Providing Foot Care

Purposes:
- To maintain the skin integrity of the feet
- To prevent foot infections
- To prevent foot odors
- To assess or monitor foot problems

Assess:
- Skin surfaces for cleanliness, odor, dryness & intactness
- Each foot & toe for shape, size, presence of lesions & areas of tenderness, ankle edema.
- Skin temperatures of both feet to assess circulatory status
- Pedal pulses: dorsalis pedis & posterior tibialis
- Self-care abilities

Equipment:
- Wash basin containing warm water
- Pillow
- Towels
- Washcloth
- Lotion/Foot powder
- Moisture resistant disposable pad
- Soap
- Toenail cleaning & trimming equipment
- Lotion/Foot powder

Procedure:
1. Introduce self.
2. Perform hand hygiene
3. Provide privacy
4. Prepare the equipment & the client
- Fill the washbasin w/ warm water at about 40 degree Celsius to 43 degree Celsius (105 degree F to 110 degree F). – Warm water promotes circulation, comfort & refreshes.

- Assist the ambulatory client to a sitting position in a chair or the bed client to a supine or semi-Fowler’s position.

- Place a pillow under the bed client’s knees. – This provides support & prevent muscle fatigue.

- Place the washbasin on the moisture-resistant pad at the foot of the bed for a bed client or on the floor infront of the chair for an ambulatory client.

- For a bed client pad the rim of the washbasin w/ a towel. – The towel prevents undue pressure on the skin.
5. Wash the foot & soak it.

- Place one of the clients feet in the basin & wash it w/ soap, paying particular attention to the interdigital areas. Prolonged soaking is not recommended for a diabetic clients or individuals w/ peripheral vascular disease. – Prolonged soaking may remove natural skin oils, thus drying the skin & making it more susceptible to cracking & injury.

- Rinse the foot well to remove soap. – Soap irritates the skin if not completely removed.

- Rub callused areas of the foot w/ the washcloth. – This helps remove dead skin layers.

- Clean the nails as required w/ an orange stick. – This removes excess debris that harbor microorganisms.

- Remove the foot from the basin & place it on the towel.
6. Dry the foot thoroughly & apply lotion or foot powder.

- Blot the foot gently w/ the towel to dry it thoroughly, particularly between the toes. – Harsh rubbing can damage the skin. Thorough drying reduces the risk of infection.

- Apply lotion or lanolin cream to the foot but not between the toes. – This lubricates dry skin & keeps the area between the toes dry or

- Apply a foot powder containing a nonirritating deodorant if the feet tend to perspire excessively. – Foot powder have greater absorbent properties than regular bath powders; some also contain menthol, which makes the feet cool.

7. If agency policy permits, trim the nails of the first foot while the second foot is soaking.

- Nail is cut or filed straight across beyond the end of the finger or toe. Avoid trimming or digging into nails at the lateral corners. This predisposes the client to ingrown toenails. Clients who have diabetes or circulatory problems should have their nails filed rather than cut; inadvertent injury to tissues can occur if scissors are used. After the initial cut or filling the nail is filed to round the corners & then cleans under the nail. Then gently pushes back the cuticle taking care not to injure it. Then the next finger.

8. Document any foot problems observed.

- Foot care is not generally recorded unless problems are noted.

- Record any signs of inflammation, infection, breaks in the skin, corns, troublesome calluses, & pressure areas. This is of particular importance for clients with peripheral vascular disease & diabetes.

Evaluation:

- Isnpect nails & skin after the soak

- Compare to prior assessment data.

- Report any abnormalities to the primary care provider.