Self-care

Foot and nail care with leg lymphedema

Dry between the toes, treat athlete's foot early, clip nails straight across, leave cuticles alone, closed low shoes, never barefoot, a weekly mirror check.

By The Renu lymphatic and massage team · 6 min read

Foot care with leg lymphedema comes down to keeping the skin between the toes dry and intact, treating athlete's foot the moment it appears, trimming toenails straight across with clippers and leaving the cuticles alone, wearing well-fitting closed shoes with a low heel and a soft sole, and never going barefoot. The reason is cellulitis: the NHS lists untreated athlete's foot and lymphoedema as risk factors for it, and Cancer Research UK says an infection can make the swelling worse. A weekly look at the whole foot in a mirror catches the small problems before they become that.

Feet are where leg lymphedema gets into trouble. They are the furthest point from the heart, they live inside shoes and socks all day, and the skin between the toes is thin and damp. Almost every bout of cellulitis we see in a leg started with something small down there: a crack from athlete’s foot, a nail cut too short, a blister from a new sandal. This page is the routine that stops the small things.

Why a toe can take out a whole leg

The NHS cellulitis page lists the risk factors plainly: poor circulation, a weakened immune system, lymphoedema, a previous episode of cellulitis, and athlete’s foot that has not been treated. Bacteria get in through a break in the skin, whether an insect bite, a cut, or skin that is cracked and dry. Cancer Research UK says an infection can make the swelling worse, and once cellulitis has happened in a lymphedema leg it has a habit of coming back; Cancer Research UK describes 14 days of antibiotics for an episode and, for people with repeated infections, a low daily dose that can continue for up to two years.

So foot care is not fussiness. It is the cheapest lymphedema treatment there is.

The daily foot routine

Wash with warm water, using a soap-free cleanser if the skin is dry (Macmillan). Not hot: the NHS lymphoedema guidance says to avoid very hot baths and showers.
Dry between every toe. Macmillan says to make sure you dry between your toes to help prevent athlete’s foot, and the NHS athlete’s foot page says to dab the feet dry rather than rub. Cancer Research UK: wash and dry the feet thoroughly, including between the toes.
Look at the whole foot. Sole, heel, between and under the toes, around each nail. You are checking for cracks, white or flaky patches, redness, blisters, a cut you did not feel.
Antifungal powder if needed. The NHS lymphoedema page lists applying anti-fungal powder when needed among its skin-care measures. If you have had athlete’s foot before, a light dusting between the toes is a reasonable habit.
Moisturise, but not between the toes. The evening emollient from our daily skin-care routine goes on the whole foot and leg; keep the web spaces dry, because damp skin there is what fungus likes.
Clean socks every day. The NHS athlete’s foot page recommends cotton, changed daily, and says not to wear the same pair of shoes more than two to three days in a row so they can dry out.

Nails: clippers, straight across, cuticles alone

Toenails cause more lymphedema infections than they should, because an ingrown nail is a wound that keeps reopening.

Cut straight across, not into the edges, and not too short. That is the NHS advice for preventing ingrown toenails.
Use clippers, not scissors, and do not push back or cut the cuticles (Macmillan). Cancer Research UK adds: be careful when cutting your nails to avoid cutting your skin.
Keep nails short and clean (Cancer Research UK), trimming after a wash when they are softer.
Get help for difficult nails. Macmillan suggests a chiropodist for toenails; the NHS lymphoedema page says to see a chiropodist for foot and nail care. If a nail is thick, curved, ingrown or you cannot reach it, that is a podiatry job, not a bathroom one. Tell the podiatrist you have lymphedema.

An ingrown toenail with pus, or one that leaves you feeling hot or shivery, is infected and needs a doctor, according to the NHS. Do not dig at it.

Athlete’s foot: treat it the week you see it

The NHS describes the signs: itchy white patches between the toes, sore and flaky patches, skin that can crack or bleed, and sometimes fluid-filled blisters. Treatments from the pharmacy come as creams, sprays and powders, usually take a few weeks to work, and you may need to try more than one. While it clears: dab dry between the toes, cotton socks daily, rotate shoes, and do not share towels, socks or shoes.

See a doctor if the treatment is not working, the foot is very painful, the infection is spreading, or you have diabetes; the NHS notes that foot problems can be more serious with diabetes, and the same caution applies to a lymphedema leg.

