8. CCA Study Notes: Safe Nail and Foot Care for Clients

The Big Picture

Nail and foot care are personal-care tasks that require close attention to safety, comfort, privacy, and client preferences.

Feet and nails need regular care because moisture, dirt, injuries, poorly fitting shoes, and damaged nails can lead to problems. Some clients also have conditions that make foot injuries more serious or slower to heal.

For CCAs, one of the biggest ideas to remember is that nail care is not the same for every client. Always follow the client’s care plan, employer policy, and directions from your supervisor.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Why Nail and Foot Care Matters

Regular nail and foot care helps prevent infection, injury, and odours.

Long or broken nails can scratch the skin or catch on clothing. Hangnails, nails pulled away from the skin, and ingrown nails can break the skin and create an opening for microbes.

Ingrown nails are toenails that grow inward at the side of the nail bed.

Feet are especially easy to injure or infect. Moisture and dirt on the feet, socks, or stockings support the growth of microbes and contribute to odours.

Key fact: Socks should be changed every day.

Foot injuries can happen when a client:

• stubs a toe
• steps on a sharp object
• has someone step on the foot
• wears poorly fitting shoes

Poorly fitting shoes can contribute to:

• bunions
• calluses
• corns
• blisters
• ingrown nails

Why Poor Circulation Makes Foot Problems More Serious

Foot infections and injuries are especially serious in older adults and people with circulation problems.

Poor circulation slows healing because it prevents white blood cells, or WBCs, and oxygenated blood from entering the area. WBCs help remove infected material, while oxygen provides energy that cells need to function.

Diabetes and vascular disease are common causes of poor circulation. Gangrene and amputation are serious possible complications.

Check the Client’s Feet Every Day

The CCA should check the client’s feet daily.

Daily checks are especially important when the client:

• has diabetes
• has a circulatory disorder
• takes medication that affects blood clotting

Report: Notify your supervisor if you notice:

• very dry skin
• unusual foot odours
• cracks or breaks in the skin, especially between the toes
• ingrown or loose nails
• red, irritated, or calloused areas on the feet, heels, or ankles
• drainage or bleeding
• black, thick, brittle, or otherwise changed nails
• corns, bunions, or blisters

Nail and Foot Soaks

A fingernail or foot soak may be included in the client’s care plan ⓘ.

Soaking helps soften nails so they are easier to clean and trim. The employer may instead direct the use of a particular lotion or a warm, moist towel.

Number to remember: Fingernail and foot soaks should last no more than 5 minutes.

Do not cut a client’s toenails immediately after soaking. The tissue around the nail becomes swollen with water and is more likely to be nicked or cut.

For fingernail cutting in the nail-care procedure, wait 5 to 10 minutes after soaking. This gives swollen tissue time to shrink.

Keep Foot Soaks Safe

Follow the care plan and employer policy ⓘ for the correct way to soften nails.

If the client can safely get into and out of the tub, a bath provides an opportunity to soak the feet. At other times, a basin may be used.

Feet burn easily. Check with your supervisor about the correct water temperature for a foot soak.

Use extra care with clients who have:

• diabetes
• reduced sensation
• circulation problems

Some facilities do not recommend soaking the feet of a client with diabetes because soaking may contribute to dry or cracked skin. Reduced sensation can also make it harder for the client to notice dangerously hot water.

Know the Nail-Care Role Limits

Toenail trimming can cause injury. Some employers do not permit support workers to trim toenails at all.

Role limit: Never assume you are allowed to trim a client’s toenails. Tell your supervisor when toenail trimming is needed and follow employer policy and the client’s care plan.

Support workers do not trim the toenails of clients who:

• have diabetes
• have poor circulation in the legs or feet
• take medications that affect blood clotting
• have very thick or ingrown nails
• are uncooperative or combative

Generally, only registered staff provide nail care to clients who have diabetes or circulation problems.

Fingernails should only be cut when your supervisor instructs you to do so and the task appears in the client’s care plan.

Safety: Use extreme caution around nearby skin whenever nail clippers are used.

Other Nail-Care Safety Rules

Follow the employer’s policies about where nail care is performed. Some facilities do not permit nail care while the client is in bed.

When possible, nail care is easier with the client sitting upright.

Observe the client throughout nail care. Watch for comfort and safety.

Report and Record: If you have concerns during nail care, report and record your observations immediately.

Equipment used for cutting nails must be discarded or thoroughly sanitized after use according to employer policy.

