What To Buy In The Foot Care Aisle

Choices abound in the foot care aisle.  It’s common to see a perplexed shopper scanning the displays and shelves of foot care products trying to figure out what to buy.  At McDermott Footcare, clients often ask what are the best items to purchase to care for their feet between foot care visits.

Let’s divide the items into categories.

Nail Scissors/Clippers/Files

Admittedly, it’s difficult to judge the quality of scissors/clippers since they often come in packaging.  You may have to decide by trial and error.  In general, buy the best quality stainless steel product you can afford.  It’s advisable to have 2 sizes of clippers:  a smaller one for the fingernails and a larger one for the toenails.

Nail files are available in metal, glass or cardboard.  A cardboard nail file is also known as an emery board.  It is more gentle than metal or glass and is disposable.

A metal nail file’s abrasive surface is usually made of mineral corundum.  It is the most abrasive file and is best for thicker nails.

Glass nail files are more expensive than metal or emery files.  Their abrasive surface is finer and smoother, therefore not suitable for tough jobs.

For personal nail scissors/clippers and nail files, it is advisable not to share with other people.  While it isn’t necessary to sterilize your personal nail tools, they should be regularly disinfected.  A disinfectant wipe will be suitable.

Corn and Callus Products

Many preparations and pads are available for corn and callus home treatment:  medicated pads, liquid drops, moleskin, corn and callus scrapers/shavers.

Medicated pads and drops can be harmful since the acid in the preparation can burn the skin around the corn or callus.  At a recent foot clinic, a client showed me a large, irritated area on the bottom of her foot.  She had been using an over-the-counter medicated pad for a few weeks and now the area around the callus was showing large areas of peeling and redness caused by the medication in the pad.

Non-medicated pads and moleskin are useful.  To avoid undue pressure (and pain) over the corn or callus, use pads with the hole in the middle or cut a hole yourself.  This way, the pad protects the corn or callus without discomfort.

I do not recommend corn and callus scrapers/shavers for in-home use.  These items are very abrasive and can cause bleeding, irritation, infection if used too aggressively.

Because of an increased risk of infection in diabetic feet, it is never recommended that diabetics use medicated pads or corn and callus scrapers/shavers.  Even a slight irritation or scratch can develop into a complicated infection.

Warts and Plantar Warts Medication

Like medicated corn and callus pads, wart preparations can also damage the skin around the wart.  It may take weeks to eradicate warts, especially plantar warts, despite claims on the packaging.  Before purchasing wart medications, try home remedies first.  Often, they are just as good as over-the-counter preparations (read here).

Again, diabetics should stay away from over-the-counter wart preparations.  There is a possibility of damage to surrounding skin which can cause infection.

Toe Spacers, Padding, Toe Props

These are great deals in the foot care aisle.  The purpose of these devices is to realign toes which are crowded together, clawing downwards or in need of some padding for increased comfort inside shoes.

Toe spacers are placed between toes that are crammed together.  They are generally comfortable if the right size is used.  Trial and error may be needed to find a toe spacer which fits and is comfortable.

Padding usually comes as foam tubes or adhesive moleskin.  They may be cut to size.

Foam tubes usually come in 3 different sizes and the one to use depends on the size of the toe.  The tube foam slips on over the entire toe, acting as a cushion and/or toe spacer.

Moleskin pads are adhesive and may be cut to fit the affected area.  There are different thicknesses of moleskin available.  Again trial and error is needed to find the right thickness.

Toe props are placed under the toes, to straighten and realign claw toes.

Insoles

The variety of insoles can be staggering at a well-stocked foot care aisle.  There are insoles for everything from plantar fasciaitis, diabetics, sweaty feet, runners, walkers, high heels, the list goes on.  In general, these are very good buys.  Again, trial and error is needed to find the one that suits you best.  Always get insoles that have a cloth layer on the top.  The cloth helps to absorb sweat.  Many insoles are made only of gel.  These will not absorb sweat and may increase the likelihood of developing athlete’s foot or bromhidrosis (smelly feet).

Heel Creams and Foot Soaks

Many of these preparations contain fragrance which is drying to the skin.  Instead of highly fragranced items, there are other choices that will not promote dryness.

Find a moisturizing body lotion or cream that contains urea.  Urea is a natural substance produced in the body and it serves to retain moisture.  Urea added to moisturizers does the same thing.  Choose a non-fragranced product.

Fragranced foot soaks contain epsom salts as the main ingredient.  For a cost-effective, less drying alternative to fancier products, combine regular, fragrance-free epsom salts with a shallow basin  of warm water.

