​When Kirk Geter, chief of podiatry at Howard University’s College of Medicine in Washington, D.C., would first enter a long term care facility to provide care, he often found that staff weren’t good at identifying foot problems or providing good daily foot care. But since educating staff was always a big part of his service, they became skilled at it. “The key to that is education, educating everyone who comes in contact with the person daily, and the family, too. Only through everyone working together is the quality of life improved for these individuals.”
Facility staff tend to be very receptive and eager to learn, Geter says, and they implemented what he taught them. “It wasn’t like they got the information and then discarded it,” he says. “It was, ‘This is good, we can work with this, and by the way, can you see some of these other individuals’” with foot problems?

Choose Correct Footwear
In some long term care facilities, Geter found that staff, despite best intentions, would put inappropriate footwear on the residents, and then “want them to be active and move around,” he says. Sometimes a resident may have chosen inappropriate footwear for themselves.
“As a general rule, as we get older, we lose the integrity of the support mechanism under our feet,” he says. “Supportive footwear would have rubber soles to provide added support. Also, as we get older our feet spread—the structures inside become looser,” so a resident’s foot size may have changed. Staff should have the podiatrist measure their feet and then check that measurement against the resident’s shoes.
Staff can also “cut down on bacterial or fungal infection by making sure feet are washed and dried daily,” Geter says. While washing the feet, the caregiver should look for any cuts or scrapes, particularly on the soles of the feet, or areas of irritation, which indicates poor-fitting footwear.
In addition, staff can encourage residents with poor circulation to do various exercises, such as walking, if that’s an option for the resident, or if it’s not, “wiggling their toes and rotating their ankles in a clockwise then counterclockwise direction,” suggests Geter. “That helps push blood through their legs to improve their circulation.”

Listen To Residents
Providing foot care to nursing facility residents is different from providing such care to community dwellers. “You often have to spend a lot more time with patients in this category,” he says. “They always want to chat more, which is great, and you need to listen to them. It’s a trust thing. Sometimes they’ll do more [of what the podiatrist recommends] if they trust you more.” So, after interviewing the podiatrist to determine his level and kind of experience, watch him or her interact with residents to see if he or she has the patience and interest in developing this level of trust with them, Geter recommends. And always ask for references and check them out, he says.