Recently I was talking to someone who had a family member that had to have a toe amputated. She commented that she thought that was very unusual, but I assured her that particular surgery – transmetatarsal (tarsal refers to the seven bones of the human tarsus that form the ankle and upper part of the foot) amputation (TMA) – is actually a common procedure, especially when diabetes is involved. The most common goal is to safeguard limb viability. It is used in both orthopedic and vascular surgery and is a treatment in patients with foot infections, necrosis, gangrene and diabetic neuropathy.

The American Podiatric Medical Association has stated that by the time an American reaches the age of 50, on average, he or she has walked a total of 75,000 miles. (No wonder I gave up my high-heels soon after I reached that milestone.) With so much use, it is common for seniors to experience a wide variety of foot disorders, many of which are painful and can limit their mobility. 

When was the last time you carefully examined your care recipient’s feet?

This is a really important task, that to tell you the truth, I do not hear mentioned often in caregiving resources. The first time I inspected my dad’s feet (I was looking for the source of a foul odor), I was shocked to discover debris and “yuck” between his toes. For years he had been bothered by a bunion, which I inherited. His remedy was to cut a hole in the top of all of his left shoes to prevent the bunion from rubbing. He also had some toenail fungus with a couple of really offensive-looking nails. Otherwise, his feet were in pretty good shape with no skin infections or open sores, and I tried to keep them that way. Growing up, Mother mentioned many times that I would have probably never been born if Daddy had not had flat feet. That was the condition that kept him from being drafted during the Korean War, so I felt an obligation to take good care of his feet. 

Elders can develop all kinds of feet problems, and hurting feet have a tendency to affect the entire body. Just think about the last time you wore a pair of ill-fitting shoes longer than you should. Ouch! (Actually, you should not wear ill-fitting shoes at all.) Care recipients with feet problems may require additional assistance with their activities of daily living. Feet are often the first parts of the body to show symptoms related to diabetic neuropathy, arthritis and other ailments. 

Let’s look at some guidelines for taking care of feet.

• As a caregiver, you should assume the responsibility of thoroughly inspecting both feet daily. The best time to do this is when your loved one is lying in bed so you can assess each foot without straining your back. Look for any cracks in the skin, discolored or brittle toenails, calluses, blisters, redness or swelling. Observe for any changes or irritation in bunions or other foot deformities. If any of these are present, you should make an appointment with a health care provider. Even if some of these problems can be treated at home, you need professional advice to prevent small problems from becoming serious ones.

• Thoroughly wash feet daily. I hope you just didn’t imagine yourself on your hand and knees, scrubbing between toes while your recipient is in the shower. That’s not at all what I had in mind. Again, it is easier to do this when your loved one is comfortably lying in bed, with only his feet uncovered. Just before bedtime may be a good time, as many people find that having their feet washed is relaxing. Place a towel or waterproof pad on the bed and use a basin of lukewarm water and mild soap. Earlier I mentioned the “yuck” I discovered between my dad’s toes. It was a build-up from powder, which he put on his feet daily. I have an easy remedy. Using the edge of a clean washcloth, gently pull it back and forth between each toe, making sure to use a clean section for each swipe. Then cleanse the entire foot with a washcloth. Gently dry, using the edge of a clean towel to swipe between each toe (same method you used to wash between them). This procedure should prevent any yucky build-up. Follow up with a dusting of quality foot powder between the toes and a moisturizing lotion on the tops and bottoms of the feet.

• Trim carefully – or not at all. If you do choose to trim toenails, be very careful not to cut the skin. Cutting straight across is best – to prevent corners being cut too close, possibly causing an in-grown toenail. If toenails are thick, deformed, or you just do not feel comfortable cutting them yourself, make an appointment with a podiatrist. Even in long-term care, we often referred patients with less-than-perfect toes to a podiatrist for regular trims – especially those who were diabetic. If your recipient’s toes are in great shape, it is probably okay to provide toenail care at home. If so, you can make it more pleasant for him and easier for you by soaking feet first in luke-warm water (a squirt of body-wash is a nice addition), and gently massage with lotion for a finishing touch. Don’t let toenails grow too long without a trim, and clip or file any that are broken or jagged. You should not try to remove corns, calluses or warts yourself. These require a doctor’s attention.

Always wash your hands and sanitize equipment after providing foot care.

• If your recipient is still ambulatory, make sure his shoes fit properly and are comfortable. Appropriate shoes provide good support for the ball of the foot, the arch and the heel. Elders do better wearing shoes with good support, even around the house. Going barefoot is not a good idea for two reasons: lack of support and possibility of injury. If there are problems that persist with footwear, you may need to buy shoes from a specialty store where the salespeople are trained to find the proper fit.

What goes on before the shoe is also consequential. When choosing socks, make sure they are made of fibers that wick sweat away from the skin (not 100% cotton – look for an acrylic blend – and avoid nylon). Best socks are seamless, not too tight and do not have a restrictive elastic band around the top. 

• In long-term care, when even a tiny skin opening was observed on a heel, we would immediately begin “floating” the heel. A pillow was used to prop ankles so feet were suspended in air, rather than pressed against the mattress. For those who spend a lot of time in bed or lying in a chair, this is also a good preventive measure.  Please don’t do what became a nightly habit for one nursing assistant that worked on my hall. She would tuck in the covers at the bottom of the bed so tightly, that patients could barely move their feet. I would go behind her and loosen them. To promote circulation, elevate feet when your loved one is resting. If they are able, encourage them to wiggle their toes or make circles with their ankles several times throughout the day. Crossing legs, whether sitting or lying, can obstruct blood flow to the legs and feet.

• In addition to a thorough daily examination of both feet, pay attention when your recipient complains of pain, numbness, or tingling or you notice redness or swelling. A doctor’s visit is in order.

Taking care of your loved one’s feet is indeed an important responsibility. It is vital to catch any problem early and get medical attention to avoid complications, some of which can be dire.  

No one wants to lose even one little piggy.

Caring Quote: “The human foot is a masterpiece of engineering and a work of art.” – Leonardo da Vinci