BASIC FOOT CARE AND MANAGING CPOMMON NAIL PATHOLOGIES

1. BASIC FOOT CARE AND MANAGING CPOMMON NAIL PATHOLOGIES Chapter 14 Matthew Cole

2. Introduction • This presentation provides basic information on caring for a patient’s feet. You should use it in conjunction with the more detailed written chapter in the printed book. • Part 1 – Basic Foot Hygiene and Infection Control • Part 2 – Basic Nail Care and Nail Care Tools • Part 3 – Cutting Toenails and Diabetic Nail Care

3. PART 1: Basic Foot Hygiene and Infection Control

4. Basic Foot Hygiene • Feet should be washed daily: • Avoid harsh soaps on fragile or dry skin. • Pay attention to the area between the toes - try a cotton bud when dealing with deformed or recently ‘fixed’ toes. • Dry the feet thoroughly after washing, especially between the toes. • Use a suitable emollient daily for anhydrotic skin, but avoid putting between the toes. • Ensure clean hosiery is used each day, as well as footwear which is clean and dry. This is very important when wounds are present or the individual has continence issues, when it must be changed as required.

5. Infection Control • Always follow standard hand hygiene protocols. • Make sure the feet are clean before starting. • You do not need to use antiseptics or skin cleansers to prepare the nails and skin. • The use of gloves when cutting toe nails is preferable but not always mandatory. Check local infection control policies. • Instruments used for cutting toenails should be either: - Disposable single use (i.e. used only once). - Pre-packed sterile, to be returned to centralised sterilisation service after use on a single person. - Single-patient use – not to be used on other patients (not preferable in multi-occupancy settings such as wards and care homes). • Sterilisation consists of washer-disinfector cleaning followed by autoclaving. • Again, check and follow your local infection control policy.

6. Basic Nail Anatomy • Free edge • Sulcus • Nail plate • Lunula • Eponychium

7. PART 2: Basic Nail Care and Nail Care Tools

8. Basic Instruments for Nail Care • Nail nipper and foot file • Foot file can also be used on callous (“hard skin”) avoiding excessive use, or use on callous that does not cause discomfort.

9. 1. NIPPERS Grip handles with top arm against your fingers and the bottom arm in your palm. Use to “nip” not cut, as you would with scissors. Nippers safer than scissors and superior to clippers. Using Instruments

10. 2. FILE: • Place file between your little and fourth fingers. • Grip with 2nd, 3rd and 4th fingers. • Use thumb to put pressure against the nail. • Use in a downwards direction only.

11. PART 3: Cutting Toenails and Diabetic Nail Care

12. Make sure the patient is accessible - think of your back! Have patient on a couch or bed. Simple nails: May be filed or cut. Cut nails straight across the top. Do not cut the nails down into the corners. The corners of the nail should be up, clear past the ends of the sulci at the end of the nail. Can you see a small, white free edge remaining? File any rough edges or sharp corners Cutting Toenails

13. Cutting Toenails 1. Cut the nail one part at a time • 2 Grip the toes and forefoot with your opposite hand to stabilise it. 3 Cover the nippers with a finger from the opposite hand once in position, but without touching the blades.

14. 4 Gradually “nip” along the nail, cutting off one piece at a time. • 5 File the nail, using a back and forth motion, with pressure only on the downward stroke. • Do not file side to side.

15. Before and After

16. Use the nipper to take small pieces at a time, using the point of the nipper to “break into” the nail. Cut using the side of the nipper. Gradually “reduce” the nail down. File the nail - caution with the dust from mycotic nails. Cutting Thick or Hard Nails

17. Patients with Diabetes • “Nurses are not allowed to cut the toenails of patients with diabetes” • This is an Urban Myth – there is no reason why simple nail care cannot be carried out by nurses and other health professionals for patients with diabetes. • Caution should be taken with those patients assessed as being at increased and high risk (neuropathy and ischaemia present in the feet – see NICE guidelines).