Pealing skin in Winter

IMG_2639Ever thought to wonder why your skin peels in the winter? While skin dries out because of lack of hydration and fewer oils,  opportunists looking for food, have also come on board. These are opportunists are called dermatophytes. Dermatophytes eat dead skin (keratin to be exact) and winter is when we provide them with a bountiful crop of dead skin. Couple that with some sweat and dampness in our winter boots and fuzzy socks, and we create a wonderful environment for these fungi to grow. While your dermatophyte load may not flourish into full-blown tinea pedis,  the chafed skin, cracked heels and closer inspection of the skin on the foot are often dead giveaways that the dermatophytes are affecting the integrity of the skin. This can be painful at the very least and at the worst can be an avoidable opportunity for infection.

Don’t fear. It is easy enough to address and prevent adverse outcomes with a little FootCare by Nurses knowhow.

  1. Keep your feet dry. – Wear wicking socks (merino wool works wonders)
  2. Keep your skin well oiled (oils like coconut and olive oil – think – if you would eat it then it’s probably good for your skin too). Oiled skin is good skin care. Use lotions with caution because they can cake or seal moisture in (read our blog about vaseline and petroleum products like mineral oil)
  3. Let your boots and shoes air out, give them a chance to dry. Change your shoe regularly. Fungi love moist places to live.
  4. Using vinegar (we recommend apple cider vinegar) as a foot soak, changes the pH of your skin. Inside and out, yeasts and fungi are sensitive to pH changes.
  5. This is about microbiology and enhancing the health of your skin, no matter what age you are. If you are not sure and need a little more instruction please reach out to us. We are happy to help and share our knowledge with you.

Thank you – Kate RN CFCN CFCS

Keeping feet happy this winter (As seen in Greenfield recorder 12/16/17

CornBy Kate Clayton-Jones
MSN RN PhD(c) CFCN CFCS

As the weather begins to cool down, to keep feet warm and comfortable winter behaviors start happening including snuggling into slippers or warmer, thicker socks. From a foot care nurse perspective, this is also a time when we see an increase in painful corns and calluses. These are conditions that are easily avoided with a little knowledge about foot care. Feet that hurt impact activities of daily living and can even lead to falls. Who wants to get off the couch or go for a walk with hurting feet?

With regard to foot care, it is actually true that an ounce of prevention is worth a pound of cure. But what does prevention actually look like? When it comes to corns, calluses, and blisters, it is typically shoes and socks that are to blame. In our practice, almost everyone who comes in with a corn or a callus is wearing shoes and socks that are not fitting well. We take care of a large variety of people including runners and walkers, elders and diabetics, so it isn’t just an elder problem, it’s a not “knowing” problem.

The main shoe culprit is that people think that their shoe size is from back of heel to tip of the longest toe. While this is somewhat correct, because you don’t want to purchase a shoe that is too small for your whole foot, the reality is that some people have long toes and some people have short toes. You can have the same total length but where your foot bends, at the metatarsal joint, is different for each person. Think short wheelbase vs long wheel-base. You want the shoe to bend where your foot bends. If your foot is not bending in the same place as the shoe, then you are at risk of developing a callus. If your foot is sliding in the shoe then you are at risk of developing a corn. Slippers and loose fitting socks are notorious for helping people grow corns. Shuffling those loosely slippered feet across a carpeted floor is hard on your skin. While those slippers may be comfortable while sitting, the loose-fitting materials cause friction on your skin every time you take a step. If you can put your finger in the back of the heel of your shoe or slipper then you are not properly positioned in that footwear. Shoes, slippers, and socks are supposed to be preventing injury not causing it.

Think about what happens to your hands if you rake leaves with loose gloves. Loose gloves cause blisters. Loose socks and shoes can give you blisters, calluses and sometimes corns. Corns are like thorns in the bottom of your feet. They are very painful and you don’t want them. Shoes and socks are like gloves for the feet. They are supposed to fit you well and serve the purpose you want them to. It’s much easier to change your shoes and socks than it is to change your feet

Socks should fit snuggly and be made of a material that wicks moisture away from the feet. They should not wrinkle up under the toes or fall down. The seams should not press into your skin. If they are leaving a mark then they are not doing their job.

