Tenacious nail fungus

Vicks Vinegar Tea tree or something else –

We see a lot of patients with nail fungus. Yup, we have heard a lot of remedies and we also understand how embarrassing and worrisome it can be. From Lemons to antifreeze we have heard stories. Despite a lot of marketing hype there is also no evidence based treatment for nail fungus. So… what to do

Vicks is a common suggestion. The rationale is that the menthol impregnated petroleum will some how suffocate and mentholate the fungus. While there may be some truth to this, the reality is the petroleum softens the nails, sometimes so much that they literally melt off. That’s one way to get rid of a fungal nail but the fungus is still there and will continue to flourish.

Any antifungal only applied to the nail (that’s tea tree, listerine, fancy nail polish, expensive liquids), struggles to get down through the protective keratin layers. People put a lot of effort into getting rid of fungus. They also often mistake a thick nail ( dystrophic) or an injured nail for a fungal nail. Sure, there are success stories, but honestly fungus is tenacious.

At FootCare by Nurses we decided to take a different approach. Instead of just looking at the nails, we look at the skin on the foot. Is there a sub clinical issue happening there? What about the immune system?

You see nail fungus has friends, and those microbiological friends are part of a system that supports nail fungus. If the immune system is struggling opportunistic infections happen. If we can kindly remove some of the friends, and the food that nail fungus eats, and then enhance the health of the skin and maybe even talk about immunity, then maybe a healthier looking, fungal free nail can grow out.

How do we do this? Well we do a full foot assessment and we are looking for clues. We ask … what’s going on ( we are nurses so we can do this). We also take a high speed rotary tool and remove (debride) the nail of fungus and reduce the thickness back to a functional thickness. Our recommended soak is Apple cider vinegar for the whole foot. Vinegar is the same acidity as the skin is supposed to be. the evidence says vinegar supports the efficacy of antifungals. We then recommend coconut oil or coconut oil based lotions. And we give instructions and monitor.

Nope, we don’t recommend Vicks or tea tree, but we understand where you are coming from. Our work is to work with people.

Keeping fungus at bay has a lot to do with the immune system. A diabetic elder is more apt to have fungal nails than a healthy elder. Men have it more than women. The vinegar soaks and the coconut oil are a management program. Yes, it takes effort and yes it’s important to understand how it works. Our way is not a plan of care for everyone, but we have a lot of patients who paid a lot of money for expensive oral antifungals, nail lacquers, Vicks and even Lazer treatments whose feet have never looked or felt as good as they do under our care.

You don’t have to have Fungal dystrophic nails, but to not have them does take some effort.

Foot care visits during Covid

Many people, for a very good reason, have been staying home. Family and care givers have been doing a phenomenal job keeping themselves and their loved ones safe during this pandemic, and we applaud everyones efforts. We also know that many feet are not getting the care that they need. Feet and thick toenails can be very scary. In the 6 months since this pandemic began (Mar-Aug) a lot of people who used to see the podiatrist or go to the nail salon for their foot care needs, have not been able to access care. At 1-2 mm growth per month this means that toenails can now be 6mm-12mm long. Toenails grow according to pressure. Some are curling, others are growing straight up, or out. Unruly nails can cause pain and discomfort and its hard to feel your feet when your nails are thick and unruly. For a lot of people not being able to trim or take care of their nails creates feelings of shame and embarrassment. Asking for help can be hard. If you notice that an elder is not walking very well, or is having foot pain or other pains, especially a person who struggles to reach their feet, please call us (413.367.8369) or email contact@footcarebynurses.net so that you can give them the gift of foot care. Feet that are not taken care of increase the chance of a fall exponentially. A fall is very preventable with good foot care. 8/30/2020

Shoe lacing study

In January, as part of my PhD dissertation work, I had the wonderful opportunity to work with 19 amazing participants and the crew at the UMass gait lab. We were looking at the effect of a shoe lacing intervention on measures of comfort and on toe pressures. For over a year now, at FootCare by Nurses, we have been been using different lacing patterns to secure shoes to peoples feet. Our patients have told us what a difference it makes to them, both in terms of comfort, and also how much better they feel in their shoes. Whats really amazing is to see the science come together with the experiences of our patients. Long and short of it, how you secure your shoes to your foot does indeed make a difference to comfort and toe pressures.