White vinegar is very good for the feet.  Make a solution of 1/4 cup white vinegar and a shallow basin of warm water for a skin-smoothing, fungus-inhibiting, inexpensive foot soak.

Other Items

Pumice stones are handy and effective for gently scrubbing away dry skin on heels.  They are also good for sloughing calluses and corns.

Athlete’s foot medications come in creams, powders and sprays.  With consistent use and other measures, they can be effective for mild athlete’s foot.  Complicated athlete’s foot should be treated by your doctor.  Diabetics with athlete’s foot should always consult their doctor.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Plantar Warts: How Did I Get Them? What Can I Do About Them?

Plantar warts are caused by a few of the 120 types of human papillomavirus, or HPV.  The virus affects the superficial areas of the skin, especially on the pressure points of the foot such as the heel and the ball of the foot.  Since it is a virus, it is contagious.  It typically enters through small cuts or irritated areas in the skin, or areas  that are constantly exposed to water.

What does a plantar wart look like?

McDermott footcare   plantar wart

A lifeguard/swim instructor developed a plantar wart on the ball of the foot as a result of long hours working in constantly wet, bare feet.

Plantar warts are small, grainy, callus-like lesions on the bottom of the foot.  There may be a single wart measuring about 2 – 3 cm; a large “mother wart” surrounded by several smaller warts; a cluster of warts grouped together, otherwise known as a mosaic wart. The centre of the wart(s) have tiny red or black dots caused by trapped capillaries.  On weight-bearing surfaces, the warts may be flattened.

How do you get plantar warts?

  • the virus enters through tiny cracks in dry skin
  • through cuts, scrapes and other skin irritations
  • through wet, softened skin from prolonged exposure to water

Who usually gets plantar warts?

  • children and teenagers since their immune system is not fully developed and since they are more likely to go barefoot
  • people with weakened immune systems

Home remedies for plantar warts

  • apply a doughnut-shaped pad (available at drugstores) around the plantar wart to reduce pressure on the area when weight-bearing
  • try an over-the-counter medicated wart remover.  Since these preparations may chemically burn the skin, protect the area around the wart with a light coating of petroleum jelly.  This remedy is not recommended for young children or diabetics.
  • gently rub the callused area with a pumice stone after soaking in a vinegar-water solution for 10-15 minutes
  • apply duct tape over the wart.  Change as needed if it becomes wet.  Re-assess the area after 3 – 4 days and leave the tape off overnight if the skin underneath appears wet.  You may apply a drop of tea tree oil before applying the tape.  It may take 6 – 7 weeks to eradicate the wart using this treatment.

When to see your doctor

  • if after 2 weeks of applying home remedies, there is no noticeable change
  • if new growths keep appearing
  • if you are unsure the growth is a wart
  • if you have a previous history of skin cancer or have a close family member with a history of skin cancer
  • if you are diabetic

How to prevent plantar warts

  • avoid walking barefoot in public shower stalls, change rooms, swimming pools, saunas
  • change your socks daily
  • check the bottom of your feet daily.  If needed, use a mirror.

    If needed, use a mirror to check the bottom of the feet.

  • keep feet clean and dry
  • do not touch warts on other people
  • if you touch a wart on yourself or on someone else, wash your hands thoroughly for at least 15 seconds using warm, soapy water
  • don’t scratch warts since this encourages their spread
  • don’t share shoes and socks
  • cover warts with waterproof tape while in swimming pools or shower stalls

Diabetes and plantar warts

If you are diabetic, always have your doctor treat plantar warts. Complications such as poor nerve functioning(neuropathy) and decreased blood circulation (micro/macroangiopathy) make home treatments dangerous for people with diabetes.

Since diabetics have concerns with decreased nerve functioning in their feet (neuropathy), it may not be possible to feel discomfort from a plantar wart.  Daily checking the entire foot to detect new growths or lesions is important.

Over – the – counter wart removers should not be used by diabetics since there is the strong possibility that harsh chemicals in the preparation may irritate healthy skin surrounding the wart.  These irritations may aggravate the area and cause skin infections.  Because of poor circulation, any skin infection in the feet of diabetics must be treated aggressively.

See also:  Lifeguards and Plantar Warts:  A Love Story

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Extreme High Heels

Extreme high heels seem to be the norm this year in women’s shoes.   Shoe store shelves are lined with them; women everywhere totter somewhat awkwardly and uncomfortably in them. 

Historically, women have had a love affair with high heels.  They will always be in fashion.  However, it seems that the heel heights of today are pushing the limits of comfort and safety.

The pictures in this blog post are the result of a visit to the local mall for an informal survey of what most shoe stores are offering for high heel aficionados.  Along with taking pictures, I tried on a variety of  shoes to find out what wearing these extreme heels feels like.

