[Table of Contents]

Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Foot Care by Health Care Providers

Introduction

Guidelines, by definition, are directing principles and indications or outlines of policy or conduct, and should not be regarded as rigid standards. These Guidelines should facilitate development of standards but respect the autonomy of organizations and recognize their governing bodies' authority and responsibility to ensure the quality of care provided to their patients/clients.

The guidelines in this document are intended for use by health care providers, including registered nurses, licensed practical nurses, and registered practical nurses, performing routine foot care that is not intentionally invasive.  The settings for the provision of foot care may include locations such as the home, seniors lodges,  community residences, or continuing and acute care facilities.  

Health care providers must follow the scope of practice, standards and regulations of their professional regulatory body in the province in which they are practising (e.g., for nurses providing foot care in Ontario, refer to Nursing Foot Care Standards of the College of Nurses of Ontario).

The number of persons requiring assistance with the care of their feet is increasing with the rising number of elderly persons in the population.  The Victorian Order of Nurses for Canada (VON) has estimated that between 15% and 20% of Canadians over the age of 65 who live at home require assistance with care of their feet⁽¹⁾.  Inadequate foot care, which may produce foot problems such as ulcers or infections, can result in pain and decreased mobility^(2,3).  This may lead to a sedentary lifestyle, which has been associated with cerebrovascular disease and impaired cognition⁽⁴⁾.  The results of a survey conducted by the VON following the nation wide project Keeping Canadians on their Feet⁽¹⁾ revealed that 69.8% of people receiving foot care reported that it helped them to walk.

A. Causes of Common Foot Infections

The origins of common foot disorders can be classified into three broad categories:  biomechanical factors (e.g., defects in foot architecture, direct trauma); manifestations of underlying general and systemic disease (e.g., diabetes, arteriosclerosis); and infections (e.g., Athlete's foot, cellulitis).  Foot infections may be bacterial, viral, or mycotic (fungal)⁽³⁾.

B. Foot Problems in Persons Living with Diabetes

Of all the causes of foot pathology, diabetes has undisputed importance.  People living with diabetes are vulnerable to foot problems associated with peripheral vascular disease and neuropathy, producing a decreased sensation to pain and touch⁽⁵⁾.  Diabetes has been diagnosed in 8 million Americans⁽⁶⁾ and 1.5 million Canadians⁽⁷⁾.  Diabetic foot infections are the most common reason for admission to hospital in persons with diabetes.  In the U.S., the direct costs of admissions for foot infections in 1983 exceeded $43 million⁽⁸⁾.  More than half of all amputations in the United States from 1989 to 1992 occurred in people with diabetes; an average of 54,000 amputations were performed each year⁽⁷⁾.  In Ontario, 45% of all amputations of a lower extremity occur in patients with diabetes, even though these people constitute approximately 5% of the population⁽⁹⁾. One group of researchers reported that the development of ulcers as a result of minor trauma, such as an accidental cut from the use of improper footwear, preceded 86% of amputations.  Unsafe nail and foot care practices have been shown to contribute to foot trauma⁽¹⁰⁾.  It has been estimated that half of all foot amputations can be averted by the prevention, early detection, and treatment of foot infections^(11,12).

C. Risk of Infection Following Foot Care

Infection prevention/control standards for health care providers in the routine care of the feet and nails could not be located in published form.  A literature review from 1980 to the present using the databases Medline and Cinahl resulted in little information regarding the source of infections precipitated by routine foot care.  A selected Internet search for information on foot care/infections found the primary focus to be foot infections associated with diabetes.  A plethora of literature exists on medical interventions for foot infections, and the nursing literature tends to focus on foot assessment, care of the feet and nails, and patient education.

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