Foot Care

Foot Care

Posted by AskNurseLinda on Oct 16, 2017 12:53 pm

Our feet are precious to us. They serve a purpose of support in both sitting and standing. Positioning of the feet provide balance and alignment of the body. Taking care of your feet is important to overall health. Some issues and how to avoid problems are listed below.

Basic hygiene is needed to care for your feet. Washing with warm soapy water and drying thoroughly between each toe is important. Washing your wet feet with a washcloth can help remove dried skin that tends to collect when your feet are not moving. Typically, this skin will be flaked away within your socks, however if movement is an issue, the skin collects, sometimes leaving big flakes that if peeled off, can lead to open sores on the feet. The texture of a wet washcloth is just right for gentle removal of flakey skin.

Remember, skin works best when left intact, without any cuts or open areas which can let in infection. Using lotion on your feet will help keep them moist. Avoid lotion between your toes. However, be sure to use lotion that is made for foot use. Foot lotion or cream will stay where you put it. Some body lotions will melt on your feet, creeping between the toes forming warm, dark, moist areas where bacteria loves to grow. Bacterial growth, most commonly as athlete’s foot, can be treated with over the counter ointment or spray for just this purpose.

When skin is not being removed naturally, or when something is rubbing your foot, a callous can develop. Most often, a callous can develop on the heel or on the ball of the foot but they can appear anywhere something is rubbing against the foot.
The skin on the bottoms of the feet is tougher as that is where the weight of our bodies meet the earth. The tough skin has developed over hundreds of years from walking directly on the earth. Any irritation from rubbing shoes, to braces, to lack of removal of dry skin, can turn into a callous. As callouses develop, they thicken and become dryer. This can easily lead to cracking open of the calloused area. This opening is another way for bacteria to enter the body as it is an opening in the protective surface of the skin.

Reducing callouses should be done carefully. If the callous is in early development, soak the area in water, then gently use a towel or washcloth to buff the area which will remove the accumulation of dried skin. Never use anything sharp or other than a washcloth as your odds of cutting into delicate skin tissue is great. Dry the foot completely and apply lotion to keep the area moist. The full callous probably will not be removed with just one try.

If the callous is well developed, you will want to do this procedure several times, removing only the surface of the callous, apply lotion for moisture and repeat over several days to slowly reduce the dried skin. Removing the callous too quickly can lead to uncovering of very tender skin since it has not been exposed to the environment. This tender skin will crack open as well, especially with pressure. If you are unsure about a severe callous or have a medical condition affecting circulation, be sure to check with your healthcare provider or podiatrist to have them perform the procedure.

Something rubbing the tops of the toes can lead to corns. These can be painful which your body will recognize even if you do not have sensation. Shoes need to be properly fitted to avoid this condition. Pads for toe corns can be purchased over the counter but if you see a spot developing, change your shoes or check to be sure your socks are smooth to avoid further development. Inspect your feet and toes frequently to note if a corn is developing so you can catch it early and avoid complications.

Maintenance of toe nails is a part of foot general hygiene. Many individuals prefer to have a podiatrist clip their toe nails. This is necessary if you have other medical issues especially circulation issues such as diabetes where a nick in the skin or a cut too close can lead to infection, ingrown toenail and other complications due to medical issues. If you trim your toe nails by yourself or with the help of another person, soak the nails first to soften them. This keeps the nails from splitting or cracking and makes the nail softer for an easier cut. Trim straight across the top of the nail to avoid an ingrown nail along the side. Nails should not be trimmed close to the nail bed. You can also chose to file your toe nails for an even safer trim.
Toe nails can develop a fungus. This appears as a white spot under the nail. Left untreated, it will spread under the nail and even to other toes. Over time, the nail will become hard and thicken. There are products that can help toe nail fungus but when left untreated for too long, oral medication may become necessary.

Edema or swelling in your feet from fluid collection is an issue for most individuals with paralysis. Edema might not always be clearly visible. It is easy to see when the extremity is puffy but sometimes, the edema is only slight or more internal. When this occurs, the skin will look tight and often shinny. There may be discoloration of the skin. Loss of body hair can accompany edema as well as poor circulation. If you push a finger over the shin bone at the front of the leg, you might notice that the skin does not return to the original position but leaves an impression. This is called pitting edema. A medical professional would classify pitting edema as 1, 2, 3 or 4 depending on the depth of the pit and the time it takes for the skin to return to the original position.

