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Soaking Before Foot & Nail Care

Foot soaking before foot and nail care is common. So common, in fact, that most patients expect it. For many, the soaking part of the foot care routine is a time to feel cared for and pampered, an unfortunately rare occurrence for many elderly and diabetic patients. However, while soaking may feel like a treat, it can open a door to various serious issues.

Infection

Infection becomes a risk when we use a container like a bucket to soak a patient's feet. Unlike washing, during which the limb isn't submersed, soaking requires proper disinfection between each treatment. Because the directions specified on most EPA-registered disinfectant products for non-critical surfaces in healthcare settings call for three to 10 minutes of wet contact time, foot soaking becomes impractical.
If direct contact with the container is not made because you’ve used a disposable plastic barrier, prolonged wet disinfection is unnecessary. However, below we will discuss some additional reasons to avoid foot soaking as part of your foot care routine.

Injury Risk

What you do in your healthcare facility sets an example for your patients. Because of the easy and relaxing nature of foot soaking, it's not uncommon for patients to return home and make foot soaking a part of their regular routine. Unfortunately, this poses a risk for injury because many patients you will treat over the course of your career lack experience and/or may be suffering from neuropathy from diabetes.
Inexperienced patients may soak for inappropriately prolonged periods of time or use chemicals not intended for skin. Those with neuropathy will not be able to properly gauge the temperature of water and burn themselves. Additionally, soaking at home carries the risk for infection because proper disinfection of the container may not have occurred.

Debridement

Although soaking the feet has been a traditional approach to foot care treatment, it is of no benefit; in fact, it can lead to maceration and worsening infection. Even during normal debridement, it can be difficult for a foot care nurse to differentiate between the callus and normal skin because as layers of the callus are removed, softer skin is continually exposed. It takes a few minutes before the newly exposed soft skin hardens again, but if the foot has been soaked even callused skin remains soft, making it nearly impossible to differentiate between tissue planes.

Dry Skin

Finally, prolonged exposure to soaps and water strips vital oils from skin and disrupts skin's delicate pH balance. Because many of your patients will already be suffering from sensitive, dry or thinning skin, it is not advisable to soak. To clean the foot and prepare it for debridement, wash it unsubmerged with soap and water, then rinse. Advise your patients to use a gentle soap such as Dove, that’s been designed to restore skin's pH balance, at home.

Your patients might initially be hesitant to give up foot soaking. This habitual and soothing pre-debridement activity has likely become a part of their routine with you, their foot care specialist, and provides them pampering they might not otherwise receive.

To wean your patients off of soaking and convert them to a healthier alternative

1. Tell them about the infection risk
2. Tell them about the drying effect on the skin
3. Convey your concern about their health
4. Offer them an alternative

Alternative

Foot soaking is a time-consuming activity that requires preparation, the act of soaking and proper disinfection. Offering a short massage is a great alternative to help your patients feel comfortable, relaxed and appreciated. Instead of soaking before foot or nail care, conclude your session with a short massage lasting about a minute, using a moisturizing lotion for added benefits.

Precautions for foot care soaking infographic