Shoes that fit protect your feet. We have found that the best way to test your shoe fit then is to take the insert out of the shoe and hold it up to the bottom of your foot. With your heel in the back of the insole,  observe – does the widest part of your foot match the widest part of the insole. If it does not, then that shoe is not designed for you. If it does, then that shoe is the right size and you also need to understand the volume of a shoe. Volume is adjusted by lacing not by moving up a ½ size, which is what many people are apt to do. Shoes work by securing your heel into the heel of the shoe. When this happens the shoe moves as one with you instead of flapping behind or flopping around. You want the shoe to be one with your foot because then it protects your foot rather than causing all sorts of problems.

Remember, your shoes and socks are supposed to be protecting your feet not hurt them. Hurting feet hurt people. Healthy feet are happy feet and we all deserve happy feet.

Please note – While not life-threatening, corns and calluses are not normal in healhty feet and should be treated and prevented. Corns and calluses can cause falls and may lead to wounds and infections. Our certified foot care nurses are trained to remove corns and dress calluses along with providing you an education about how to prevent them.  While you are in charge of your own feet, seeking professional help to address corns and calluses may be in your best interest. Professionals who can help are trained in foot care and include podiatrists, foot care nurses, and medical professionals who can perform surgery. 

When to Epsom

By Kate Clayton-Jones
MSN RN PhD(c) CFCN CFCS

When to use Epsom salts – Epsom salts are useful when trying to draw toxins or infection out. Often an Epsom salt soak is suggested for softening the skin around an ingrown toenail. It has its purpose and is very good at it. However, it should not be done that often, especially with elderly or at risk feet, because it DOES soften the skin AND pulls toxins/ moisture out of the skin. The very thing you are trying to do can also be harmful. Skin is supposed to have integrity. it protects you from the environment. So keeping it healthy and happy should be about giving it what it needs not taking things away.

Skin health depends on what you eat, the way that your hormones and metabolism are functioning and a host of other environmental factors. If you aren’t sure ask us. If you know why you are doing something and you are getting the results that you want – that’s great. But, If you keep doing the same thing over and over again and you are getting results you don’t like (e.g pealing or macerated skin) then stop. Reassess and make a new plan. You might be pleasantly surprised how much better your skin then looks and feels.

Please, no petroleum

By Kate Clayton-Jones
MSN PhD(c) RN CFCN CFCS

Here is my appeal to you all.
Please don’t use Vaseline or petroleum-based creams or salves on feet, especially on the feet of diabetics or the elderly.

Why… you ask? What’s wrong with using it?

Vaseline is a petroleum-based product and petroleum-based products are occlusives. This means they seal the moisture in. At first, that might sound good. But if you stop to think about it, holding moisture next to the skin is not good for the skin. You’ve heard of wicking moisture away. When moisture is not wicked away it causes maceration, which means the softening and breaking down of the skin resulting from prolonged exposure to moisture.  This is also creating the perfect moist or even wet environment for bacteria and fungus. In the world of wound care, keeping wounds moist is why we use petroleum – think skin tear. But even in wound care, there are better products because it is known that petroleum products such as Vaseline creates its own problem. These are the problems that you and I are trying to avoid – things like cracked heels and dry skin.   Vaseline induced skin breakdown

 

 

Vaseline induced skin breakdowns are painful. Painful feet adversely affect the people who own them.

 

Natural oils such as coconut oil or olive oil are much better choices. Oils have been used on the skin for centuries with good success. The skin loves the oil and can still breathe. This is especially important for those with sweaty feet. Yes, you can have dry skin and sweaty feet at the same time and not all flaky skin is dry skin. We often find that it is actually related to other things like neuropathies, tinea pedis or skin touching skin. These are important issues to be considered and addressed.

So please, from all of us at FootCare by Nurses please help us prevent cracked heels, painful feet, fungal issues and maceration by choosing to use a kinder, more effective product on those feet. If you are not sure, and what you are doing doesn’t seem to be working, we would be happy to guide you.

