2 Foot Productions

Basic Foot Care for Nurses and Carers across Australia

What is basic foot care? Basic foot care in your workplace, consider the following aspects of basic foot care: Definitions from basic foot care guidelines & relevant regulations. Cleaning feet Drying feet Checking for foot problems Attending to foot problems Moisturising feet Trimming toenails Choosing good footwear

Definitions from basic foot care guidelines & relevant regulations.

Podiatrists Regulation 1995 (now repealed)

“Basic foot care means the fundamental attention given to normal toe nails and skin surfaces of the foot, including the cutting of toe nails, the removal of superficial dead skin material interdigitally and the application to the skin of emollients or re hydrating agents, when indicated.”

Australian Podiatry Councils policy on Podiatry Assistants

“Foot hygiene is defined as fundamental attention given to normal toe nails and skin surfaces of the foot, including washing and drying, the cutting and filing of toe nails, the removal of superficial dead skin material interdigitally and the application of drying or softening agents.“

ACT basic foot care policy

“Basic Foot Care is defined as: The cutting of normal health nails and the maintenance of foot hygiene such as can be expected in self care (routine care) of a person in a low risk category.”

“Basic foot care does not include debridement of callosities and corns with a surgical scalpel. Basic foot care providers include health care workers and carers.”

“Normal Healthy Nails are defined as: Nails that have no underlying pathology of a systemic or structural nature.”

“Foot Hygiene is defined as: The cleansing of the foot, the debridement of rough skin with a smoothing agent such as a pedicure file or pumice stone, the removal of inter-digital debris with a swab, applying moisturising agents to the skin, the cutting and filing of normal healthy nails.”

Cleaning feet

Keeping feet clean is obviously an essential part of basic foot care. Good foot hygiene will help keep skin and nail infections at bay and help prevent foot odour.

You need to be quite particular when you are cleaning someone's feet. If you are washing the feet in the shower, use what ever gentle soap free cleanser you are using on the rest of the body. It is very important to clean carefully between all of the toes. The moveable shower heads are fantastic for reaching down to the feet.

However, if you find it hard to get down to the feet and do a thorough job in the shower, just wet the feet in the shower and afterwards – find something that will fit in between the toes to finish the job.

Things you could try include:

Baby wipes
Wet gauze or cotton wool swabs
Cotton buds.

If you feel there is a need for some heavy duty cleaning, a nicely scented foot soak can be fine. You will need to be particular about the temperature of the water - not too hot, not too cold - and don’t let the feet soak for too long. Long foot soaks can damage and dry out the skin. One to two minutes is plenty. It is probably best to avoid foot soaks all together if the person has diabetes or poor circulation.

Drying feet

Getting feet dry and keeping them dry can be a challenge.

It can be hard to dry in between toes that are fixed closely together. A thin washer or a piece of gauze can do the trick.

If there is a space in between two toes that is particularly macerated – or moist – a rubbing alcohol, such as isocol on a cotton bud can help dry the area more efficiently. Isocol is used undiluted on the skin. If excessive drying of the skin occurs after using such a preparation, discontinue use. Do not use a drying agent on the skin if the skin is broken. Instead, use thorough hygiene practices and plenty of air for a few days until the skin breaks heal, and then use an astringent if needed.

Don't use a hair dryer to dry feet. Among other safety issues, this can result in burns to a foot that has reduced sensation.

If feet tend to get sweaty through the course of a day :

A powder such as Prantal powder can help reduce the amount of sweat produced by the feet.

Use natural fibre socks - such as cotton socks.

Try an open toed sandal. There are good open toed sandals available that are closed in at the heel, have a good fastening and a good sole.

If shoes or socks get wet through the day - change them as quickly as possible.

Checking for foot problems

While you are cleaning and drying the feet – take the time to check for any foot problems. Identifying and treating foot problems promptly is one of the keys to moving the healing process along.

You will find some parts of the foot are more difficult to observe than others.

The back of the heel can be difficult to see clearly. Try getting the person to sit up straight in a chair, and bend their knee so that their heel is clearly visible.

Sometimes it can be hard to observe in between the toes when they are fixed tightly together. Hold the toes gently in your hands and separate carefully. Sometimes you can move the toes apart, sometimes you might need to carefully pull one toe up, and one down slightly.

