Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

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Hi all,

I have a cancer patient receiving chemo who has developed Hand-Foot syndrome (Erythrodysesthesia) with debilitatingly painful frictional lesions over several weight bearing areas of both feet. Soft silicone insoles have not helped much. Has anyone any ideas on how to improve this 52 yo fellow's quality of life (it is now limiting his ability to get around the golf course, so things are serious)

Barry Hawes

 

Re: Hand-Foot Syndrome

Is it the sores which are an issue or the neuropathy (allodynia?) or both?

 

Re: Hand-Foot Syndrome

Primarily the wounds/sores.

Barry

 

Maybe worth treating as same as epidermolysis bullosa... Alison Barlow podiatrist Salford Uni UK did a lot of work with people with this condition. Contact her she may have suggestions in reducing the friction

a.barlow@salford.ac.uk

 

Thanks for that

Barry Hawes

 

Have a chat to his dr, some of the following may be worth consideration to address some of the excess chemical in the soft tissue.

i)Oral or topical (applied to the skin) corticosteroids
ii)Topical dimethyl sulfoxide
iii)Vitamin B6 (pyridoxine)
iv)Over-the-counter pain relievers, such as acetaminophen

Hope this helps.

Good luck

 

Thanks for that Nicholas.

Barry Hawes

 

Hi Barry where are the lesions ?

I have a patient under cyclic medication for his cancer which causes the skin to break down as well, on the plantar aspect of his feet in particular at the skin line at the 1st MPJ. Using a graphite stiff plate under the foot it provides immediate relief coupled with a soft innersole. Would this suit this patient?

Cheers

 

Hi Mark,

Yes this fellows lesions are around the periphery of the heel and medial aspect of the 1st MTPJ (areas of high friction/shear forces) He has been wearing polyprop foot orthoses with deep heel cups for an overuse injury for many years. Removing these did not help at all. Has tried all sorts of topical preps from his GP, who referred him to me. From what I've read reducing friction and heat is the only answer for these lesions.

Did you just use a flat plate in the shoe, or thermomoulded orthotic? What type of material did you use as a cushioning insole?

Any further advice gratefully received!

Cheers,

Barry

 

This clinical trial was just registered:
Study of 0.1% Uracil Ointment (1UO) Ointment for the Prevention of Hand-Foot Syndrome

 

Using an orthoses with a plastizote (poyethylene foam) cover is an excellent choice for pressure reduction. Plastizote conforms to the foot over a very short period of time protecting boney prominances. This is what I use on the majority of my diabetic and nueropathic feet.

Since reducing heat is important with this pt. I would cover the plastizote with a very thin layer of soft leather as plastizote alone can make the foot warm and increase sweating, the leather prevents this. This combination works well.

I would also have pt. try a sock that has a high percentage of acrylic blend. Studies have shown that acrylic has superior moisture wicking properties. It wicks it from the skin and pulls it to the exterior of the sock to be evaperated (less moisture means less friction )

Another sock type would be a double sock system (a sock within a sock) which helps reduce friction significantly.
One last idea is using a product called shear band. This is a thin teflon type material which can be cut from a sheet and applied to the inner of the shoe in areas of suspected rubbing. Areas such as the inner counter and vamp are typical spots. The sock will just glide over the shear band.

Hope this helps.



Joe Eads, C.Ped

 

Hi Barry

I have used the Centri graphite plates which I get from OAPL about $40 dollars for a pair you need to know the European foot size and they come in group sizing i.e. size 38-40 and there are 2 thicknesses flexible and rigid. You can grind them down to suit/fit a shoes but be careful the grinding of graphite tends to wear and glug up the wheel.

The patient I was speaking of has a pair of Dr Comfort shoes and we just use the innersole which comes with the shoes a plastazote simple device.

You mention heat and friction as the issues perhaps trying the plates glued into some sandles might be worth a go???

Cheers

 

Hi Barry,

I haven't used this specifically for your patient's condition, but Silic 15 cream (by ego) is good for helping to protect the skin from friction.