Corns, Bunions, and Blisters

Support workers do not treat corns, bunions, or blisters.

These problems may require care from a podiatrist, a physician who specializes in evaluating and treating diseases of the foot.

Preparing for Nail and Foot Care

Before starting:

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Perform proper hand hygiene.
4. Gather the needed supplies.
5. Arrange the supplies within easy reach.
6. Provide privacy and perform hand hygiene again.
7. Help the client into a bedside chair and place the call bell ⓘ within reach when applicable.

Supplies include items such as:

• basin, soap, towels, and washcloth
• bath thermometer
• kidney basin
• nail clippers for the fingernails
• a nail file with a sharp tip for cleaning under the nails
• lotion or petroleum jelly
• paper towels and disposable bath mat
• gloves

Gathering supplies before starting helps you remain with the client and work efficiently.

Preparing the Feet

1. Place the bath mat under the client’s feet.
2. Help the client remove shoes and socks.
3. Apply the employer-approved lotion for softening the nails, or wrap the feet in a warm, moist towel.
4. Wrap the feet with a towel or waterproof pad to help keep them warm.
5. If the toes are especially dirty or thick, check the care plan and employer policy to see whether a presoak is needed.
6. If soaking is permitted, prepare the water at the temperature stated in the care plan and measure it according to employer policy.
7. Place the basin on the bath mat before helping the client put their feet into it.
8. Help the client place their feet in the basin when directed by the care plan.
9. Adjust the overbed table or work area so it is low and close to the client. If needed, place a blanket around the client’s shoulders and keep the legs covered with a towel while the feet soak or are prepared for nail care.
10. Keep the client warm and comfortable.

Some clients become dizzy when bending down to remove shoes. Dizziness associated with postural hypotension can contribute to falls.

Caring for the Fingernails

If the client’s fingernails are thick or visibly dirty, they may need soaking.

1. Prepare the kidney basin and measure the water temperature according to employer policy.
2. Position the client’s hands and arms comfortably.
3. Soak for no more than 5 minutes, according to the care plan.
4. Remove the basin and dry the hands thoroughly, including between the fingers.
5. Wait 5 to 10 minutes before cutting.
6. Put on gloves.
7. Clean under each fingernail with the nail file tip, wiping the tip after each nail.
8. If fingernail cutting is included in the care plan and directed by your supervisor, use nail clippers carefully.
9. Cut the fingernails in a gentle curve, even with or slightly below the fingertips, according to the care plan and employer policy.
10. Once the nails are dry and no longer soft, use an emery board or nail file to shape them.
11. File in one direction only.

Do not file wet nails. Wet nails can develop jagged edges.

Do not use a back-and-forth filing motion. This can damage the nail and cause discomfort.

Caring for the Feet and Toenails

When foot washing or soaking is part of the care:

1. Wash the feet with soap and a washcloth, including between the toes.
2. Rinse the feet and between the toes.
3. Remove the feet from the basin.
4. Dry thoroughly, especially between the toes.
5. Clean dirt from under the toenails with the edge of a nail file.
6. Only trim toenails when you have been specifically instructed and the task is permitted by the care plan and employer policy.
7. Apply lotion or petroleum jelly to the tops and soles of the feet, but not between the toes.
8. Warm the lotion in your hands before applying it.
9. Remove gloves and perform hand hygiene.
10. Help the client put on socks and shoes when needed.

Drying between the toes is important because moisture can support the growth of pathogens and contribute to skin infection.

Lotion helps lubricate the skin and prevent cracking. Do not place lotion between the toes.

Finishing Nail and Foot Care

After the procedure:

1. Make sure the client is safe and comfortable.
2. Place the call bell within reach when applicable.
3. Follow the care plan for bed rail use when applicable.
4. Clean and sanitize reusable equipment.
5. Return equipment and supplies to their proper places.
6. Discard disposable items and wear gloves while cleaning.
7. Remove privacy measures.
8. Handle soiled linen according to employer policy.
9. Perform proper hand hygiene.
10. Report and record your actions and observations according to employer policy.

Some bed, call-bell, and overbed-table steps used in facilities may not apply in community settings.

Common Mix-Ups

Wrong Idea	Better Idea
Put foot lotion everywhere.	Apply it to the tops and soles, not between the toes.
File fingernails while they are still soft and wet.	Wait until they are dry and no longer soft, then file in one direction.