Look for any of the following foot problems:

• Corns
• Callous
• Tinea
• Splits in the skin
• Blisters
• Nail problems
• And other wounds

When observing any of these problems, look closely for signs of infection, slow healing or breakdown of surrounding tissue. These signs include:

• Redness
• Heat
• Swelling
• The presence of pus or exudate
• Bleeding into the surrounding skin
• And pain may also be present

Don't forget, it can be useful to ask how the feet feel, but this is not always a reliable indictor of foot health in an elderly person. Sensation in the feet is often reduced in elderly people and so foot problems can go unnoticed and unfelt.

Attending to foot problems

Once you have identified the presence of a foot problem, there are a few things you can do straight away to help manage the situation.

• Callous
• Corns
• Foot Deformity
• Fungal Toenails
• Ingrown Toenails
• Pressure Area Care
• Tinea

For more information on what you can do to help specific foot problems. The main points here are to:

1. Observe the foot problem early
   Early detection of foot problems leads to early intervention which can help the healing process move along.
   
   
2. Decide what factors are contributing to the problem,
   Always consider the cause of the problem,
   Are bad shoes contributing?
   Is poor hygiene a factor?
   Is foot deformity making the problem worse?
   These issues will need to be addressed if you want to have any real success in managing foot problems.
   
   
3. Be able to put your hands on appropriate dressings or paddings
   There are many fantastic foot paddings and dressings available to help with common foot problems. Have a look in your local pharmacy in the foot care section, next time you are there.
   
   
4. Monitor the condition as needed
   It is important to keep an eye on any foot problem - something that is not too bad one day, can deteriorate quickly the next.

Foot problems are notoriously slow to heal. You will need to keep an eye on any problems you find. If a serious foot problem is identified or if there are signs of infection present, a review by a GP or podiatrist will be needed.

Moisturising feet

One of the most beneficial things you can do for feet is to moisturize the skin.

A simple emollient such as sorbolene cream is fine. Don’t get too excited by all the different varieties, just find one that is cheap and suits you. You will find that different creams will absorb into the skin differently. Some will sit on the skin for a while, some will seem to absorb quite quickly.

Never put cream on some ones feet just before they stand up and walk around bare foot. The feet will be very slippery and especially on tiles in a bath room - you will have a disaster waiting to happen.

Try putting the cream on just before socks and shoes go on, or just before bed. Better still – do both.

Rub the cream all over the feet. Pay attention to what you feel with your hands – sometimes your hands will pick up painful lumps and bumps that they eye didn’t see.

Generally, it isn’t a good idea to rub cream in between the toes and then put socks and shoes on – it can get quite macerated in there. Don’t forget however that sorbolene is used as a soap alternative – and you can use sorbolene in between the toes if you then carefully wipe out the excess with a piece of gauze.

As mentioned earlier, it is not really the brand of cream that is so important, what is important is that the cream is used every day.

If skin is particularly dry there are various urea creams, which draw extra moisture into the skin. You can buy these from your local pharmacy.

If dry, thickened skin is a problem, the heel balms such as Eulactol and Du’it are great. These creams are more expensive, so you just use a small amount on the problem areas, and splash the sorbolene around everywhere else.

Try and take a minute to massage the cream into the feet.

• It feels wonderful,
• It can help ease muscular and arthritic aches and pains and
• Can help with the circulation to the feet.

Take the challenge - with the help of an RN think of someone you know with poor circulation and dry skin. Gently massage sorbolene cream into their feet twice a day and see the difference you make in just a week.

– You'll be the most popular nurse in the place.

Trimming toenails

Trimming normal toenails is a basic hygiene necessity.

There are a few factors to keep in mind when trimming toenails.

1. Is it appropriate that you trim toenails?
   Sometimes the answer will be yes, sometimes no.
   You can trim “normal” toenails.
   Once you start seeing ingrown toenails, very thick toenails or fungal toenails you should get advice from a podiatrist or GP.
   Where you have someone with diabetes or peripheral vascular disease, again it is a good idea to get specific instruction from a GP or podiatrist.
   
