The Rollin' RN's

Foot Care For People With A Spinal Cord Injury (SCI): Gotta Keep Those Piggies Happy!


Taking good care of your feet is a normal part of the daily routine for everyone but when you have a Spinal Cord Injury, proper foot care takes on a whole new meaning.

Proper foot care is vital because many people with SCI have little or no sensation in their feet. They tend to spend many hours sitting in their wheelchair, which can lead to swelling in the feet. Circulation in the legs and feet also slows down which can lead to slow wound healing. All these facts set the stage for unattended little things such as bumps, bruises, scrapes and improperly fitting footwear to quickly turn into big things such as skin infections or pressure sores.

Following are some care tips to keep your feet healthy and happy.

Wash, dry and inspect your feet daily. After bathing, make sure to thoroughly dry between the toes. Extra moisture left between the toes can lead to skin breakdown or fungal infections. If skin becomes dry, flaky or cracked rub the feet with a good moisturizer but remember not to apply between the toes to avoid unwanted moisture that can lead to fungus or other problems. Inspect your feet for any unusual changes. Do not try to deal with corns, calluses or other foot problems by yourself. They should be treated by a health professional such as a podiatrist (foot doctor).

Avoid going barefoot. It’s too easy to bump your feet and not be aware.

Wear breathable socks that fit well and don’t leave red marks. Check the toes to make sure they aren’t cramped in the socks. Select shoes carefully. Keep in mind that feet may swell during the day. It is recommended to buy shoes larger and wider to accommodate this. New shoes should be worn for a couple of hours and then removed to check for any pressure issues. Pay extra attention to heels, toes, ankles and outside areas of the feet. Increase the wear time in two-hour increments checking for any redness. When buying new shoes, keep the box and receipt until you know the shoes will work for you. And don’t forget to protect your feet when you swim. Water shoes are a good option.

Treat cuts and sores as soon as they appear on your feet. Cuts and sores can become easily infected and tend to heal at a much slower rate for people with SCI. Mild cuts can be handled at home but check with your doctor for cuts that aren’t improving or look like they may be infected. For areas of redness, remove the cause of pressure from the reddened area and look for the skin color to return to normal.

Signs that the beginnings of a pressure sore may be occurring:

  • When the skin is not broken but is red or discolored.

  • The area shows changes in hardness or temperature compared to surrounding areas.

  • When you press on it, it stays red and does not lighten or turn white (blanching).

  • The redness or change in color does not fade within 30 minutes after the cause of pressure is removed.

For areas of redness that meet any of these criteria, contact your doctor immediately.

Protect your feet at night. Lying in the same position at night puts the heels, ankles and bony prominences of the feet at risk for pressure sores. Repositioning at night can help. When lying on the back, use pillows to float the heels so they are off the bed. Lying on the side, place a pillow between the ankles and between the bed and ankle. Another option is to wear pressure relieving boots or thick fuzzy socks to protect these vulnerable areas.

Following are some common foot problems to watch for:

Athlete’s Foot


Athlete’s foot is a common minor skin infection that can cause flaky, peeling skin and/or cracks between the toes, which can be sore and may become infected. It is caused by a fungus that grows on or in the top layer of skin. It grows best in warm, moist places, such as the area between the toes. For diagnosis, your doctor may refer you to a podiatrist (foot doctor) or a dermatologist (skin doctor). Treatment can include an over-the-counter lotion, cream or spray. For bad cases the doctor may prescribe a prescription for pills or a topical lotion. The best way to prevent Athlete’s Foot is to keep the feet clean and dry, paying close attention to between the toes.

Toenail Fungus


Toenail fungus is the growth of fungus on the toenail or in the toenail bed. Like Athlete’s foot fungus, this fungus grows best in warm, moist environments such as between the toes. It’s actually a very common diagnosis. Infected nails are usually thicker than normal and may look warped and yellow and break easily. If fungus builds up under the nail it can loosen and even separate the nail from the bed. Again, for diagnosis, your doctor may refer you to a podiatrist or dermatologist. Treatment can include topical cream directly applied to the nail, a topical nail lacquer, an antifungal oral prescription pill or a combination of these. Another treatment is to remove the entire nail. Whatever the treatment prescribed, it is important to use the prescription as long as directed by the doctor. Also keep in mind that an infected nail needs time to grow out which could mean weeks. Toenail fungus is hard to treat and has a high reoccurrence rate. So it’s important to treat the current infection and take steps to avoid getting it again. Wash the feet with an antifungal soap and take extra care to get them dry, especially between the toes. Tea tree oil is a common household treatment for toenail fungus that is recommended by WebMD.

Ingrown Toenails


An ingrown toenail occurs when the nail grows into the flesh instead of over it. It usually affects the big toe. When this happens, the site can become painful and infected and may not heal until the nail is removed. Ingrown toenails are most frequently caused by cutting the toenail too short or rounding the nail edges. Another cause is wearing ill-fitting shoes or socks that press the nail into the toe. Pain, swelling, and redness around a toenail are a symptom of an ingrown nail. The sharp end of the nail will be pressing into the flesh on one or both sides of the nail. If you notice an infection, see your doctor, who may prescribe an antibiotic. In many cases, your doctor may recommend partial removal of a severely ingrown nail. Prevent ingrown toenails by trimming the toenails straight across and filing the edges with an emery board or nail file. Keep the toenails trimmed so they are even with the tips of your toes.

Slow down, check out those piggies, and incorporate just a few extra minutes into your daily routine. Giving a bit of extra attention to your feet will be time well spent to keep them healthy and complication free.

It's all good, so keep on rollin,’

Roberta, RN and Patty, BSN, RNC

The Rollin’ RNs ™



References:

http://www.webmd.com/skin-problems-and-treatments/tc/athletes-foot-topic-overview#1

http://www.webmd.com/skin-problems-and-treatments/ss/slideshow-toenail-fungus

http://www.webmd.com/a-to-z-guides/supplement-guide-tea-tree-oil

http://www.webmd.com/skin-problems-and-treatments/understanding-ingrown-nail-basics

http://www.msktc.org/sci/factsheets/skincare/Recognizing-and-Treating-Pressure-Sores

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