitors and taxanes. The toxicity from some medicines affects the nail fold and bed, distorting nail cell growth. This can arise even after two months of commencing cancer treatment. Nail problems can be extremely painful, impact patients' quality of life, and even lead to depression. Some patients stop their anticancer therapy completely as they have found the pain and appearance of their nails too unbearable.

Skin

Skin that surrounds nails may become inflamed and even develop infections with redness and discharge. Ulcerations may develop under nails, which may remain hidden unless identified by careful sectional nail removal by a podiatrist or doctor. Also, due to sensation loss, some patients may experience areas of extreme pressure. This can cause the skin underneath the nail to breakdown with the risk of infection. The breakdown of tissue is known as an ulcer and needs specialist treatment from a podiatrist to help the area to heal.

Hand-Foot Syndrome

Hand-foot syndrome or palmar-plantar erthrodysesthesia (PPE) occurs because some treating medicines target cells such as skin. Because the skin has a rapid turnover to replace older cells, the palms and soles may appear stained red. Initial symptoms are: swelling, numbness, a sense of tightness/stiffness (potentially due to the swelling), and pain in the palms and/or soles.

Xerosis

Xerosis is a form of dry skin. Splits in the skin, called fissures, develop on the outside of the soles and heels, leading to water loss and, hence, dryness. Painful, hard skin areas, called calluses, can form under the balls of the feet at the sites where friction is greatest.

It is also worth noting that patients with certain underlying medical conditions are at increased risk of developing these complications, such as patients with diabetes and immunocompromised conditions, such as thyroid changes.  These patients may already exhibit nerve damage and delayed healing.  

As 1 in 5 cancer sufferers also have diabetes, this condition adds to the overall risk to life expectancy. Diabetic patients should be encouraged to see their podiatrist more regularly or at least early in their treatment cycle to reassess their diabetic foot status. Podiatrists contribute to the team approach and can flag up early foot concerns.

Thanks for reading ‘Five Conditions in Feet caused by Cancer Treatment,’ written by Afni Shah-Hamilton and edited by David R. Tollafield for Consulting Foot Pain.

Catch up with David at the Foot and Ankle Show. Sign up to hear the talk.

David has written a number of articles on foot swellings, lumps, bumps, and rare foot cancers taken from his long career as a podiatric surgeon.

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