District Nursing Student shares her thoughts on foot care

We realise that there are many excellent District Nurses working tirelessly in the community and delivering a wonderful service. However, many patients and their carers don't always know about all the services on offer to them. Also, as many e-mails to KISSING IT BETTER reveal, sometimes things can go wrong, and good, sensible information doesn't always reach everyone.

We should value the contribution of any practitioners in the community who may like to send in their own thoughts on this subject. For now, these are the thoughts of Juliet Shaw, a District Nursing Student from Worcestershire Primary Care Trust.

Juliet is a Registered General Nurse and is due to complete her District Nursing Training degree in July 2011. She wrote the following account after completing a module on the 'Management of long-term conditions'. Her special interest was the foot care of someone with diabetes. However, many of the ideas listed below would apply to anyone who may be in danger of damaging their feet as a result of a chronic condition.

Please note that although, as a patient, you may know a great deal about your particular illness or circumstances, it is always important to check with an appropriate medical practitioner or foot specialist before using any of the following suggestions.


Juliet writes....
'I believe there are so many little things that can be done to improve the quality of foot care and make a big difference to quality of life. These are some of the things that I have learnt which I hope will be of help to patients and their carers. But it is important to seek advice from a medical practitioner as care should be tailored to the individual needs of the patient;

Some patients really can't look after their feet themselves, because, maybe they can't bend down far enough to reach their feet, or their eyesight isn't good enough to see properly. So, carers may need to be taught by trained nursing or medical staff to do this for them, and know what to do if they spot a problem.

As a nurse, I am hugely aware of the need to be extremely sensitive to the feelings of the patient, who might find it embarrassing to have someone else looking at their feet. Spend some time listening to their concerns, explaining about the importance of foot care, and building up a rapport.e

It is important to be mindful, that some patients may not be able to feel pain if they injure their feet, or the sensation of heat and cold, because of damage to the nerves caused by diabetes, or other conditions, so extra special care must be taken.

Vulnerable patients need to have their feet washed and checked every day, but don't soak, or use foot spas. Both can cause the skin to become very dry, increasing the risk of infection, and foot spas may also damage skin that is often already thin and fragile, especially when patients can’t feel when the action of the spa is becoming uncomfortable.

When washing feet, make sure the water is not too hot; the patient may not be able to feel the temperature of the water (buying a water thermometer is advisable, if not, test the water with your elbow). Dry feet very carefully, especially between the toes. Apply cream if the skin is dry, but only on medical advice.

Check the feet every day for any changes in the skin or nails. Look at the top of the feet, the soles of the feet, around the heels, between the toes and at the toe nails. You are looking for blisters, hard areas of skin, cracks in the skin, signs of injury e.g. bruising, bleeding, swelling, reduced movement; signs of infection e.g. unusually pink/red, warm or hot, swollen areas of skin with or without pain, reduced movement; signs of poor circulation e.g. numbness, cool feet, pale, unusually discoloured skin, bluish nail beds. Keep a record of this and if you notice any of these, seek medical advice.

Advise patients to avoid self-management of foot problems, and see a medical practitioner e.g. Podiatrist, GP, consultant specialist, or member of the specialist diabetic team, as soon as possible.

Check inside shoes or slippers before you put them on, to make sure there is nothing in them that could injure the feet. For example, I once knew a diabetic lady who injured her foot badly, because she had a drawing pin sticking through the sole of her slipper that she couldn't feel!

Advise patients not to go barefoot to avoid risk of injury.

Advise patients to avoid the use of hot water bottles and electric blankets and not to sit too close to fires or radiators which could risk burning their feet. If their feet have suffered some form of nerve damage, they may be less aware of heat or pain.

Advise patients to not let their toe nails get too long, and avoid cutting them themselves as they risk damaging the skin around the nail Advise them to see a podiatrist.

Advise patients not to use corn plasters until they have checked with a medical practitioner.

Advise patients to wear specialist footwear if it has been recommended by medical staff. Otherwise, advise to always wear well fitting shoes, with broad toes and low heels, to prevent damage to the skin from shoes rubbing. Break new shoes in gradually, as wearing them for long periods of time may cause them to rub.

If the patient has diabetes, advise patients to attend their annual diabetic review which includes assessment of the feet.

Advise patients to try and maintain a healthy lifestyle. If they have had diabetes, or are at risk of diabetes, good blood sugar control is vital as this can impact on the health of their feet.

Patients are, I know, given very good advice about foot care, but timely reminders are always a good idea'.

Juliet Shaw
District Nursing Student