Shoes: closed, low, soft, and never none

The NHS oedema page recommends wide, comfortable shoes with a low heel and a soft sole, and the lymphoedema prevention page adds shoes that fit correctly and give support on the top of the foot. Cancer Research UK says well-fitting shoes, and to avoid going barefoot. Macmillan: it is safest not to walk around barefoot.

In practice:

Fit shoes in the afternoon, when a lymphedema foot is at its largest; the NHS notes swelling is often worse after standing or sitting in one position for a long time.
Check inside new shoes for seams or rough spots before the first wear, and check the foot after.
Pool decks, beaches, hotel rooms: shoes on. Cuts and bites on the foot are exactly what the advice is trying to prevent.
Compression and toe caps. If you wear an open-toe stocking, the toes still need protection; see open-toe versus closed-toe compression.

The weekly mirror check

Once a week, same day, same light, put a hand mirror on the floor and look at the parts of your feet you cannot see from above: the soles, the heels, under the toes. Compare the two feet. Press gently around each nail. Note anything new on your phone with a photo. This is a habit, not a medical test; it exists so that a crack or a blister is found on day one rather than day four. Cancer Research UK’s exercise advice is to check the swollen area during and after activity and to contact your lymphoedema specialist if anything changes, and the same applies to feet after a long walk or a new pair of shoes.

Stop and call

Treat the following as same-day medical care, not something to watch for a few days:

Skin on the foot or leg that is painful, hot and swollen, usually red, sometimes blistered: the NHS description of cellulitis. Flu-like symptoms with swollen, painful glands count too.
A temperature of 37.5°C or higher, or below 36°C, which Cancer Research UK lists among infection signs. On brown or black skin, Cancer Research UK says redness can appear yellow, purple or darker than usual.
An ingrown toenail with pus, or feeling hot or shivery with it (NHS).
A cut or crack that is swollen, red, more painful or leaking pus (NHS).
Sudden swelling in one leg that is unexplained, severe pain, or swelling that came on suddenly: the NHS says this needs urgent assessment.

Call emergency services for shortness of breath, chest tightness or coughing up blood (NHS). While cellulitis is treated, the NHS says to keep the leg raised and not to wear compression stockings until you have recovered. The when to seek medical care page keeps all of this in one place.

At Renu

Feet are examined at every complete decongestive therapy visit, because the therapist’s hands are on them anyway and a crack between the toes changes the plan for the day. Meeghan Mackenzie, our Certified Lymphedema Therapist and Certified Compression Fitter, will also check that your stocking is not rubbing a toe or a heel. For the wider picture of a swollen leg, her journal piece on five ways to decrease leg swelling and the overview of lymphedema and lipedema are the places to start.

Questions people ask

How should I cut my toenails if I have lymphedema?

Straight across, not into the edges, and not too short, which is the NHS advice for preventing ingrown toenails. Macmillan says to use nail clippers instead of scissors and not to push back or cut the cuticles. If reaching your feet is hard, or a nail is thick or ingrown, both Macmillan and the NHS suggest a chiropodist or podiatrist rather than doing it yourself.

What does athlete's foot look like, and why does it matter so much?

The NHS describes itchy white patches between the toes, sore flaky patches, skin that can crack or bleed, and sometimes fluid-filled blisters. It matters because the NHS lists untreated athlete's foot as a risk factor for cellulitis, and cracked skin between the toes is an open door. Pharmacy creams, sprays and powders usually take a few weeks to work.

Can I wear sandals in summer?

Open shoes leave the skin exposed to cuts and bites, and the NHS and Cancer Research UK both say to avoid going barefoot. The NHS recommends wide, comfortable shoes with a low heel and a soft sole, with support on the top of the foot. If you want air in summer, a closed, soft, well-ventilated shoe is the safer compromise, with sunscreen on any exposed skin.

Is it safe to soak my feet?

Warm, not hot, and not for long. The NHS lymphoedema guidance says to avoid very hot baths and showers, and heat can increase swelling. Dry thoroughly afterward, especially between the toes, and moisturise as part of your evening routine.

What is the quickest way to tell if my foot is infected?

Cellulitis makes the skin painful, hot and swollen, and usually red, sometimes with blisters; you may feel flu-like with swollen glands. Cancer Research UK adds a temperature of 37.5°C or higher, or below 36°C, and notes that on darker skin the redness can look purple, yellow or just darker than usual. Any of these in a lymphedema leg means same-day medical care.