Little round circles and flaking skin

By Kate Clayton-Jones
MSN PhD(c) RN CFCN CFCS

Summer time is a time of joy, for both you and microbes. During the winter months, many of us keep our feet warm and dry by using good clean socks and leather shoes. In the summer though, we switch to flip-flops and shoes that have rubber soles. Shoes that fit come in all sorts of textures and materials. But if your feet sweat, you want to continue to keep them dry. Sweaty feet provide a great environment for growing dermatophytes, which often manifest on the skin as tiny round pealing circles and flaking skin. More severe cases include redness (moccasin pattern) and a burning pain. Itching can also happen between and around the toes. Typically self-diagnosed, the dermatophyte infection is often called tinea pedis and it is a fungal infection. Dermatophytes thrive on keratin. Your skin and nails have keratin, and your sweaty feet in combination with the rubber soles found in comfortable shoes such as Teva’s, Keen’s, flip flops, Croc’s, running shoes and river shoes, are warm damp environments. Fungus just loves keratin and warm damp environments. So if you want to grow fungus on your feet,  stay with shoes that keep your feet damp. If you don’t, then there are over the counter and prescribed medications that can be applied directly to your skin and to your shoes, and there are also old-fashioned inexpensive effective remedies like vinegar soaks (1/2 vinegar/ 1/2 water 20 mins for 3-4 days) and lavender sachets (to put in your shoes). These treatments change the environment so that the dermatophytes can’t thrive. No matter the treatment, it is then important to keep your feet dry; good hygiene, wear socks that wick moisture away and shoes that absorb moisture – e.g leather-based shoes and sandals.

If you have any questions or concerns, please don’t be afraid to consult with a medical professional. It also important to stay away from petroleum-based creams (they are occlusive and trap moisture) and harsh chemicals and please don’t use bleach or gasoline, that just isn’t smart.

Fungi are very important components of our ecosystem. They are the decomposers. They also have their own medicinal properties and can be a complete meal. While mushrooms are a great summer treat on a barbeque or stirred into a favored dish,  preventing fungi from growing on your feet or skin requires just a little application of knowledge, some good footwear and skin hygiene.

Does flap cause your feet to crack?

By Kate Clayton-Jones
MSN PhD(c) RN CFCN CFCS

Are your feet cracked because you flap? When the heel of your shoes flap when you walk, it creates friction. The friction dries out the skin on the heel and causes cracking. To prevent this, your heel should always sit snuggly in the shoe, even when you are walking. The technical term is the vamp holds your heel into the counter. Not all shoes are well engineered for your feet but the application of a little know how can prevent painful cracked feet.

the flap

Peripheral Neuropathy

By Kate Clayton-Jones
MSN PhD(c) RN CFCN CFCS

At FootCare by Nurses, we take care of a lot of people who tell us that they have peripheral neuropathy. When asked “what kind?” there is often a long pause. Peripheral neuropathy affects a lot of people. It manifests in a number of different ways. For whatever reason, be it diabetes, an injury, muscle weakness or lack of blood flow or something else, the nerves in our hands and feet (the periphery of our body) stop functioning normally. Symptoms are described as pain, numbness, cold, hot, excessive sweating, increased sensitivity and burning. These sensations may or may not occur as a result of a stimulus. For some people, it is just a nuisance, for others, it is a debilitating condition. Having sensation in your feet is protective. Not being able to feel your feet can lead to negative outcomes from insult such as; cuts, blisters, infections and even amputations. Insensate feet can also throw off balance, which can lead to falls.

At FootCare by Nurses we believe in prevention and person-centered care. With regard to peripheral neuropathies, while we cannot cure it, from our perspective there are some things that we can do and encourage you to do, that are helpful for enhancing circulation. Wearing socks that wick away moisture is important for those with autonomic neuropathy. Lamb’s wool between the toes can also be a useful tool for excessive sweating. Using the right moisturizers that are not petroleum based (petroleum is an occlusive, which means it is not well absorbed) and learning how to take care of your skin is important for overall skin health.  Since some peripheral neuropathies are related to microvascular blood flow, actions that enhance blood flow to the extremities are very helpful. These include massage to the feet and encouraging people to participate in exercises found in disciplines such as tai chi, chi gong, and low impact yoga. Our nurses can even show you deliberate foot and toe exercises that can be helpful.