Some women argue that the platform sole in these shoes serves to soften the angle at which the shoe tilts (the pitch).  However, at heel heights of 5 and 6 inches, the pitch of the shoes is still high.

With each pair of shoes I tried, my body was thrust forward.  I could feel my toes being shoved into the front of the toe box even in shoes that were properly sized.  Balancing was precarious as I made a conscious effort to maintain proper posture.  I didn’t even attempt walking.  In the booties shown here, I overturned my ankle.

Fans of these heels often say that they are comfortable and easy to walk in when you get used to them.  Again, an informal survey watching women wearing very high heels indicates to me that they struggle to walk in them and facial expressions show some degree of discomfort.

In a previous high heel blog (here), I outlined the harmful effects of frequently wearing high heels.   These included bunion formation, hammer toes, crowding together of toes and ingrown toenails. As well, the calf muscles, knees, hips and back are strained as the body tries to maintain balance.

The McDermott Footcare client who agreed to have these pictures taken of her feet stated that she wore high, ill-fitting shoes for many years.  Now in her later years, she finds walking very difficult.

Note how the toes are permanently shortened and crowded together.  This is the result of toes being pushed forward in a narrow toe box for many years.  As well, the shape of the foot indicates that my client constantly wore shoes that were too small.

Realistically, women will continue to wear high heels.  This is understandable since a fashionable pair of shoes elevates an outfit and makes women feel attractive.

The same survey of shoes confirmed that there are many attractive, more comfortable options in high heels available at the same stores.  It’s not that women should stop wearing heels all together; it’s that we should be making more reasonable choices, keeping in mind the health of our feet, ankles, knees, hips and back.  We should also be alternating reasonably high heels with flatter shoes.

Fashion and health can co-exist quite well in the wardrobe of a stylish woman.  Many choices are available in a range of styles and prices.  There is no need to sacrifice comfort, health and safety for fashion.

.Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Skin Cancer And Your Feet

May is Skin Cancer Awareness month.   People of all skin colours and ethnicity should be aware of the signs and symptoms of skin cancer.  We often forget to give our feet the same care we give to other parts of our body.  When it comes skin cancer, this is especially problematic since skin cancer in the feet is often not detected until the later stages and the outcome is poor.

Three Types of Skin Cancer

Malignant Melanoma  is the most serious type.  A change in the appearance of a mole or pigmented area is an early sign.

Malignant melanoma. Photo courtesy of National Cancer Institute.

Look for a change in size, shape, and colour.  Watch for irregular, ragged edges, a mole that has more than one colour, is asymmetrical, oozing, bleeding or feels itchy.  While some melanomas may be tiny, most are larger than 6 millimeters.  In dark-skinned people, it usually occurs under the fingernails, the palms of the hands, under the toenails or on the soles of the foot.

In its early stage, Squamous Cell Carcinoma may appear as a small, scaly bump or plaque which may be inflamed.  It may look like a callus and have a history of repeated bleeding or cracking.

Common symptoms of basal cell and squamous cell carcinoma. Photo courtesy of National Cancer Institute.

It may resemble a plantar wart, fungal infection, eczema, or a skin ulcer that doesn’t heal.  According to the National Cancer Institute, in dark-skinned people this cancer usually occurs in areas that are not exposed to the sun, such as the feet.   In light-skinned people, it is more common on the head, face, neck and ears.

Basal Cell Skin Cancer usually occurs on areas that are exposed to the sun.  The National Cancer Institute describes it as a bump that is small, shiny, pale or waxy.

It may also be firm and red or appear as a sore or lump that bleeds or develops a crust or scab.  Alternatively, it may show up as a scaly, itchy, tender spot.

Common symptoms of basal cell and squamous cell carcinoma. Photo courtesy of National Cancer Institute.

Risk Factors

  • For all types of skin cancer, exposure to sunlight is a major risk factor.  Having even one blistering sunburn increases the risk.  Redhead or blonde, grey or blue-eyed, fair-skinned people have a higher risk of sunburn but dark-skinned and people who tan well are also at risk because of total lifetime sun exposure.
  • Having a family history of skin cancer increases the risk as does a personal history of earlier skin cancer.
  • Having a large number (over 50) of common moles is a risk factor.
  • Old scars, inflammation, burns, skin ulcers as well as exposure to arsenic increase the risk for squamous cell and basal cell carcinoma.

    Common symptoms of basal cell and squamous cell carcinoma. Photo courtesy of National Cancer Institute.