   
2. What equipment will you be using, where will you be keeping it and how will you be cleaning it?
   Go to our page on Basic Foot Care In Aged Facilities for more ideas on this topic.
   
   
3. Where and when will you trim toenails?
   How will you fit this task into your daily routine?
   Will you have a special room set up?
   Do you have time straight after a shower?
   Where is the light best?
   Where can you make a bit of a mess?
   
   
4. How do you trim toenails? How much do you take off? What do you do if nine of the nails are healthy, and one is a problem?
   Always do what you can. If there are a few toenails that are too thick, too curved or ingrown, leave them and do the rest.
   Trim toe nails straight across, do not cut down the side of the nail. Use a nail file to round off any sharp edges.
   Leave a small amount of “white” at the top of the nail. Do not cut the nail down as low as you can. It is better to leave a bit of length on the nails and have to trim them more often, than cut the nail too low and risk an infection. A podiatrist will cut a nail quite low, and will only have to see the client every 6-8 weeks as a general rule. If you just trim a small amount off the end of the nail, you may need to trim the nails again in 4 weeks.

Choosing good footwear

You will have a major role in helping the people you care for, select good shoes. Poor footwear is a considerable falls risk factor in elderly people. Along with causing foot problems such as corns and ingrown toenails, bad shoes can interfere with balance.

In the residents wardrobe, look carefully at all the shoes available. Decide which are fine and which might need to be replaced. If it is not appropriate to throw shoes out, put them in a plastic bag right at the back of the wardrobe. It is no good leaving them in the cupboard, where they are a temptation.

Look at the sole of the shoe.

Is it in good condition and attached firmly to the shoe?
Is the grip in good condition or worn away?
Is it made of a cushioning rubber that will not slip on wet surfaces?
Leather soles will be too slippery for an elderly person.

While you are examining the sole, bend the shoe in half. It should bend at the ball of the shoe – where your foot bends at the toes - not in the arch area of the shoe.

Next look at the heel counter.

Is it nice and deep?
Will it cup the heel well and not slip when walking?
Is it firm enough?
A firm and high heel counter has been shown to improve balance in older people.

Next look at the fastening on the shoe.

Velcro is good because it is easier for someone who has difficulty reaching their feet.
Laces and buckles will also do the job of keeping the shoe securely on the foot.
It is good if the shoe is adjustable in some way – so if feet swell a little, or if thick socks are worn one day and thin the next, they can be loosened while maintaining a comfortable fit.

Now look at the toe box.

Is it wide enough for the foot?
Is it deep enough for any clawed toes?
The material that the toe box is made out of is also important.
Very soft materials are available that put less pressure on the toes, but still provide some protection to the foot.

Look at the overall condition of the shoe.

Is it clean?

Sometimes the entire shoe can go in the wash. Sometimes you can take the insole out and replace it, and then wipe the shoe down.

There are some great sandal style shoes available, they provide good support and a good fit.

A great shoe for people living in an aged care facility is the pulman slipper. It is completely adjustable, and machine washable.

When considering what type of shoe is appropriate consider the activity level of the person.

Are they bed or chair bound?

Consider a warm thick sock to protect the foot –perhaps with grips on the bottom incase they need to weight bear to transfer. If someone is not walking – they really don’t need shoes on.

Is the person limited in their walking?

Consider something like the Pulman slipper.

Is the person very active?

Well lets hang onto that and get them into a good walking shoe – something lightweight, supportive and held firmly on the foot.

Does the person have foot ulcers or marked swelling of the feet?

Again - try something like the pulman slipper.

This has to be said - high heeled shoes are no good. They put too much pressure on the fore foot and alter walking style and balance. It is not appropriate for older ladies (or men for that matter) to be scooting around an aged care facility behind their walkers in a pair of high heeled shoes. But now that’s out in the open, good luck changing old habits.

Always remember,

• Birthdays,
• Mothers day,
• Fathers day and
• Christmas time are great opportunities to remind family that Dad needs a new pair of shoes. If the family can't get Dad out to the shops – tell them to buy their shoes from a shop that will refund or exchange if they find the shoe doesn't fit when they get it home.

Bad shoes cause more problems than they solve. Your job of keeping feet in shape will be a lot easier if you can get everyone into good shoes.