Bed Care For Feet

Due to the increasing costs of care homes, and the increased risk of the covid-19 virus in general, more people are choosing to use home care companies to stay at home longer.  Commonly, a key piece of medical equipment is the bed, with it's guard frames at the side, the very sturdy headboard, the back support to enable the user to be able to sit up without the use of 10 pillows, and a footboard at the bottom.  The other main feature, for hygene reasons, is the waterproof / wipe clean matress.  All these features are designed to keep the user safe and comfortable, but recently I saw a situation which needed some basic changes to prevent a potentially major health problem and raises the challenge of bed care for feet.

Please note this article contains photo's of traumered toe nails, before, during and after a treatment.  As podiatrists we see and deal with these types of nails day-in and day out, and give patients a great deal of satisfaction and comfort from our treatment.  HOWEVER, some more sensitive people may not wish to view the images, so click here to return to my home page.

I'd like to start by saying a big thank you to my client who has allowed me to use the photo's taken of his feet in this article to help prevent similar problems occuring.  The gentleman is a large chap, and very tall.  He has been in a wheelchair for many years, and is now confined to his bed for most of the day, unless being taken out by carers.

The Existing Health Risks

With the client being tall, he is already at an increased risk a condition called Peripheral Arterial Disease (PAD), which in simple terms means he could had reduced blood flow to his feet, resulting in a slower rate of healing in the event of infection.  He's also a Type 2 Diabetic, which also means he's at a higher risk of problems with his feet.

The problems we have in this particular case are the following.

1. The patient is quite heavy
2. He has limited sensation in his feet
3. His legs are very long

When you combine his weight, limited feeling in his feel and his long legs together, when the patient is propped up by the back support for him to eat or watch TV, he's sliding down the bed, as the washable matress is slippy.  This is causing his feet to be pressed against the foot board, and cause pressure on his toe nails, pushing them back into his toes.

His toe nails are normally cut short on a regular basis, but with recent events, including an extended stay in hospital, his nails had grown longer than normal, and had extra pressure on the toes from the bed board.

When nails aren't cut back to a short, comfortable length on a regular basis, the nail grows beyond the end of the toe (the big toe's in this case).  In this case, the nails had been left too long, due to lock-down restrictions, and with the feet pressing against the foot-board of the bed, the nails have been pushed back into the toe.  This is the equivelent of stubbing your toe very hard, or wearing shoes which are too small.  The blackened area round the nails is dried blood, where the toe has bled, due to repeated high amounts of pressure against the nails.

In a situation like this, we want to cut the nails back, to prevent any further nail trauma, and clean up the dried blood to make sure there is no infection going on underneath the dried wound.

The right toe is still very sore underneath, and this is due to the nail being pushed around, and irritating the skin at the side of the nail.  However, now the nail has been cut back, this should stop.    The left toe has some signs of trauma remaining, but not as bad as the right.  Going forward, we need these wounds to heal, so the toes get an inadine dressing applied, along with a sterile dressing on top, and some tubular toe bandage applied, all fixed in place with a hypoallergenic tape.

And finally, all dressed and protected to prevent further infection.  After several follow-up visits, the toes calm down, and continue to improve.  The key action for moving forward is to prevent this from occurring again.  Obviously regular cutting of the toe nails buy a qualified professional is essential, but what else can be done?  In this case, the main object causing the pressure on the toes was the footboard at the bottom of the bed.  This cannot be removed, for safety reasons, so the next sensible option is to place a pillow under the feet to raise them up, and make sure the toes are clearing the footboard.  The bottom of the feet can still press against it if the person slides down the bed too far, and will still need their feet checking for pressure sores (common in many people who are bed-bound), but this will prevent pressure being placed straight onto the end of the toe nails, and causing a repeat of this problem.

This type of injury can be caused if you stub your toe, and your nails are long.  If your nails aren't long, you are more likely to get a swollen / bruised toe, which should resolve itself within 1-2 weeks.

As mentioned earlier, wearing shoes which are not fitted correctly (combined with long nails), can also cause this problem.  If the shoes are too small, you will have a constant pressure on the nails.  If the shoes are too big, your feet will be sliding around inside your footwear, and hitting the end of the toe box.  This is quite common in walkers, who buy boots a whole size larger than they need, so they can wear 2 pairs of socks.  In this case, I'd always recommend buying the correct size footwear, and wear a very thin pair of socks against the foot, with a thicker sock on top.  This will reduce the over-all thickness of two pairs of normal socks, and the thin pair allows sweat to leave the foot, and be absorbed into the second pair, keeping the foot dry, and reducing the risk of fungal infections. 

Keep your toe nails cut comfortably short.  If you can't manage your own feet, make sure you get them cut by someone suitably qualified.  Always make sure you wear the correct size footwear.  And if you have a family member using a medical bed, don't let the feet press against the footboard.