For many people with a long-term condition such as diabetes, it is really important for them to look after their feet and to spot early signs of any problems.
Podiatry is the modern term for chiropody, and reflects the increased scope of the profession to become a medical speciality dealing with the assessment, diagnosis and treatment of the lower limb. NHS podiatrists no longer carry out day-to-day foot care, unless treatment is required, so it is usually the PA’s job to do this.
We organised a training workshop delivered by the senior podiatrist from RDaSH which gave PAs information and guidance on nail care, maintaining good foot health and preventing problems. As a number of PA’s were unable to attend we thought it would be useful to pick out some of the key information for this newsletter.
People who are at greater risk of foot problems
As we get older we’re all more prone to foot problems like corns, blisters and foot infections as skin becomes thinner and less elastic. Other reasons for increased risk include:
- Loss of feeling in the feet
- Reduced blood flow
- Hard skin or corns on the feet
- The shape of the feet has changed
- Poor eyesight/impaired vision
- Being unable to look after their own feet
- A history of foot ulcers
- An amputation to part of the foot
People with conditions such as diabetes, peripheral arterial disease and rheumatoid arthritis should be eligible for annual checks with an NHS podiatrist.
How to look after feet
It is the responsibility of the PA to help their employer to look after their feet and toenails to try to stop any problems arising in the first place.
- Toenails should be filed using a long handled broad file which can be bought from any chemist or through the podiatrist. The nails should be filed front to back (not side to side).
- There is no reason for nails to be cut with clippers or scissors as these can cause injury, torn nails and ingrown nails.
- Make sure toes and feet are kept clean and properly dried, comfortable and warm.
- Surgical spirit or witch hazel can be used to dry between the toes.
- Encourage a healthy, balanced diet to keep blood glucose levels stable, lower cholesterol and blood pressure
- Use foot moisturiser on dry and rough skin. Do not apply moisturising cream between the toes
- Check for cracks and breaks in the skin and inflammation such as blisters
- Look for signs of infection like nail fungus
- Avoid loose fitting slippers for people with reduced mobility as they can rub and can increase the risk of falls
- Tight socks and compression stockings can cause toes to curl under and rub together. Tights and socks should be removed as much as possible to let air circulate (raise the feet to prevent swelling if necessary). Compression stockings with open toes are preferable.
- Shoes – a well fitting soft leather shoe, boot or trainer with a wide, stable heel that fastens with a lace, Velcro or strap will help to keep the firmly in place, which will help prevent rubbing. Look inside each shoe for small objects and to check the insides are not worn or creased.
If you notice any changes in the feet of the person you care for, support them to contact their GP immediately.
Spotting a foot attack
- A foot attack is an injury to a foot of someone with diabetes and/or has reduced feeling or circulation in their feet. It is a medical emergency that needs immediate attention.
- Is the foot red, warm or swollen?
- Is there any pain or throbbing?
- Is there a break in the skin or any discharge onto the socks or stockings?
- Do they feel unwell/have flulike symptoms?
A foot ulcer develops when the skin has broken down and the tissue underneath is exposed. People in the high risk categories often find their skin does not heal well and is likely to develop ulcers or infections after even minor injury. A foot ulcer also can become infected and the infection may become severe.
Further information and advice
- NHS Choices Healthy Feet
- Doncaster podiatry services: (01302) 640050