Title:  Foot Care

Advisory Ruling Number: 9305

Authority:
The Massachusetts Board of Registration in Nursing (Board) is created and authorized by Massachusetts General Laws (M.G.L.) c. 13, ss. 13, 14, 14A, 15 and 15D, and G.L. c. 112, ss. 74 through 81C to protect the health, safety, and welfare of the citizens of the Commonwealth through the regulation of nursing practice and education.  In addition, M.G.L. c.30A, s. 8 authorizes the Board to make advisory rulings with respect to the applicability to any person, property or state of facts of any statute or regulation enforced or administered by the Board.  Each nurse is required to practice in accordance with accepted standards of practice and is responsible and accountable for his or her nursing judgments, actions, and competency.  The Board’s regulation at 244 CMR 9.03(6) requires all nurses to comply with any other law and regulation related to licensure and practice.

Date Issued: January, 1979

Dates Revised: July 15, 1992; September 25, 2002; March 9, 2011, December 10, 2014

Scope of Practice: Registered Nurse and Licensed Practical Nurse

Purpose:
To guide the practice of Registered Nurses and Licensed Practical Nurses whose practice incorporates foot care to meet nursing and client goals including, but not limited to, health promotion, client teaching, health risk reduction, and promotion of safety and comfort.

Advisory:
Foot care is an important component of nursing care.  Nurses must apply evidence based principles when assessing, planning, implementing and evaluating an individual’s foot health care needs.  Licensed nurses who incorporate foot care into their practice must recognize foot signs and symptoms that may represent conditions requiring treatment beyond their scope of practice and refer to appropriate members of the health care team for collaboration and orders for continued treatment.  Nurses may perform nursing techniques and procedures related to foot care only after appropriate education and demonstrated clinical competency that includes adherence to standard precautions and principles of asepsis and infection control.

Clients must grant informed consent in writing or orally, with substantiating documentation by the nurse.  In obtaining informed consent for a nursing intervention, the nurse will provide the client with information about foot care, including its intended benefits and potential risks.   Collaboration and consultation between members of the health care team is essential.  Documentation of consent, assessment information, plan of care, interventions and evaluation must adhere to current standards of practice.

Nurses who provide foot care must have theoretical knowledge of and demonstrate clinical competency in:

  1. Foot and lower extremity anatomy and physiology;
  2. Structure and function of the foot and nail;
  3. Common foot pathology and related nursing interventions;
  4. Changes in the foot due to age and chronic diseases;
  5. Nursing assessment of the foot and lower extremity;
  6. Use of instruments used in nursing foot care; and
  7. Infection control.

Foot care is considered a nursing intervention that includes, but is not limited to, the following components:

  1. Assessment of past medical history including Diabetes Mellitus, Peripheral Vascular Disease or Peripheral Neuropathy;
  2. Assessment of circulation;
  3. Assessment of skin integrity, foot and nail structure;
  4. Implementation of a plan of foot care that is consistent with recognized standards of practice that includes:
    1. Hygiene and shortening of toe and finger nails;
    2. The use of emery boards or pedicure drill with emery disc attachment, to smooth corns or calluses Referral to an appropriate practitioner for further assessment and orders for continued care for alterations in skin integrity, foot structure and/or other abnormalities that may require application of prescription or non-prescription treatments and/or devices; and
    3. Evaluation of client status and effectiveness of foot plan of care. 

Client education includes, but is not limited to the following:

  1. Self care;
  2. Appropriate footwear;
  3. Nutrition;
  4. Exercise;
  5. Compliance with medical regimes; and
  6. Reporting changes and/or problems to their primary care provider.

For the purpose of this Advisory Ruling on Nursing Practice, the application of prescription and/or non-prescription medications or treatments, intended for reasons other than moisturizing and/or provision of a protective moisture barrier for intact skin, requires an order(s) from duly authorized prescribers identifying the minimum required elements[1] of a prescription prior to implementation. 
 

References:
College of Licensed Practical Nurses of Manitoba. Certified Foot Care Nurses Interest Group: Standards of Practicehttp://www.footcarenurse.ca/download/standards.pdf

Bryant, Ruth et al, editors.  Acute & Chronic Wounds: Current Management Concepts.  Howes-Trammel, et al.  Foot and Nail Care.  Chapter 15, © 2011, Elsevier, Inc.  http://www.maphn.org/Resources/Documents/Foot%20and%20Nail%20Care%20Chapter%20Bryant%20TEXT%202010.pdf

Burton, M. et al, editors.  Fundamentals of Nursing Care.  © 2015 by F. A. Davis Company.

Indian Health Service Division of Diabetes Treatment and Prevention.  Indian Health Diabetes Best Practice Foot Care.  April 2011. http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2011_BP_FootCare_508c.pdf

Treas, L. et al, editors.  Basic Nursing.  © 2014 by F. A. Davis Company

Wound, Ostomy and Continence Nursing Certification Board Foot Care Certification http://www.wocncb.org/certification/foot-care-certification accessed October 28, 2014



[1] Name of ultimate user, name of the medication/substance, dose and route of the medication/substance, frequency of the medication/substance administration, a valid medication/substance order date, specific directions for administration, signature of the duly authorized prescriber, signature of the individual accepting/verifying the order.

 


This information is provided by the Division of Health Professions Licensure within the Department of Public Health.