The Dentists of Feet: How Colorado VNA is Keeping Feet Healthy

Over the last two decades, we’ve come to understand that oral health means much more than healthy teeth. As the American Dental Association states “Your mouth is a window into the health of your body” and regular visits to a dentist allow for a view into general health and wellness. Similarly, foot care is about so much more than simply clipping toe nails, especially for older adults and those with diabetes. Our feet often reveal signs of disease such as nerve disorders, gout, arthritis, melanoma, and heart disease. Feet can tell us about the state of our circulation and the condition of our thyroid. Our feet falter when our shoes are too tight, our toenails too long, we don’t moisturize our skin, and problems such as ulcerations and infections go unnoticed and untreated.

This is why for over 30 years Colorado VNA registered nurses have been providing foot care, and why we believe foot care should be an integral part of preventive care for older adults and those with diabetes.

The highest risk group of patients for foot maladies is diabetic patients. The CDC has reported that over 29.1 million people, or 9.3% of the US population, have diabetes. In Colorado, more than 19,000 adults were diagnosed with diabetes in 2012 and there is belief that as many as 100,000 or more Coloradans could be unaware that they have diabetes. Further, nearly 33% of adults age 65+ have diabetes. According to the Indian Health Service ~40% of people with diabetes will develop nerve damage in their feet, ~20% will have an acute foot problem, ~15% will develop a serious wound (costing about $13,000-$30,000 to treat), and 5-10% of people with diabetes will progress to amputation (at a cost of about $50,000). Indeed, the most common cause of hospitalizations among persons with diabetes is diabetic foot problems, including ulcerations, infections, and gangrene.

Almost all of the above conditions can be prevented or diagnosed early with primary care and the care that Colorado VNA provides at its 150+ foot care clinics across the Front Range. While clients attend clinics for various reasons – difficulty bending over for self-care, trouble finding a family member or friend to assist, limited hand strength due to arthritis, etc. – all receive the same high-quality and comprehensive RN visit that entails:

• medication reconciliation;
• blood pressure monitoring;
• a foot exam for inspection for any discoloration, swelling, corns, calluses, or other changes of the foot, ankle, and leg below the knee including identifying cancers of the nails and skin;
• trimming, cutting, clipping, and debridement of nails;
• minor buffing of corns or calluses (if applicable); and
• hygienic and preventive maintenance care such as cleaning the feet and testing for neuropathy (nerve damage).

Further, our nurses have repeated contact with their clients over long periods of time, sometimes years, and are in a good position to note health changes that may go unnoticed during routine medical visits, such as darkened nail beds that could be early signs of melanoma.

To continue the dental care analogy, Colorado VNA’s nurses provide both the routine care AND assessment for the need for more specialized care provided by podiatrists, surgeons, cardiologists, and other medical specialists. Colorado VNA’s nurses are also an extension of these specialists as they assist with administering care plans in an effort to keep patients healthy and on their feet. Colorado VNA has also started offering more complex foot care services, such as the use of dremels, which are provided by nurses certified by the Wound, Ostomy and Continence Nursing Certification Board. And, just in the last year, Colorado VNA has begun providing foot care in the home when patients are home bound and meet appropriate Medicare guidelines.

Routine foot care is a little understood and often undervalued part of the healthcare system.  Too many older adults turn to nail salons where they run the risk of being exposed to improperly cleaned tools and technicians that are not trained to look for ingrown, overgrown, and thickened toenails as well as fungal infections. Over the next year Colorado VNA will be gathering more clinical data in an effort to demonstrate improved health outcomes such as decreased falls, fewer serious wounds, decreased hospitalizations and/or surgeries resulting in amputations, and better compliance with care plans, as well as higher patient satisfaction. Each month, Colorado VNA cares for more than 1,000 clients, which allows us to generate an incredible wealth of data to share. We are confident that our foot care service is keeping individuals healthier and independent longer. Stay tuned for further updates on our foot care services in the coming months!

For more information about our foot care clinics or to schedule a visit, please call 303-698-6496 or visit https://vnacolorado.org/medical-foot-care-program/.