Nursing Foot Care: a wholistic approach

At McDermott Footcare, the first visit with a new client includes a concise assessment of pre-existing medical conditions. The reason is because pre-existing medical conditions are reflected in the health of the feet. It is important to consider what is happening to the entire body and not just the feet.

  • arthritis affects the joints in the feet resulting in pain, inflammation, swelling, calluses, and corns
  • a weakened immune system results in fungal and bacterial infections of the feet and toenails that are difficult to treat
  • steroids such as prednisone may cause brittle, thickened toenails
  • poor circulation to the extremities from conditions such as peripheral vascular disease and diabetes may result in pain, numbness, neuropathy, swelling, changes in the colour of the skin, bacterial and fungal infections of the feet and toenails, thickening of toenails, amputation

In nursing foot care, as in all medically-related care, a wholistic approach is best. Since care at McDermott Footcare is provided by a registered nurse, counselling and health teaching is provided as needed. Clients sometimes have health-related questions and they find the knowledge and advice of a registered nurse reassuring and helpful; this gives clients peace of mind.

A wholistic approach to nursing foot care must also recognize the importance of spiritual care. Honouring the person’s spiritual dimension, irregardless of their religious beliefs, is accomplished by treating clients with respect, being nonjudgmental, and actively listening to them.

In healthcare-related professions, it is easy to focus on the procedure that must be performed, the disease that must be treated, the diagnosis that must be addressed. But the persons we care for are so much more than the diagnosis with which they present. In order to give the best care, we must always take a wholistic approach and consider each person’s mind, body, and spirit connection.

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

 

Advertisements

Why Do My Calluses and Corns Keep Coming Back?

shutterstock_113610121-1

A plantar callus

As a Toronto and surrounding area in-home certified foot care nurse, this is a question I often hear. There are many reasons why corns and calluses keep coming back. First of all, what are corns and calluses?

What are the three types of corns?

Seed corn – often found on the ball or the heel of the foot, it is a small, white plug in the skin. It can be painful.

Hard corn – often found on the top of the toe or on the outside of the little toe. It has a thick, white surface.

Soft corn – found between the toes, most often between the fourth and fifth toes.

What is a callus?

A callus is an area of skin that has been subjected to repeated rubbing or friction. An area of dense, rough skin develops to protect the sensitive skin underneath. A callus on the bottom of the foot is called a plantar callus.

What causes corns and calluses?

  • ill-fitting shoes that are either too tight or too loose
  • narrow or pointy-toed shoes
  • high heels
  • structural problems of the foot including hammer toes, bunions, lack of fatty padding on the ball of the foot

How do I stop or at least minimize the occurrence of repeated corns and calluses?

  • have shoes properly fitted
  • avoid wearing very high heels
  • wear mid-high heels that are no more than 2 inches high
  • make sure shoes have well padded insoles
  • there are many good insoles available in the foot care aisle of a well-stocked pharmacy
  • apply moisturizer to affected areas. Use a moisturizer that contains urea since this is especially effective.
  • if you have bunions,  hammertoes or wide feet, make sure your shoes comfortably accommodate them
  • while showering or bathing, use a pumice stone to gently exfoliate dry, rough patches
  • have your corns and calluses reduced by a certified foot care nurse who is trained to do so.

A word about diabetes and corns/calluses:

The risk of getting an infection in the foot is higher in a person with diabetes. Poor healing of open sores and wounds in the foot leads to infection and a higher risk of lower limb amputation. For this reason, a person with diabetes is strongly advised to avoid reducing calluses and removing corns on their own.

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

Foot Care Presentations to Toronto Community Groups

McDermott Footcare gives informational foot care presentations to Toronto seniors’ and community groups. A recent two-day presentation and foot care demonstration was given to the St. Lucia Toronto Association.

Members of the St. Lucia Toronto Association asked many relevant questions regarding foot care. Here are some of their voiced concerns:

What can a certified foot care nurse do for me? A certified foot care nurse can:

  • clip and file toenails, including thickened, discoloured, fungal toenails
  • recognize the presence of athlete’s foot
  • recommend effective home remedies to treat athlete’s foot or
  • advise that a doctor’s treatment and prescription is needed  for more severe cases of athlete’s foot
  • take out ingrown toenails
  • reduce corns and calluses
  • provide padding for corns and calluses
  • advise clients re: purchasing proper shoes and socks

I am diabetic. How do I look after my feet?

  • eat a variety of healthy foods that fall within the guidelines of proper nutrition for diabetics
  • check your blood sugar as per physician’s recommendations to maintain blood sugar levels within accepted guidelines
  • check your feet daily for any cuts, abrasions, bruises
  • contact a certified foot care nurse to provide on-going care of your feet
  • click this link to read a McDermott Footcare article about diabetic foot care

What brand of shoe should I buy?

There are many brands on the market that make comfortable shoes; however, it is more important to look at the style of the shoe regardless of the brand. Click the link (here) to learn about guidelines for purchasing good shoes.