Not much seems to be written about toes but they are incredibly important little appendages at the end of our feet. The great toe is a lever to help push us forward, and the other 4 toes are for balance. In our practice we often see several toes being used to hold shoes on, as evidenced by toe prints in the front of shoes. It is our observation that toes are not that intelligent and can only perform one task at a time. If a person choses to hold their shoe on with their toes then the toes can no longer be used to balance the person. For many the toes holding the shoe on just puts a little more tension on the foot. For elders who are already of balance, the additional removal of those balancing toes could be the difference between a good life and being confined to a wheel chair or worse, fracturing a hip. So I invite you to look at your toes and ask them to prioritize balance over shoe holding on tasks. The shoe can be attached using other methods such as strapping or shoe lacing. Here is a helpful hint – if your heal is lifting in your shoe when you walk, the only way you are going to hold that shoe on is with your toes. it is therefore important to your good health to secure your heel – have fun K8

Dear health care professional

I am deeply concerned. I recently saw a patient that has a cancer diagnosis, is diabetic  and severely immunocompromised. Your team suggested a skin care product that contains both mineral oil and petrolatum. The WOCN and science does not actually recommend petroleum-based products.1. Petroleum creates a non-permeable film on the skin. A good idea at first, it seals in toxins that the skin is trying to get rid of. 2. Contaminates are not always quality controlled well. Science shows our bodies do not process these contaminates. Stored in fat these contaminates are linked to cancer. 3. The skin is the largest organ of the body, while it is quite resilient, it also is also absorptive. Would you eat mineral oil or petrolatum? I question why you recommend products like Eucerin, vaseline  or “Uddely Smooth” to patients struggling?  Have you read the ingredients? We keep an EMR & photographs of skin. Post your recommendations comments include pain to touch and observations include cracked, macerated and unhappy skin. If you have a patient’s budget and health in mind, please support the acid mantle and oils the skin needs. We suggest using edible oils.   Coconut olive oil (A+) Olive oil is hypoallergenic.  A formulary product = Medline Remedy line which is olive oil based. Whole foods/ Amazon has a coconut/lime lotion. There are others. Diabetics end up with macerated toes when petroleum seals in the moisture and cancer patients need oils to help them shed the toxins they are taking to help them stay alive. The body cannot absorb wax which is why I ask that you please consider your recommendations based on foundational science and the things the skin really needs that supports and enhances your patient’s health

Painful feet

While 1 in 3 Americans say their feet hurt often, At FootCare by Nurses we know that feet don’t have to hurt, and the solution to those hurting feet doesn’t have to be expensive. Given that a pair of custom orthotics can cost north of $300, and a good pair of shoes is easily $100, I ask myself, if these are the solution’s,  why do people still have foot pain.

I think there are two ways to solve a problem. One is to fix it when it breaks, the other is to prevent it from happening in the first place. The medical model is the “fix it” when it is “broken” model.  For example, you might overstretch your foot tendons from a day of walking around New York City. A gorgeous and wonderful day, but now your feet hurt. The next day you get out of bed and you notice that they still hurt. What to do now. You go to the internet and discover that you may have plantar fasciitis. So you follow the exercises, and the recommendations and you may even pick up some special insert that promises the moon. If that doesn’t work then, eventually, you end up at the doctor’s office, where you get a diagnosis and a referral to PT. They work with you, maybe recommend those orthotics and after several sessions, if you are lucky, you are pain-free.

So now look at the prevention model. You are excited to go for a walk in New York. You know the streets are hard concrete so, much as you would like to be fashionable, you also don’t want your feet to hurt from all the walking. You choose socks that wick moisture away and fit well, to protect your skin, and you lace on your good walking shoes, making sure your heel is secured into the counter of the shoe. You might even pack an umbrella and some snacks, and now you are ready to take on the beauty of the city. At the end of the day, your legs may ache from all that walking, but your feet won’t hurt in the morning and you won’t have to spend time and money trying to fix something that you didn’t break.

At FootCare by Nurses, we would like to think that by sharing the “why and how” knowledge, that you will be empowered to make decisions that are more about prevention. We can even teach you how to pick a pair of fashionable shoes that fit well and protect your feet.

Shoe fitting has become a lost art in our society, but properly fitting shoes are so important to our overall functionality.  Feet are dynamic, they need to move and flex. Shoes are supposed to protect feet, but often they end up hurting feet, for example, ingrown nails are more often than not associated with improper shoe fit.

