Basic Foot and Nail Care in Aged Care

Foot issues are common in aged care – foot pain affects approximately one in four older people (Menz 2016).

Feet should not be overlooked. Foot health conditions can have severe implications, including:

• Impaired mobility.
• Limited independence.
• Diminished quality of life.

(Menz 2016; Black 2017)

The fatty cushioning under our heels and balls of our feet thins and skin loses its elasticity and strength as we age (Health Direct 2019; Australian Podiatry Association 2019,) making older adults more susceptible to foot damage.

In addition, many older people may struggle with foot care as they grapple with other impairments such as poor vision and restricted mobility (Podiatry NZ 2016).

On the more extreme end of foot complications are bone deformities, such as bunions and arthritis. These deformities can implicate foot care and lead to an increase in falls (Australian Podiatry Association 2019).

This article is a general guide for foot and nail care in aged care. Basic foot and nail care relates to Aged Care Quality Standards: Standard 3 - Personal Care and Clinical Care.

Common Foot Conditions

• Arch pain (plantar fasciitis)
• Causes include incorrect footwear, flat feet and walking on hard surfaces.

• Tinea
• Also called ‘athlete’s foot’, tinea is an infection characterised by a red, itchy rash.

• Bunions
• Bunions can push your toes and feet out of shape.

• Warts
• Can appear on the sole, heel or toes.

• Corns and calluses
• A result of pressure from footwear or walking.

• Ingrown toenails
• A toenail curls down and grows into the skin.

• Diabetic foot conditions
• Diabetic foot is the condition of people with diabetic peripheral neuropathy. It results in an insensitive and often deformed foot. Clients who have preexisting conditions, such as this, are particularly vulnerable.

(Health Direct 2019; Health Direct 2017)

Foot Care

• Wash and dry feet (including between toes).
• Check for problems such as cuts, bruises, blisters, swelling and pus.
• Moisturise skin.
• Avoid over-the-counter corn cures.
• Ensure that shoes fit correctly.
• Encourage sensible, supportive footwear.
• Change socks daily.
• Recommend a resident uses a hand mirror to check underneath their feet.
• Recommend an annual foot check by a podiatrist.

(Health Direct 2019; Limbs4Life n.d.; Diabetes Australia 2015; Sydney Medical Centre 2019)

Foot Injuries

Injuries such as cuts, blisters, sores, red areas or cracks should be tended to immediately.

• Wash and dry the area with care.
• Apply antiseptic.
• Dress with a sterile dressing.
• Monitor the healing of the wound over a 24-hour period and seek timely medical attention if it does not improve.

(Diabetes Australia 2015)

Nail Care

• Nails should be cut straight across and filed smooth by a podiatrist.
• Thick and ingrown nails should be attended to by a podiatrist.
• Rub moisturiser into the skin around nails.
• Changes in nails, such as in colour, swelling, texture or signs of bleeding should be monitored.

(Seniors Information Service Incorporated n.d.; Mayoclinic 2018)

Preventing Nail Problems

• Ensure that the resident is wearing shoes that fit them.
• Nails should be trimmed properly by a podiatrist. This invoves soaking feet beforehand, cutting straight across the nail and not tapering corners or trimming too short.
• Keep feet clean and dry.

(Health Direct 2017)

Illnesses that May Affect Foot Health

• Arthritis: can manifest in many forms, it has the potential to damage the joints of the feet.
• Diabetes: can damage the nerves in your feet, reducing blood flow and increasing the risk of infection.
• Poor Blood Flow: can lead to skin changes, pain, coldness, and splintered toenails.

(Health Direct 2019)

Additional Resources

• The Aged Care Quality Standards: https://agedcare.health.gov.au/quality/aged-care-quality-standards#Standard%204
• Australian Podiatry Association, fact sheets: https://www.podiatry.org.au/foot-health-resources/foot-health-fact-sheets/fact-sheets
• Diabetes Australia: https://www.diabetesaustralia.com.au/
• Limbs 4 Life, a resource for amputees: https://www.limbs4life.org.au/

References

• Australian Podiatry Association, Ageing Feet, Australian Podiatry Association, viewed 17 September 2019, https://www.podiatry.org.au/foot-health-resources/ageing-feet
• Black, H 2017, ‘Influence of Mental Health on Diabetic Foot Outcomes’, Lower Extremity Review, viewed 17 September 2019, https://lermagazine.com/article/influence-of-mental-health-on-diabetic-foot-outcomes
• Diabetes Australia 2015, Foot Care, Diabetes Australia, viewed 17 September 2019, https://www.diabetesaustralia.com.au/foot-care
• Health Direct 2017, Ingrown Toenails, Health Direct, viewed 17 September 2019, https://www.healthdirect.gov.au/ingrown-toenails
• Health Direct 2019, Foot Care, Health Direct, viewed 17 September 2019, https://www.healthdirect.gov.au/foot-care
• Limbs 4 Life, Foot Care, Limbs 4 Life, viewed 17 September 2019, https://www.limbs4life.org.au/health-matters/foot-care
• Mayoclinic, Fingernails: Do’s and Don’ts for Healthy Nails, Mayoclinic, viewed 17 September 2019, https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/nails/art-20044954
• Menz, HB 2016, ‘Chronic Foot Pain in Older People’, Maturitas, Volume 91, pp. 110-114.
• Podiatry NZ 2016, Aged Care Guidelines for Podiatrists, Podiatry NZ, viewed 17 September 2019, https://www.podiatry.org.nz/assets/Aged_Care_Advisory.pdf
• Seniors Information Services Incorporated n.d., Care of Your Feet, Seniors Information Services Incorporated, viewed 17 September 2019, http://www.seniors.asn.au/centric/health_wellbeing/healthy_lifestyle/care_of_your_feet.jsp
• Sydney Medical Centre 2019, Easy Foot-Care Guide for a General Health Boost, Sydney Medical Centre, viewed 17 September 2019, https://www.sydmedicalcentre.com.au/articles/physio/easy-foot-care-guide-for-a-general-health-boost/

(Answers: c, b, a)