One way the body keeps fluid out of dependent extremities is to use the pumping motion of movement. If movement is not present, you can provide it by performing gentle range of motion exercises to the affected limbs. You can also use anti-embolism stockings which provides external support enabling the vascular system to return the fluid to the heart and eventually be excreted out of the body. Elevating the legs and feet for periods during the day will reduce the effect of gravity making the fluid return easier.

Foot drop is often seen in individuals with paralysis of the legs. The muscles of the body are balanced with one muscle pulling and extremity and one muscle pushing it away from the body. In the legs, the pulling muscles can cause the feet pull down, pointing the toes pointing toward the ground. Even something as simple as the weight of a sheet over the feet when lying in bed will further assist the pulling muscles to ‘drop’ the feet. When in bed, you toes should point to the ceiling. When sitting the toes are at a 90 degree angle from your body. When the toes point toward the ground or the foot is flat, in line with the leg, foot drop is diagnosed.

Foot drop can lead to contracture of the ankle as that is the joint that is mainly affected. Without correcting the foot drop, the position can become permanently fixed with the development a contracture. Once this happens, it becomes impossible to move the ankle joint through the full range of motion or even to move it at all. Your body will respond to a contracture, usually by pain even if you do not feel pain. The body’s response can lead to referred pain (pain felt in another part of the body like the shoulder), autonomic dysreflexia (AD), increased spasms, or other noxious stimuli.

Correction of a contracture is done either by serial splinting or casting which can take a long period of time or by surgery which also has inherent risks. Both of these circumstances can be avoided by being proactive with prevention methods.

Ways to avoid ankle contractures and foot drop include wearing pressure reducing boots when in bed and properly fitting shoes when up. The foot should be placed on the wheelchair footrests so it is fully supported. Often seen are feet that have the heel on the rest but the toes sliding off the footrest and pointed down, toward the ground. Both the night boots and keeping the foot on the foot rest will keep the foot in alignment. Performing range of motion exercises will keep the ankle supple, avoiding contractures.

Shoes are an important element to keeping feet healthy. A properly fitting shoe will keep the foot in alignment, help keep it on the foot rest and will avoid any sort of injury to your feet. Wearing shoes will protect your feet from bumping into something, possibly breaking a toe or creating a pressure injury. They can also help to keep your feet warm and dry. If you do have a foot injury, get treatment as complications can occur even if your sensation does not indicate trouble.

Your foot size changes over the course of your lifetime with or without a spinal cord injury. The size shoe you wore in high school is not the same as you will need later in life. Shoes should be fitted for length and width. The toes should be uncramped in the toe box of the shoe. You can measure the toe area by gently pressing on the outside of the shoe to make sure there is enough room. Check your feet frequently to make sure there are no red pressure areas from your shoes. Make sure your foot is positioned correctly within the shoe. Spams can cause the foot to curl within your shoe.

Shoes should be made out of natural materials so there is some air circulation. Leather and breathable athletic shoes work well. Avoid shoes made of plastic, even if they have air holes. These shoes will keep your feet moist. Some athletic shoes are made of artificial materials that do not breathe. You do not want to create and environment for your foot that does not have air circulation because that creates a dark, warm, moist area for bacterial growth and skin breakdown.

Socks will help keep your feet warm and reduce rubbing from your shoes. Socks are similar in that you want fabric that breathes. Cotton with some elastic work well. Socks made entirely of cotton tend to bunch up and lead to pressure areas or callouses. There are socks that are made for individuals with diabetes. They are somewhat expensive but they are thicker and have a lot of stretch which will allow for some swelling from edema. Socks that are too tight or have tight bands to hold them up can add to the development of blood clots from constriction blood vessels in the legs. Panty hose or nylon anklets are manmade material, are not breathable and often have tight bands to hold them up.

Some individuals have difficulty finding and wearing shoes due to extreme edema. Your feet can vastly change during the day. If necessary and your feet are immobile, you can try a size up to accommodate swelling. It is important that you elevate your legs, use elastic stockings and do gentle range of motion to control your swelling. If the problem is extreme, you might need sequential compression stockings (the machine that intermittently applies pressure to your legs) at night or even a diuretic medication.

Taking care of our feet is important for everyone. That is the part of our bodies that is furthest from the heart so circulation can be an issue. Foot care is necessary for overall health and wellbeing. Aching feet leads to other healthcare issues so care for them is essential. Nurse Linda

Re: Foot Care

Posted by panistefanin on Nov 17, 2017 1:26 am

Excellent post. Thank you very much!!
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Re: Foot Care

Posted by JessicaL on Dec 7, 2017 5:23 am

Cool! Very advanced post

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