Putting feet first

Even cutting toenails can be a difficult and occasionally dangerous activity for older people. Dan Parton reports.

To younger people it may sound strange, but as we get older looking after our feet becomes more challenging for various reasons – primarily we become less supple, we may also develop arthritis.  And then there’s your eyesight, which makes it more difficult to see what’s going on down there too.

About 1/3 over 65s in England, more than two million people, are now unable to cut their own toenails, according to Age UK.

Common problems

• Ingrown toenail; this is where the nail curves downward and grows into the skin, usually at the sides of the nail. The nail then irritates the skin, creating pain, redness, swelling, and warmth in the toe. If the nail breaks the skin it can allow bacteria in, which causes an infection. Ingrown toenails can be especially serious for people with impaired circulation, diabetes or other systemic diseases. In some cases, it is only treatable with an operation.
• Fungal nail infection; the infection is usually painless at first and the nail(s) may only look thickened and discoloured – often a yellowy-green colour. But if untreated, the infection can cause the nail to come away from the skin, crumble or fall off and the skin around can also become infected. If this is left untreated, walking can become extremely painful.
• Older people are also prone to onychogryphosis, or thickened toenails. This is caused by dropping a heavy object on a toe or gradual damage over the years. Again, this can cause pain and makes walking difficult. It is sometimes mistaken for a fungal infection because the nail becomes similarly discoloured.
• If left untended, toenails can grow over the end of the toes and make wearing shoes difficult. They can also grow underneath the toe and dig into the skin.

The knock on effects

For older people, problems with feet can lead to desperate measures. We heard stories in 2007 from the then Director General of Age Concern of one man using garden shears and another kicking walls with his bare feet essentially because neither could easily cut their own toenails with nail scissors anymore. Older people are driven to these dangerous lengths out of pain and frustration.

If issues go untreated, there’s not only the discomfort or pain, but it also impacts the sufferer’s ability to walk; there’s a reduction in much needed exercise, which can in turn lead to feelings of insecurity and then potentially loneliness as immobility sets in.

For family members and friends, keep an eye out for older people who seemingly become less keen or able to walk. It may be a sign that foot problems exist, which for the individual is too uncomfortable to discuss.

What can I do?

If something has become critical, the first stop is your GP. While a podiatrist (AKA chiropodist) can assess the problem and, if need be, thin down a thickened nail, they cannot prescribe antifungal tablets or paint, which a GP can do.

All these ailments are treatable, but in some cases, especially fungal infections, it can take more than a year for the condition to clear.

Prevention is better than cure

For those that can still cut their own toenails – or if someone does it for an older person – a few simple guidelines should help to keep toenails healthy:

• It is best to cut toenails after bathing when they are softer.
• When cutting, follow the shape of the toe. Do not be tempted to cut them too short, especially at the corners; this can lead to an ingrown toenail.
• Using nail clippers may be easier than regular nail scissors, which can slip.
• After clipping, use a file or emery board to smooth the nails.
• Wear properly fitted shoes that do not press, squeeze or rub on the toes.
• Wash feet regularly with soap and water; drying thoroughly afterwards helps to prevent infections.

For older people that cannot cut their own toenails, visiting a podiatrist regularly will help to alleviate any problems.

Charities such as Age Concern offer local toenail cutting services to people over 60 years old. Here, trained staff can cut toenails, file hard skin and give general advice on footcare. Home visits can also be arranged for housebound clients.

Who pays for chiropody (podiatry) services?

Footcare is a crisis that has emerged for older people in recent years as a result of cuts in NHS chiropody services. An individual’s ability to get the service is now a location lottery and depends on the policy of the local authority or NHS provider along with the criticality of the symptoms. This is leaving many older people without access to services which previous generations enjoyed free of charge on the NHS.

Private chiropodists are common, but they can be costly; usually about £25-£30 per session. If you can find the money, however, it’s a worthwhile investment if it keeps you out and about.