If you want to avoid problems the shoe should fit the function and the pattern of a shoe needs to fit your foot pattern. You also need to know how to secure your shoes to your feet, to prevent your shoes from causing harm. It’s really just that simple.



lacing your shoes

A 2015 article in Popular Mechanics talked about what that last hole in your sneakers lacing pattern is about. Turns out if you feed your lace back in, you can anchor your lace so that it does not come untied. Sadly though, the article did not discuss many other things that lacing can do for a person trying to wear a shoe.

Shoes are designed to protect your feet. Loggers, to log, should wear logging shoes, not ballet shoes. Translated, we need to all be wearing the shoe that is designed for the job at hand. Running shoes are for running. They are angled to propel one forward. This is good for running but not so good for an elder who already has balance problems.

Shoes are also supposed to fit properly so that the toes (which are supposed to be balancers, not shoe holder-oners) are free, not constrained. For a shoe to work, the heal of the foot needs to be secured to the heal of the shoe. This can be done with a lace, a strap or glue (just kidding). Once the heal is secured then the person wearing the shoe doesn’t actually have to do any fancy footwork to hold the shoe on. This relieves tension and allows the toes to be used for balance. The release of tension improves circulation. For people suffering from neuropathies or illnesses that affect blood flow and circulation, this is huge.

We do a 1 finger test. We developed it literally to help people understand that being forward in their shoes was not good. We then developed a lacing pattern that secures people into the back of their shoes. The result, people feel lighter, more in control and much better balanced because they are now wearing their shoes correctly. Teaching people how to wear their shoes and socks (yes even their flip flops) to maximize the benefit and minimize the damages, in the least expensive way possible,  is what we do. Check out our lacing video.

Thanks – Kate


Watch out for those sandals – Weak feet can lead to painful feet

All winter long we tend to walk around in quite substantial shoes. As the days warm up though, most of us are looking at those sandals and flip flops and counting the days until we can comfortably slip into them. Most flip-flops and sandals have little

support, so our feet have to adjust. Now is the time to get your feet ready.
1. Start by strengthening your toes – try picking up a towel with your feet a couple of times a day.
2. Write the alphabet with your feet – big circles in and out. This will stretch and strengthen your ankles and your foot muscles.
3. Practice walking around the house in your summer shoes. Note how you are using your toes and feet. Your feet ought to be relaxed when you walk (toes are not supposed to hold your shoes on). If they are not, then you might consider looking at structurally better-designed shoes with a strap that holds your heel firmly in place (not a heel strap but the strap that goes over your foot). The sole should also not bend in half (this causes lateral instability and can lead to foot strain).

If you do feel pain in your foot. Don’t push it. Sit down and massage your foot and try to figure out where the pain is coming from. Are your toes holding your shoes on causing tension in your ligaments? Is the shoe the right size? Prevent the problem from happening in the first place is the best plan, but if you do run into trouble, ice reduces inflammation. If you then put your foot into a stable shoe for a few days, the problem ought to resolve.

Foot pain is not normal. If you want some help please give us a ring or make an appointment. We are in the prevention business so we are good at helping you prevent foot problems from happening, while also being respectful of summer desires.

Keeping those ski tips up

We see a lot of patients who are struggling with balance and fear of falling. They may even say something like “I have hammer toes” or “my feet always feel clenched”.  At FootCare by Nurses, through education, touch, and massage we can actually help feet regain the balance, strength, and flexibility that are needed, in order for them to function well.

When toes are clenched it is often indicative of weight being forward on the foot. Toes are meant to balance us, so, when the weight is forward (like climbing up a hill)  the toes clench, and dig in. This can easily be demonstrated by just leaning forward and feeling your toes.  Sometimes people complain about the ball of their foot hurting. This is also related to where weight is being placed.

While our bodies are strong in many ways, our bodies are also designed to balance our weight certain ways and move weight across our bodies in other ways. The big toe and its 1st metatarsal relative is actually a pivot and leverage point for a body in motion, not a weight bearing point, which is what we see a lot of. Weight not worn the way the body is designed to carry it will eventually cause pain and even structural damage, such as bunions, hammer toes,  mallet toes, knee pain, hip and back pain and even neck pain.