Protect Your Feet

The single, most effective way to prevent skin cancer in the feet is to avoid sun exposure, especially between 10 a.m. and 4 p.m.  For most of us, this is unrealistic as is keeping the feet covered.

A broad-spectrum sunscreen applied diligently and liberally to all areas of exposed skin is the most practical solution to sun protection.  Re-apply every two hours and don’t forget the kids who may need to re-apply more often if they have been in the water.

Check Your Feet

It is important to check your feet daily. Look carefully at all areas, including between the toes, the soles of the feet and the nail bed underneath the nails. Make note of any changes to existing moles or the appearance of new moles and other skin markings.  The same applies to skin tags.  If needed, use a mirror held under the foot to check the soles of the feet.  Similarly, ask someone to help you check areas that are difficult to see.  If you find anything suspicious or worrisome, see your doctor immediately.

The warm weather is finally here.  Enjoy it!  But remember to be kind to your feet!

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Foot Care and the Sandwich Generation

“Mom has an ingrown toenail.  Can you come and see her?” 

“My uncle has diabetes.  Do you do foot care on diabetics?”

McDermott Footcare is often contacted by people in Toronto and the GTA who would like a foot care nurse to come and care for a relative’s feet –  mom, dad, uncle, aunt, grandparent – someone they love.  The people who call  McDermott Footcare are busy juggling kids, jobs, lives, but they are also extremely committed to providing the best care for at least one elderly relative.  This is the sandwich generation – responsible for their own immediate family on the one hand and elderly relatives on the other. 

 The internet is full of articles and resources on this phenomenon.  Just Google “sandwich generation Toronto” and you’ll get too many sites for me to link on this blog. 

I am a member of the Sandwich Generation.  My balancing act consists of 8 kids ranging from grade school to a university graduate on one side of the scale and my mom, who is almost as much work, on the other side.  Before dad passed away from complications of Parkinson’s Disease, he was on the scale too.   I still haven’t managed to find the right balance and I know I’m not alone.

People who contact me on behalf of a relative share the common trait of being  dedicated to improving  mom’s and dad’s comfort and well-being.  One daughter schedules her mother’s  foot care appointments over her lunch hour so she can come home from work when I visit her mom.   A son whose father has recently been admitted to a long- term care facility insists that McDermott Footcare be allowed to continue caring  for his dad even though the facility  has their own foot care nurse.   Someone schedules visits for aunt, mom and dad to be seen all at the same time – that’s organized!  Others make sure that visits are regularly booked.   Of course, I look after my mom’s feet.

It’s not easy.   Some days we can’t tell right from left.  Unexpected events can be challenging.    But lovingly giving back to the people who gave so much for us makes everything worthwhile.

 

Tea, Cookies and Potpourri

On Thursday, Dec. 8, I spent a wonderful afternoon making Christmas potpourri and having tea and cookies with a lovely and lively group of seniors.  We were at a community resource centre.   McDermott Footcare had been invited to come and see what they’re all about.

Amidst tea served in porcelain cups, hot mulled cider and an abundance of Christmas cookies, we crafted our individual potpourri.  The resource room smelled of Christmas – cloves, ginger, cinnamon.  Kimberley Davies, Community Relations Manager of Amica at Bayview, guided us through our craft projects.

Some of the seniors reminisced about Christmases past, childhood winter adventures and a simpler time.   For me, that was the best part of the afternoon – getting to know the guests and listening to their stories. 

Thank you to the staff of the community resource centre for your hospitality.  Most of all, thank you to Jack, John, Lorna and the other guests who shared part of your lives with me over afternoon tea, cookies and potpourri.  What a great reminder that foot care is not just about feet 🙂

Why I Became A Foot Care Nurse

 It’s funny how seemingly random, unrelated events all come together to influence a major career decision.  Former patients, past incidents, personal circumstances all played a role in getting me where I am today.

As an RN working in both acute care and continuing care, I often cared for patients with different conditions.  My focus was always on the medical issues, the post-op complications, the controlled chaos of a busy unit.  Even though I sometimes encountered patients with foot issues, I was unprepared to do anything about them.  Even if I did feel compelled to address their overgrown nails and other problems, I didn’t have the time.

I still remember the first time I saw onychogryphosis nails (toenails that look like curled ram’s horns).  I was a brand new RN working on an orthopedic floor and I was so shocked I stared at the patient’s feet.  I didn’t know nails could do that! They were extremely fungal as well.  That disturbing image has stayed with me all these years. 

Fast forward to about 5 years ago.  My dad had Parkinson’s Disease.  He only allowed my mom to care for him and refused all of my pleading to bring in home care.  Dad’s feet were not as bad as that onychogryphotic patient of years ago, but he needed foot care badly.  Unfortunately, he refused all efforts to have his feet problems addressed and we were powerless to convince him otherwise.

