The Importance of Nursing Foot Care for Elderly Parents

shutterstock_3306989Increasingly, McDermott Footcare receives out-of-town and out-of-province enquiries from people requesting nursing foot care services for their parents or other family members who live in Toronto, Canada.  This indicates families’ close involvement in the care and well-being of their elderly parents.

Often, people express concerns that mom and dad are unable to care for their feet because of these common underlying factors:

  • a diagnosis of diabetes
  • arthritis that makes self-care challenging
  • limited mobility
  • poor eyesight
  • inability to reach their feet
  • a diagnosis of Alzheimer’s Disease or dementia
  • other medical conditions that limit self-care
  • the use of blood thinner medication
  • thickened, fungal toenails that are difficult to clip

In the elderly population, fungal nail and skin conditions as well as painful corns, calluses and structural changes are common.  An important consideration to note is that parents may be reluctant to show their feet or talk about foot-related issues because they are embarrassed by the appearance of their feet.  Patience and understanding are needed when discussing these issues with elderly parents since mom and dad hesitate to show their feet, even to their adult children. Very often a new client will say to me: “oh nurse, you’ve never seen feet as ugly as mine.”   Mom and dad need reassurance that they can seek nursing foot care without embarrassment or fear of judgement.

If mom or dad express pain and difficulty when walking, gently ask them about their feet.  In most cases, maintaining regular nursing foot care visits will resolve their concerns and enable them to remain active and on their feet.

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

What To Look For In A Foot Care Nurse

Who is a certified foot care nurse?

Only currently registered, licensed Registered Nurses, Registered Practical Nurses and Licensed Practical Nurses who have completed a certification course in Advanced Nursing Foot Care  can practice nursing foot care.  In Ontario, Canada, the public can access information on the College of Nurses of Ontario (CNO) website verifying the current standing of an RN or RPN to practice nursing in Ontario.  A certified foot care nurse should be able to produce a certificate of completion in Advanced Nursing Foot Care.  Don’t hesitate to ask to see it.

What services can I expect?

  • Obtain a medical/nursing history and be able to make correlations between medical conditions and medications as they apply to the overall health of the feet
  • Assessment of the feet
  • Toenail cleaning, clipping, filing
  • Removal of ingrown toenails
  •  Corn and callus reduction
  • Padding of tender areas
  • Foot massage
  • Assessment and recommendations for footwear
  • Assessment and recommendations for skin conditions such as tinea pedis and cellulitis

Who benefits from nursing foot care?

  • diabetics
  • people with rheumatoid arthritis
  • individuals with vision problems
  • individuals with mobility problems
  • anyone who is unable to self-treat conditions such as fungal and thickened toenails, corns, calluses, athlete’s foot (tinea pedis)

Payment and Coverage?

For Canadian veterans, nursing foot care is covered by the Department of Veterans Affairs (DVA).  Ask the foot care nurse if she/he is a DVA Provider.

There is a fee for service for certified nursing foot care services.  Some private insurance providers will cover a portion of the fee.  Nursing foot care services are an allowable income tax deduction.

Always obtain a receipt for payments made.  Make sure the foot care nurse includes their nursing license/registration number on the receipt.

Other Questions to Ask the Foot Care Nurse?

  1. How do you clean your instruments?  In Ontario, Canada, the Ministry of Health and Long-Term Care mandates that foot care instruments are to be sterilized by autoclave.  No other method of cleaning/disinfecting will thoroughly sterilize instruments.  Some foot care nurses still do not sterilize by autoclave.  Before the first visit, ask if their instruments are autoclaved.
  2. Frequency of visits?  Typically, visits are scheduled for every 6 weeks.  This may vary depending on individual clients.

Where to find a foot care nurse?

  • online – some certified foot care nurses have online listings, blogs
  • home healthcare agencies may provide certified nursing foot care as in-home visits or in clinics
  • your doctor may be able to make a referral
  • in Ontario, Canada, Community Care Access Centres (CCAC) have listings of certified foot care nurses
  • word of mouth

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

Summer Foot Care Tips For Diabetics (And Others)


In the words of George Gershwin, from his opera, Porgy and Bess, “Summertime, and the livin’ is easy…..”  It’s time to kick off our socks and shoes and feel the warmth on our hardworking feet.  It’s very tempting to walk about in our bare feet, enjoying  the softness of the grass and squishing the sand between our toes.

However, for people with diabetes and other people with decreased nerve sensitivity and circulation in their feet, walking barefoot could turn a pleasant summer day into a medical dilemma.  Diminished ability to feel different sensations in the feet as well as poor wound healing due to poor circulation can cause problems.

A person who cannot adequately detect sensations of pain will not be aware of cuts to their feet, especially the bottom and in between the toes.  It is not unusual for a diabetic patient to be unaware that they have developed a cut, splinter or other abrasion until someone, such a certified foot care nurse, detects the issue. By then, there is often the beginning of an infection which must be dealt with aggressively.  The existence of poor circulation, which goes together with poor nerve functioning, means that the body needs help fighting the infection.  Diabetics have a higher than average incidence of lower leg amputations.  Even the smallest infection can quickly become very aggressive.

Another reason it is never a good idea for diabetics to walk in bare feet is the decreased ability to feel changes in temperature.  The pavement as well as the sandy beach can be problematic if we are unable to detect how hot these surfaces can become.  It is easy to scorch and burn the bottoms of the feet without realizing it.  Even a minor burn can become a major infection.

Plantar wart from a public pool.

Without the protection of sandals or other appropriate footwear, it is possible to develop fungal, viral and bacterial infections from walking on public surfaces such as pool decks, saunas, change rooms.  Plantar warts, athlete’s foot and toenail fungus are the most common conditions that are picked up from these surfaces.

Because we tend to perspire more in warm weather, athlete’s foot is a common problem.  Again, in diabetics and others with nerve/circulation deficits, athlete’s foot must be diligently treated.  Athlete’s foot that is allowed to spread can cause abrasions and infection.  Read about why athlete’s foot is dangerous in diabetics and what to do about it here.

Don’t forget to liberally apply sunscreen to your feet when wearing sandals.  Skin cancer in the feet often goes undetected.  For a primer on skin cancer and the feet, as well as pictures of what different skin cancers look like, read here.

 We often develop dry, cracked heels in the summer because of the amount of activity we do and because of the effects of the sun and hot weather on the skin.  Here are 8 tips for dealing with dry, cracked heels.

As well, with our toes exposed, women enjoy the pampering of pedicures.  Be educated about getting a safe maniciure/pedicure, here.

Wear well-fitted sandals that support your feet. Check your feet daily, once in the morning and once in the evening.  If this is difficult to do, have someone check your feet for you or use a mirror held against the bottom of your foot to get a good view.

It’s easy to take care of our feet while we enjoy the beautiful weather.  Have a wonderful summer!

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

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