So how are you supposed to wear your weight? Balance is actually found towards the outside and back of the foot. Try standing with your feet about shoulder-width apart. Then lift up your great toes. Look up as you do this. You will notice that your stand more upright and will feel a shift of weight from the inside of your body to the outside. Now take your arms. Put them down by your side and then rotate your hands and arms outwards. This will open up your chest and shoulders, also bringing the weight out. What you should notice now is that you are standing more upright, and feel more balanced. In the clinic, we would have given you a before and after push test so that you could see the difference in your balance and your connection to the ground. By lifting your ‘Ski-tips” you have moved the weight from the inside (pronation) to outside (supination) and also back onto your heel. Now your ankle bones are aligned into your tibia, which is how the bodies weight is supposed to be distributed when standing. Now take a few steps. Notice that starting at a balanced place actually allows you to walk heel to toe and that you might even have a bit more spring in your step. If you still feel a little top heavy, breathe out. This will lower your center of gravity.

Ankle and foot strength is also important. It’s easy to strengthen those. Do the alphabet several times a day with your ankles. Pay special attention to moving the foot in and out, not just up and down (as if you were stepping on the gas). Practice picking things up with your toes to strengthen your forefoot. Shoes do not allow the foot to fully function, which is why it is important to keep feet strong and healthy. Feet are supposed to be flexible and they are the foundation upon which we count on to move us around. Practicing raising your ski tips up and doing your alphabet daily will not only strengthen your feet, it will also enhance your pumping system. All of this enhances health and well-being.

Taking up running/ walking again

So, you have decided to lose some pounds, shed some winter blues and you have spring fever. You can’t wait to pull out those sandals, in fact, you have already dusted them off. Before you head out full of glee please be mindful that your feet have been encapsulated in boots, solid shoes, and slippers for many months and they might not be quite up to speed. What you want to avoid here is giving yourself plantar fasciitis or some kind of foot injury that will waylay your whole summers worth of plans.

So here are a couple of tips and tricks that won’t hurt you to do, and may prevent you from running or walking into trouble.

  1. Warm up your feet – that means stretching out your toes, rotating your ankles (slowly) clenching and stretching. tuck your fingers into your toes, squish and flex your feet.  Wake those muscles up so that they can support you and your activities. Go slow and be deliberate. You want all 26 bones to be moving freely and blood and lymph to flow throughout.
  2. Make sure your shoes fit properly. So many people we see fail our 1 finger test. The one finger test is when you can put your finger down the back of your shoe which means you are sliding forward in them. Shoes work by securing your heel into the heel of the shoe. If you are not doing that then all sorts of avoidable stresses happen to your feet.
  3.  Balance on your feet. Putting your weight on the ball of your foot is not what your body is designed for. Subtle signs, like your foot falling asleep while you pump on that elliptical machine, are your body telling you that something isn’t quite right.  Please listen to your body. Take the time to align your pulleys and levers (thighs over knees over hips over feet). Think how badly your car drives when the wheels are out of balance or alignment. Its the same with your body, it doesn’t work well out of alignment.
  4. Remember to hydrate. Drinking water is about dilution. Hydration is about absorbing fluids. Put a little OJ, Lemon or even vinegar in that water. Add turmeric and or ginger to help with inflammation and digestion.  Low oil is not good for your car engine. being dry is not good for you.
  5. Graduated compression socks are a gift for you and your body. We love Sockwell 15-20s because they stand up well, wick moisture, and come in fun colors. No matter the brand, just make sure your socks are graduated compression and not holding moisture. You don’t need sweaty feet.
  6. Have fun. Go ahead, put your sandals on and wear them around the house. Let your feet and body get used to them.
  7. If you feel an ache or a pain stop, readjust and pay attention. If your foot aches at the end of a run or a walk, give it a little massage and love, Some remedies, for example, arnica works well to reduce inflammation, ice is for bruising and heat is to enhance blood flow. A little compression can reduce swelling. While Epsom salts may feel great, it will also leach the oils out of your skin.  Pain tells its own story, for example, tendons tend to whine, nerves tend to be sharp, bones tend to ache. If the pain doesn’t go away with a little TLC you might want to seek out professional advice.

No matter what activities you have planned spring truly is around the corner. So many foot problems are avoidable with a little bit of knowledge. We are happy to share and help you get your feet ready. Additionally, if you happen to have fungal or thick nails and don’t want them … we can also help you in that department.