If your Toronto and area community and seniors’ group would like to have a speaker regarding how to maintain healthy feet, please contact McDermott Footcare at 416-997-2949 or at mcdermottfootcare@gmail.com

Nursing Foot Care: Frequently Asked Questions

Recently, McDermott Footcare was a guest expert at a community home care information seminar.  Here are some of the questions asked by the audience as well as frequently asked questions:

How do I know that a foot care nurse is properly trained?  Anyone claiming to be a foot care nurse should be able to show you a Certificate of Completion of an Advanced Nursing  Foot Care course.  In addition, the RN or RPN should have a current Licence to Practice nursing from a nursing regulatory/disciplinary body.  In Ontario, Canada, the College of Nurses of Ontario will be able to verify if the RN or RPN is a professional nurse in good standing with no disciplinary actions against him/her.   Only a RN or RPN can take courses leading to certification in Advanced Nursing Foot Care.

Why does the nurse have to take a nursing history/assessment?  As RNs and RPNs, we understand that there is a connection between the health of the feet and the health of the body as a whole.  Poor circulation and nerve function in the feet affect skin condition, and the ability of the feet to recover from open wounds and infection.  Certain medications affect the condition of the nails and skin, causing them to become brittle, fungal, thickened, discoloured, difficult to cut.   In addition, some medications decrease the body’s ability to fight infection resulting in fungal infections of the feet.  A properly trained certified foot care nurse will be able to satisfactorily explain the correlation between health, medications and feet.

Initial nursing assessment of a diabetic client.

How do I prepare for a home visit from a foot care nurse?  Choose a comfortable chair that you would like to sit in for the duration of the treatment.  A recliner works best as does a chair with a footstool.  If neither is available, the certified foot care nurse can improvise, creating a suitable area to place the feet.  One or two fresh towels are useful also.  There is no need to soak your feet just before or during the visit.

Using the client’s bed as a suitable work surface.

How long is a visit?  The first visit is usually a little bit longer since an initial assessment has to be obtained.  Typically, the first visit is about an hour, depending on the foot care needed.  Subesequent visits are shorter.

Will you teach me how to care for my feet between visits?  An important part  of quality professional nursing care  includes thorough health teaching.  A properly trained, certified foot care nurse should be able to provide appropriate guidelines for self-care of nails and skin between visits.  The RN or RPN will also be able to determine if further medical treatment is needed and advise seeing your doctor.

How much does nursing foot care cost?   Prices vary between nurses and in different jurisdictions.  The nurse may charge a distance fee.  Ask the nurse for their fee.

Can I claim this?  In Ontario, Canada, nursing foot care is an allowable income tax expense.  Some private insurance companies will reimburse up to 80% of cost.  Depending on the fee charged, the Department of Veterans Affairs will reimburse all or part of the cost.  Always ask the certified foot care nurse for a receipt.  Make sure the RN or RPN registration licence is included in the receipt since this is necessary for reimbursement.

Can I have a one-time only appointment?  Certainly.

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

Why Athlete’s Foot Is Dangerous In Diabetes

Athlete’s Foot (tinea pedis) commonly occurs in diabetics.  Since the flaking and peeling skin symptomatic of this fungal infection can resemble large areas of dry skin, affected clients often mistake it for very dry skin.  At McDermott Footcare, monitoring the presence of Athlete’s Foot in diabetic clients is part of the routine, on-going assessment.

What does Athlete’s Foot look like?

The appearance of Athlete’s Foot was described in this earlier blog post (read here), but it bears repeating.

In its beginning stage, Athlete’s Foot shows up as flaky, scaly, peeling skin between the toes, most likely between the fourth and fifth toes.  There may also be  superficial cracking or fissures of the skin between the toes.  It may or may not be itchy.  It is odourless.  If there is a noticeable odour, this indicates a bacterial infection which is different from Athlete’s Foot but of equal concern.

The flaky, scaly area may spread down the soles of the foot.  As it spreads, the affected area often becomes reddened and may feel itchy or burning.  It may develop into moccasin-type Athlete’s Foot, covering an area that would typically be covered by a moccasin-type shoe.

Athlete’s Foot concerns for diabetics

Athlete’s Foot that remains untreated may cause abrasions, small cuts and bleeding in the skin.  This provides an opportunity to develop a bacterial infection known as cellulitis.

Cellulitis is a non-contagious bacterial infection that may occur secondary to Athlete’s Foot.  Diabetics are more prone to developing cellulitis because of a weakened immune system.  It is characterized by redness, swelling, warmth, tenderness and tightness of the skin in the affected area.  Oral antibiotics are prescribed as treatment.  If cellulitis does not respond well to antibiotic therapy, areas of blackened, necrotized or dead tissue may develop, which may result in amputation.

The circulatory system is weaker in people with diabetes.  Poor circulation causes weakening of the immune system, which causes increased risk of infection.  Any infection left untreated can be dangerous.  For a diabetic, the danger increases since unresolved infections in the feet and lower limbs are a leading cause of amputations.  That’s why even mild Athlete’s Foot becomes a concern.

Steps to prevent and treat Athlete’s Foot at home were addressed in a previous McDermott Footcare blog (read here).  It is important for everyone, but especially diabetics, to understand these steps for preventing the fungal infection.  For diabetics, the home remedies should be used as part of a comprehensive treatment plan which includes prescribed anti-fungal creams or ointment from your doctor.

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