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Foot Care At Home

Nails, corns and calluses?  Instructions to take care of them at home.

Professional foot care was a common healthcare service provided by nurses and podiatrists until the onset of COVID-19 and stay-at-home provisions.  Routine foot care is the term used to describe care of toe nails or calluses on a regularly scheduled basis.  Medicare approves routine foot care services every 60 days or more based on need.  Need is often defined as the degree of risk that a patient has related to foot care services.  Poor circulation is carefully defined in the Medicare Guidelines as a defining risk factor that qualifies a patient for routine foot care.  Diabetes and peripheral neuropathy are also qualifying conditions that ensure Medicare coverage for routine foot care.

With the onset of COVID-19 based stay-at-home orders, we have to ask whether routine foot care can be safely provided at home.  The answer to that question is yes, in most cases, routine foot care can be provided safely by friends or family members.  In my clinical practice, I do on occasion see a patient that I simply won’t touch until I’ve established a quantitative measure of their arterial status.  That test can be either an ABI (ankle brachial index) or a CTA (computerized tomography, arterial).  The ABI, although an older test still provides helpful quantitative data regarding arterial flow of the lower extremity.  CTA is popular, particularly for assessment of the level of occlusion of an artery.  When ordering CTA, I stress with the techs that I want an inflow image to the toes.

For those who are unfamiliar with trimming a thick fungal nail or trimming a thick callus, experience does really count.  With a few tries, I think family members can learn some of the subtleties of performing foot care services.  Healthcare tip* - I always have a little piece of gauze and some antiseptic handy just in case the skin is broken while trimming a nail or callus.

How to perform periodic nail care at home

With age, nails tend to change in a number of ways including thickening, becoming discolored or by separating from the underlying nail bed.  The damp environment in the shoe contributes to fungal infections which cause thick, discolored nails.  Nails may also become pinched (pincer nails) or spoon shaped (koilonychias).  Follow these simple steps to insure safe debridement (trimming of toe nails).

  1. Start by trimming the length - Using a curved nail cutter, start at the tip of the toe (hyponychium) trimming the free portion of the tip of the nail.
  2. Move on to thickness – Trimming the length of the nail first helps to determine the thickness of the nail.  Use the curved nail cutters to thin the nail.  Remember that the natural curvature of the nail will make it thicker along the sides and relatively thinner in the center.
  3. Finish with the corners – Once the nail has been shortened and thinned, it is now easier to trim the corners of the nail.  This is the ‘ouchy’ stage where some patient will be concerned about breaking the skin.  With experience, you’ll get better at knowing how much nail to trim in the corners of the nail.  Be sure that trimming is complete and that no spurs are left at the corners of the nail that might result in an ingrown nail.

How to perform periodic callus care at home

Calluses most commonly overlie a prominent area of bone.  Just like the spots in your hand that callus when you do heavy labor, calluses on the feet are going to thicken with increased activity.  The types of calluses that we see in foot care are remarkably diverse.  Some calluses have a small, hard core while other calluses are broad and flat.  Podiatrists who are trained in trimming calluses will use a surgical blade to quickly cut away significant layers of hard callus.  Using a surgical blade is probably not the best starting point for most family members attempting to learn how to perform routine foot care.  A callus file or abrasive, like a pumice stone, would be a better starting point for those just learning.

  1. Preliminary steps - Clean the skin with soap and water.  Some foot care providers prefer to soak the feet prior to care to soften the skin.
  2. Removal of callus – take your time and remove small portions of skin.  Some foot care providers find it easiest to remove a portion of the callus every week rather than the entire callus every few months.
  3. If the skin is broken in the act of trimming the callus, apply some topical antiseptic or triple antibiotic.

Routine foot care can be performed safely at home.  There is a bit of art that goes into routine foot care – how deep to trim, how much to trim, etc.  With experience, you’ll find routine foot care can be fun and saves a trip to the doctor for a non-essential service.  If you do have questions regarding routine foot care, please join me in the Myfootshop.com foot care forum for further discussion and guidance.

Questions about nail care at home?  Join the conversation at this link.

Jeff

Jeffrey Oster, DPM

Jeffrey A. Oster, DPM

Medical Advisor
Myfootshop.com

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