Having worked with the EB community for the past 22 years, he noted that he had seen how podiatry practices had been refined to deal with this patient population. Dr. Khan is one of several experts behind EB podiatry guidelines issued by DEBRA International last year (Br J Dermatol. 2019 Aug 9. doi: 10.1111/bjd.18381) and has run the charity’s first practical EB podiatry skills course to educate more podiatrists on the intricacies of managing EB feet.
During his talk, Dr. Kahn mentioned several innovations that came about by working with external companies, such as the production of special cotton socks containing silver fibers to help reduce the symptom of hot feet, and development of a cooling insole that helped draw moisture and odor away from the foot while providing comfort to the wearer.
One of the main problems for those with EB is finding comfortable footwear that doesn’t aggravate their symptoms, Dr. Khan emphasized.
According to the EB podiatry guidelines, footwear needs to be supportive, and “its primary focus should be aimed at minimizing blistering by reducing friction.” If blisters are already present, the guidelines note that dressings and topical antiseptics or antibiotics might be used until the blisters heal. “Therefore, suitable shoes or footwear are essential to accommodate dressings and not lead to further trauma to the damaged area. Footwear that is adjustable may be beneficial in these circumstances.”
What constitutes appropriate footwear is open to debate and was the topic of a separate poster presentation at meeting. Mark O’Sullivan, EB team podiatrist at Solihull and Birmingham Women’s and Children’s NHS Foundation Trust, and associates looked at whether wearing rocker bottom footwear could ease the formation of blisters in patients with EBS.
The team studied nine patients who reported regular plantar blistering. An in-shoe measurement system was devised to measure patients’ plantar pressure while they were wearing their existing footwear and then again when they were wearing new footwear with a rocker bottom. Participants completed questionnaires about the development of blisters on their feet, their activity levels, and pain.
The rocker bottom footwear reduced the peak plantar pressure by 30.5% and the total plantar pressure by 31.8%, compared with regular footwear. A shift in the average pressure under the foot was seen, moving from the heels of the feet to the midfoot area, while remaining similar in the front foot area.
“Patient feedback has been mixed,” Mr. O’Sullivan said when presenting the poster. “Patients state that blisters have often reduced in the heels and forefoot, but new blisters have developed in the midfoot.” As a result, some study participants chose to alternate wearing the rocker bottom footwear with their normal shoes, to even out the places where blisters might form.