Neuropathy is nerve damage due to diabetes, peripheral vascular disease, infection, traumatic injury, inherited causes, or environmental toxins. The most common cause of peripheral neuropathy is diabetes. Elevated blood sugar reduces the elasticity of your blood vessels, causing them to narrow. When the vessels narrow, blood flow is reduced. This reduction in blood flow can also cause high blood pressure.
With reduced blood flow, normal sensation and function in the feet is interrupted. The reduction of blood flow is what causes nerve damage and pain. Neuropathy effects each person differently. You may have numbness, tingling, aching, burning, sharp shooting pain, a combination of all the sensations, or no feeling in your feet at all. Some patients report the loss of full sensation in just their feet, or up to a certain level on their leg(s). The pain they say, is unlike anything they have ever experienced before.
If you have diabetes, or neuropathy, it is important to check your feet every day, including the bottoms, tops, toes, nails, and in between. With the loss of feeling in your feet, you could step on a sharp object and not even know it. Meanwhile an infection could start. Unless you inspect your feet every day, wounds and infections can go unnoticed until the severity of the sore requires hospitalization. Diabetic foot wounds are the most common reason for those with diabetes to be hospitalized. For this reason, never go barefoot.
Shoes or slippers with a non-slip tread should always be worn when you are transferring from a bed or chair, standing, or walking. Shoes should always be worn with socks to wick the perspiration away from your skin. Regularly check your shoes and slippers for moisture and/or pebbles or objects before you put the shoes or slippers on your feet. Alternate the shoes you wear each day. Spray them with anti-fungal shoe spray when you take them off, to air them out. Wear the opposite or another pair of shoes the next day.
Thickened, misshaped toenails are not unusual as we get older. It has to do with shoes we've worn over the years, family bone structure, trauma to the nail from dropping something on a toe, or from fungus. Fungus is not necessarily due to lack of hygiene. Locker rooms, spas and nail salons, or the inside of your shoes are all prone to fungus and bacteria. By the time you are an older adult you have many miles on your feet, they have worn many different types of shoes, and you may have banged your toes a time or two. The thickened toenails come from damage to the nail bed and/or fungus. Once the nail bed is damaged, toenails rarely grow "normally" again. Fungus is almost impossible to get rid of without constant and consistent application of topical agents. There is a pill that is sometimes prescribed, but not advised for seniors, due to possible ill effects to the liver. Vick's VapoRub has shown positive results for improving the appearance of fungal nails in clinical trials. It has anti-fungal properties in it and is less expensive than topical anti-fungal agents prescribed or sold at many local stores.
Despite the stubbornness of fungus in the nails, the length, shape, and thickness of toenails can be managed with the proper tools, and care of a certified foot care nurse. We can improve the appearance and comfort of your toenails in and outside of your shoes.
As people age, their skin becomes thin and more fragile if it is not regularly moisturized with lotion or cream. Skin also becomes dehydrated from not drinking enough water and fluids, to replenish what you lose from urination, perspiration, etc. Diabetes and other chronic conditions can also dry out the skin.
It is not necessary to shower or take a full bath every day. That too, dries out your skin. When you bathe or shower, you should use warm water, not hot. Moisturize your skin immediately after showering to hold in the moisture. Apply moisturizer to your legs, and the tops and bottoms of your feet. NEVER apply lotion or cream between your toes. It retains the moisture there, causes the skin to break down and invites bacteria and fungus to the environment. Make sure you dry your feet and in between your toes completely. A clean dry washcloth, swiped back and forth between the toes, works well to remove dead, dry skin and debris from between toes
Statistically speaking, I have not seen enough truly positive outcomes of surgery for hammer toes and bunions to make me shout of their benefits. Patients tell me of new pain that they didn't have before the surgery, bunions "coming back", new deformities of the toes, and other reasons patients felt this type of surgery was not worth the pain they had to go through.
In some cases, a patient's pain is so great, surgery appears to be their only choice. Surgery, in my opinion, should be a last choice option for deformed toes and bunions. If they are not causing you pain, just be sure your toes and the width of your foot have enough room without rubbing. Finding a shoe with a wider or high toe box is far easier, less expensive, and less painful than surgery, especially if you are no more happy or comfortable after surgery. There are also many kinds of pads, and padding that I would suggest you try, before suffering with the pain, or opting for surgery.
Based on my experience, I find every 8-10 weeks for people 70 years of age and older, to be about right. As adults get older, toenail growth generally slows down. This is in part, due to reduced circulation. It is common for folks who go to a podiatrist for toenail trimming, to go every 10 to 12 weeks, as the patient'ss insurance will pay for the care no more often than that. For those who can get it covered by insurance, I advise you to take advantage of that benefit if you can. Some people want and need routine foot care more often. Nurses certified in high-risk foot care are more than capable of providing care that does not require the medical intervention or diagnosis of a doctor. Toenail trimming, reduction of thick toenails, callouses and corns, freeing ingrown toenails (if not infected), are all tasks well-suited for a certified foot care nurse. Expedient scheduling of appointments within 1-2 weeks of your call, and compassionate, thorough care in the privacy of your own home is what sets out service apart.
Whenever you are sitting, elevate your feet and legs with a recliner, hassock, stool, or pillows, allowing the blood to flow more easily back to your heart. Wear compression stockings. This also helps improve the circulation of blood in your legs. Be more active and less sedentary if you are able. Reduce your salt intake and avoid adding salt to meals and snacks. Drink more water, to dilute the sodium in your body, and flush out the toxins.
Fundamental Foot Care, started by Heather Fogg, RN, CFCS, in October 2019, provides in-home foot care in private homes, apartments, and senior living communities and facilities in the greater Bangor area, Ellsworth, MDI, and Blue Hill areas, Dover-Foxcroft/Dexter areas, and now serving greater Portland, S. Portland, and Scarborough. It is a private pay service. We also organize Community Foot Care Clinics at churches, schools, town halls, and other public venues to increase the ready availability of medically based foot care. The clinics allow us to keep costs down so we can pass that savings on to older adults and community members who desperately need this service. As we look to expand the development of our Community Foot Care Clinics across the state of Maine, we will utilize the these opportunities to train more nurses in high-risk foot care. We encourage communities, and organizations to reach out to Heather Fogg at 207-991-0141 or email firstname.lastname@example.org if you would like to sponsor a Community Foot -Care Clinic in your area.
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