There is also another cause for blood flow restriction. It is called edema. There are many causes for edema. Examples include restricted lymph flow (lymphedema), cardiac-related edema and dependent edema. Even the mildest edema restricts lymph and microvascular flow by putting pressure on the peripheral vessels. Massage and lymph flow enhancing exercises can help. If there are no arterial concerns wearing a mild (8-15 or moderate 15-20) graduated compression sock can make a great positive impact on peripheral blood flow. On the market now are some great, fun and very comfortable compression socks. In fact, most of our nurses choose to wear them regularly because they are so comfortable and make such an incredible difference.

Medications can also influence microvascular flow. Medications can be life-saving, but learning about how they impact you and your peripheral circulation can bring peace of mind. There is nothing worse than being in pain constantly especially when you don’t understand why. At FootCare by Nurses, we have rubbed feeling back into people’s feet and pain away too many times to think of our work as mere coincidence. The science behind our work has to do with helping our patients understand how things work, the way that the fascia connects to the rest of the body and utilizing the benefits of circulation-enhancing massage and exercises.

Please feel free to share your experiences and ask your FootCare by Nurses nurse any questions you have about peripheral neuropathy.

New Clinic – Easthampton headed up by Kristin BSN RN CFCS

On Wednesday, June 28th 2017, Kristin debuted FootCare by Nurses care at the Easthampton Senior Center, which is located in the old post office building in the center of Easthampton, MA.  Kim, the director,  and her amazing staff not only have set up a great care room equipped with a beautiful zero gravity chair, they also brought in cookies for the occasion.  Cookies and foot care including a great reflexology based foot massage – WOW! what a treat!

Kristin came to us from the world of dialysis, so she is very aware of medical compromise that can influence foot health.  Like many nurses who are initially introduced to being able to even take care of peoples’ feet, Kristin was initially timid. However, she studied hard and practiced a lot and has taken to foot care like a happy fish in water. She is a great educator, has a good sense of humor and is skilled at making people feel comfortable.

The Easthampton Senior Center has a lot of great activities including providing Reiki and massage for seniors. They also are able to provide workshops and help elders get access to the services that they need, in order to stay healthy and as independent as possible. We encourage people to support their local senior centers and take advantage of what they have to offer. In Massachusetts, we are blessed to have a state that supports their seniors, as this is not always true elsewhere. To know that if we don’t fully utilize the services offered, we may be at risk of losing them in budget cut rounds. So please, let your community and politicians know how much senior care matters to you by actively participating,  sharing and encouraging in the cookies, services and support Kim and her great team are working hard to provide for you.

 

Back in time

6/23/17

Walking around the Mutton and Mead festival in Montague today, I saw a lot of different foot wear. Dressed in costumes, many wore moccasins, boots of leather and skins and even shoes with curly jester toes. Spectators wore everything from sandals to high heels.

Until the sneaker came along, shoe design had not changed since the middle ages and feet haven’t changed since man began to walk the earth. I have to then assume that the same problems I see from shoes nowadays have actually been around for a long time. While shoes are there to protect our feet, they are also molds that shape our feet. As we come into adulthood, our bones begin to harden. Shoe fit during teenage years is going to influence foot health throughout adulthood. Those fancy shoes that we feel great in in our 20’s are going to be our nemesis in our 50’s. Don’t get me wrong here, you can still wear fancy shoes and sandals, but please make sure they fit your feet well. A night in tight shoes may be a little uncomfortable, but shoes that don’t fit your feet well day after day after day, are going to slowly change the shape of your feet … and you may not like the end result. All I am saying is be aware. Feet should not be ignored. Pain is not normal and should not be happening at the end of a long work day. Using a little wisdom and knowledge, no matter your age, can keep your feet healthy and happy.