Providing Foot Care in Mental Health: A Case Study

Abstract.   People with mental illness have a need for foot care.  This paper presents three case studies of foot care provided to patients in a psychiatric hospital.  Ages ranged from 50 to 75 with diagnosis of depression, suicidal thoughts, dementia and confusion.   Comorbidities included diabetes and overwhelming fungal infection on feet and toenails.  Two were males and one was female. 

In the past and present foot care has usually been provided to residents of long term care facilities, senior centers or in podiatrist offices.  In general, mental health facilities do not provide this care.  No formal foot care has ever been provided in this facility before, however, staff nurses providing overall care for patients do apply creams to feet when ordered by the physician.      

In this study foot care began with trimming and cleaning of toenails and general inspection of feet.  After a hard callous was found on a diabetic foot, more education was provided to patients to include inspecting feet daily, inspecting shoes and applying cream at night.  All three patients were encouraged to see a podiatrist on a regular basis.  While providing foot care, therapeutic interchanges occurred that allowed the nurse to provide emotional support as well.

Patient’s responses were usually immediate expressing relief of painful nails due to the cleaning and trimming process and feeling more steady on their feet.  Callouses were found on the bottoms of the feet of both diabetics. 

Clinical implications include foot care can help establish a therapeutic relationship, help diabetics manage anxiety and help relieve foot pain improving mental health. It saves money by preventing diabetic foot ulcers and patient falls; both of which Medicare could deny payment for.  Limitations include that some patients in mental health facilities are too psychotic and confused to allow foot care to be done.