On Christmas Day one year before he passed away, dad slipped and fell on the ice after Christmas Day Mass and ended up in the Emergency Room.  As I was prepping him to be seen by the doctor on call, I took off his socks and he became very upset.  He begged me to cover his feet because he was ashamed of  their appearance. 

When dad was in palliative care in the hospital, two weeks before he died, mom overheard a nurse remark on the awful condition of his feet.  She was certain my dad was neglected at home because his feet were horrendous.  The nurse’s unfair assessment hurt my entire family, most of all my mom.

After dad passed away, I convinced mom to let me hire a foot care nurse for her.  She hesitated at first, even argued and yelled at me the morning of the nurse’s first visit, but eventually she began to enjoy the wonderful care.  I was always present when mom was having her foot care appointments and would watch with fascination while the nurse did her thing.

So what do all these experiences have to do with my career move?  I needed a change from my increasingly demanding job as a visiting nurse in community.  While I loved my work seeing patients in their homes, the pace and hours of my job left me with little time and energy for the most important people in my life, my family.  I wanted to work; I needed to work, but I needed balance most of all.  So, I handed in my resignation despite that fact that I had no other position to go to.

After much thought, and even more prayer, I felt that foot care nursing was something I should pursue.  I went back to school and realized that I really enjoyed my course.  Because I was striving for balance between my professional and personal life, I decided that my best course of action was to be an RN in independent practise – start my own nursing business – as a foot care nurse.

I am very much aware of all the foot care episodes of the past when I visit my clients.  I remember all the patients who would have benefited from foot care; dad’s shame when his feet were exposed; mom’s initial reluctance and eventual pleasure from good foot care. 

My dad has taught me to be aware that some people are embarassed when they first show me their feet.  Many clients are certain that I have never seen anything worse!  (oh yes, I have) Feet are very intimate and people need to feel they won’t be judged if they place this part of their body in my hands.  A level of trust develops between my client and myself as I spend 30 minutes or more talking and listening to them as I do their foot care.  Many times, I will be the only person they see that day.  I may be the only one  to remind them to take their pills, make sure they eat on time and just ask them how they are. 

I enjoy my work – I really do.  The people who hire me,  either for themselves or for a family member, seem to like my work.  They arrange regular foot care visits with me every 4 to 7 weeks. That’s a pretty good indicator!  It’s a privilege to be allowed into clients’ homes and an even greater privilege to be asked to care for their feet.

 

About Nursing Foot Care

 In the world of foot care options, nursing foot care is a trusted, professional, convenient choice for discerning healthcare consumers.   Among the various alternatives available, only Registered Nurses possess considerable nursing knowledge and expertise  in order to provide timely,  holistic care which considers the well-being of the entire person.

As a Registered Nurse specializing in foot care, I hold a Certificate in Advanced Nursing Foot Care from an accredited educational institution.  As well, I update my skills and knowledge through continuing education for Foot Care Nurses.  The College of Nurses of Ontario, the Canadian Nurses Association and the Registered Nurses Association of Ontario regulate my practice as a Certified Foot Care Nurse and require that I adhere to Standards of Practice that apply to Registered Nurses,  Certified Foot Care Nurses and Registered Nurses in independent practice.

As a Certified Foot Care Nurse, I believe in the importance of quality foot care as an integral aspect of my clients’ health.  I recognize that my clients may face certain challenges that make it difficult for them to care for their own feet.  Changes in vision, flexibility, hand strength, coordination and mental acuity may make personal foot care onerous. 

 Conditions such as diabetes, rheumatoid arthritis, osteoarthritis, vascular disease and other degenerative conditions affect the health of the feet.  These conditions will often cause pain, nerve damage, skin problems, as well as circulation deficits.  All of these affect the health  and appearance of the feet as well as a person’s ability to use them.  I am able to address, in a non-invasive way, problems which  may develop.  I typically address concerns regarding thickened and fungal nails, corns, callouses, bunions, nerve and circulation deficits, athlete’s foot and other matters.

As a Registered Nurse, I strive to prevent further foot problems for my clients and to address current issues.  To that end, part of my care consists of providing  clear and simple health teaching which allows my clients or their families to better care for their feet between nursing visits.  If needed, I can also make referrals to other healthcare providers.

Clients who regularly receive nursing foot care express an increased sense of comfort and well-being.  The health and appearance of the feet are restored so that the client may once again participate in social activities and activities of daily living because their feet no longer cause discomfort,  pain and embarassment.  The client or their family is empowered and satisified.