Footcare guidance

2. Understanding Personal Footcare

The challenge publicly funded services face is to make sure they deliver safe, effective and person centred care. This is underpinned by best value, supporting empowerment and enablement for people where this is appropriate.

There is no doubt, demands on services have increased since the Covid-19 pandemic. These are further compounded by workforce shortages, leading to additional pressures on already stretched health and care services, including podiatry.

More than ever, it is pertinent for our limited healthcare resources to focus on provision that delivers best outcomes for people as set out by ‘Delivering Value based Health & Care- a vision for Scotland (2023).^[1] To achieve better value, people should be supported to look after their feet and know when it is appropriate for them to seek support from NHS podiatry services.

What is Personal Footcare?

The Scottish definition for personal footcare agreed by the national working group has been adapted from the version proposed by the Department of Health.^[2]

Personal footcare is part of a personal hygiene routine for feet and covers a set of tasks that an adult, whatever their age, would normally do for themselves if they are able to. The specific tasks are detailed below:

Key message 1: what is personal footcare?

Toenail care

• Clipping and filing toenails safely and keeping them at a length which feels comfortable

Skin care

• Smoothing and moisturising dry and rough skin
• Keeping feet clean, dry, comfortable and warm
• Checking for cracks and breaks in the skin
• Looking for signs of infection or other obvious early problems and seeking professional advice

Checking footwear

• Checking footwear for comfort, fit, state of repair and safety

The broad function of NHS podiatry services is documented by the Royal College of Podiatry and is illustrated in figure 1^[3]:

What is provided by NHS podiatry services?

NHS podiatrists are trained to work autonomously and as part of multidisciplinary teams. Within the NHS podiatrists provide safe, effective and person centred service that includes^[4],[5]:

• Assessment, diagnosis, advice, and treatment for complications of the foot and the lower limb. The early involvement of podiatrists in the management of people with peripheral vascular disease or neuropathy can prevent future lower limb and foot problems
• Management and treatment of foot and ankle musculoskeletal disorders.
• Screening and provision of preventative treatment plans to people with diabetes and those with peripheral arterial disease
• Prescribing medicines independently, providing patients with direct access to the interventions they need.
• Playing a significant role in the public health and prevention agenda specifically around falls prevention, dermatology (malignant melanoma detection), diabetes prevention, cardiovascular risk reduction, medicines management, antibiotic stewardship and keeping people mobile and active.^[5]

Examples of NHS podiatry provisions:

Issues NHS podiatrists can provide treatment for:

• Management of acute foot and ankle conditions such as foot ulceration and foot infections
  • Treatment of ulcers and non- healing wounds
  • Provision of foot pressure reduction devices to support healing
  • Prescribing medicine
• Surgical removal of ingrowing toenails
  • Treatment of ingrowing toenails
  • Prescribing of antibiotics
  • Provision of nail surgery
• Management of musculoskeletal foot and ankle conditions such as muscle, tendon, and joint disorders and nerve pain. For example, painful walking, structural problems, nerve pain, arthritis, injuries and pressure areas in the foot
  • Self management advice
  • Biomechanical assessment
  • Exercise therapy
  • Steroid injections
  • Provision of insoles and orthotics
  • Other therapies such as shockwave and laser therapy
  • Podiatry surgery of the foot,
  • working as part of orthopaedic teams
• Offer preventative treatment to prevent hard skin and corns to those people who are at risk of foot ulceration for example
  • Reduction of corns and callus
  • Surgical removal of foot lesions
  • Insole and orthotic provision and other foot pressure reduction devices.
  • Footwear- advice
  • Diabetes foot assessment and care planning for moderate and high risk diabetic
• Circulation and vascular assessment
• Assessment of painful lesions that are stopping you from walking
• Some but not all services offer verrucae treatment for persistent verrucae and painful deep corn removal under local anesthetic (deep enucleation or electrosurgery)

Issues NHS podiatrists are not providing treatment for:

• Toe nail cutting
• Fungal skin and nail treatment – can offer advice on medication but not regular treatment
• Regular corn and hard skin reduction for people who are not at risk of foot ulceration.
• Regular treatment for skin conditions such as athlete’s foot – can provide advice but not regular treatment
• Verrucae treatment (not painful and less than 2 years)

When resources are available NHS podiatry services may:

• Provide education to non-podiatry providers across all care sectors to help them to confidently undertake personal footcare for those individuals who require support with this.
• Undertaking personal footcare does not require special training and is part of daily personal hygiene. NHS Inform hosts a range of educational resources available free of charge that can support individuals and carers with personal footcare: Looking after your feet to help prevent falls | NHS inform
• Provide support, assistance and encouragement to individuals and their carers to self care where this is possible

Since the introduction of the personal footcare guidance in 2013, the majority of NHS podiatry departments have seen a significant reduction in their workforce. In Scotland, NHS podiatry departments are no longer funded to provide personal footcare, including toenail cutting.

Key message 2:

Undertaking personal footcare does not require special training and is part of daily personal hygiene