Looking after feet is essential for everyone including people with dementia. Good foot health contributes towards retaining mobility, reducing the risk of falling and maintaining independence and quality of life. Foot pain is common and the causes are multifactorial. So identifying that there is a problem as early as possible can be part of a wider pain management strategy. This can prevent more complex injuries developing. It can also alleviates distress that can lead to behaviours that cause difficulties for the person and those who support them.
The person with dementia or their carers have an important role to play in attending to personal footcare as a matter of routine. It can be an area of self care where problems can go unnoticed because feet are generally covered. This might be particularly relevant where a person retains responsibility for getting washed and dressed themselves but lacks the insight to understand when there is an issue or is unable to communicate this. Be alert to the fact that footcare may be neglected especially if the person has physical problems, for example restrictions to their range of movement or dizziness when they bend which might make it difficult for them to look after their own feet. Changes to gait, reluctance to mobilise or general irritability might all be indications that there are problems with someone’s feet.
Healthcare professionals may need become involved, routinely or when problems arise. This may be particularly relevant when a person has other long term conditions such as diabetes, peripheral arterial disease and rheumatoid arthritis. Effective routines around footcare can help prevent problems altogether or timely treatment to be sought that might nip more serious problems in the bud. Seek advice about what local services are appropriate and accessible from your GP.
Good Practice Around Personal Footcare
- Make sure that footwear are a good fit and suitable for the activities that the person is going to participate in. Think about heel height, the type of material that a shoe is made of and how supportive it needs to be. Ensure that soles are non slip.
- Try to work early after diagnosis with a person who wears unsuitable footwear and who might be reluctant to change lifetime preferences. Of course I’m thinking of those who insist on wearing high heels or floppy worn down slippers. Support the person with making more appropriate choices if possible.
- Make sure that shoes do not have any objects in them such as small stones or have wear or tear inside that might cause rubbing and abrasions.
- Going barefoot should be discouraged as this increases the potential for injury.
- Check that socks and hosiery fit well and do not have damage that could cause discomfort or skin damage. They should be changed daily to minimise the risk of infection.
- Wash feet daily. Make sure that they are dried properly and apply moisturiser.
- Feet should be checked daily for redness, swelling, rough skin, signs of fungal infection, discoloured or broken nails, cuts and abrasions and restricted movement. Seek advice from a healthcare professional such as a practice nurse, GP or podiatry service at an early stage. A pharmacist may be able to help where a person is otherwise healthy and problems are minor in nature.
- Think about the logistics of nail cutting. Seek advice about who should do this. For some people this will be a routine tasks but for others more specialist support will be needed. Some people, like those with the chronic illnesses that I mentioned earlier will be eligible for NHS care in the United Kingdom. However this is not a service that is offered across the board to everyone with dementia and private provision may need to be explored.