How to Help Prevent Skin/Soft Tissue Injuries to the Feet
Foot problems - especially injuries to the skin of the foot and/or the fat pads - are very common. According to the National Foot Health Assessment 2012 conducted for the Institute for Preventive Foot Health (IPFH) by the NPD Group, close to 80 percent of adults in the United States have experienced at least one foot-related ailment or condition at some point in their lives.
Foot problems such as blisters, calluses and athlete’s foot can interfere with mobility; they also can lead to damage to underlying blood vessels, nerves, tendons, ligaments and other foot structures, setting the stage for more severe problems.
At IPFH, we recommend the practice of skin/soft tissue management to protect feet from damage. Specifically, we advise taking proactive measures to protect:
- The outer layer of skin (epidermis) from chafing and abrasion.
- The underlying layers of skin (dermis and hypodermis) from impact, pressure and shear forces.
- The fat pads on the heel and ball of the foot and underside of the toes, which are especially vulnerable in older adults.
Until age 30, fat pads are thick, strong and supple, and the feet are mostly problem-free. But as we get older, the fat pads begin to degrade, offering less protection from the forces of impact, pressure and shear. Our foot muscles also become weaker, tendons and ligaments become less resilient, and our foot or feet may ache by the end of the day.
By age 50 or so, many people have lost as much as 50 percent of their fat pads, and the skin around the foot is likely to have thinned considerably. The result: the foot is more vulnerable to damage from impact during walking and other activities and to blisters, cuts, bruises and other forms of skin/tissue damage. Untreated, this damage can lead to ulcers that may become infected, raising the risk of amputation.
To help prevent injuries to the foot skin and fat pads and to manage any problems you may already have, we at IPFH suggest the following:
- Inspect your feet daily. Check the top, bottom and sides of your feet and between your toes. Use a mirror if you can’t reach down and turn your foot over to look at it. You can also ask a family member or friend to help you.
- If you see any lesions (cracks, cuts, blisters), tend to them immediately with antibiotic cream and a wound dressing (gauze bandage or a Band-Aid). See your doctor immediately if there is any sign of infection.
- Be aware of bruises, which are a sign that injury has occurred below the skin. A bruise often precedes tissue damage, so you should consider it a warning sign of potential problems to come--especially if the bruise takes a long time to heal.
- Also feel for lumps or bumps; temperature differences (one part warm, another part cool); pain, burning, tingling or numbness, which are signs of neuropathy; or loss of hair on your foot or leg, which can signal reduced blood flow. Any of these signs mean your foot is at risk. See your doctor or a foot health professional immediately.
- Wash your feet in lukewarm—not hot—water daily. If you have neuropathy, use your elbow to test the temperature of the water. Make sure you wash between your toes and then dry your feet thoroughly, including between the toes.
- Apply a thin film of skin-softening lotion to the top and the bottom of your foot. Don’t apply lotion between your toes because it can create a moist environment that favors fungal growth.
- Cut your toenails carefully. Trim straight across and soften the edges with an emery board to reduce the chance of developing ingrown toenails. If you can’t reach your toes easily, have a family member, friend or foot health professional trim toenails for you. Don’t cut your toenails yourself if you have neuropathy or other foot problems related to diabetes or other diseases that affect circulation.
- Never trim corns or calluses with a sharp implement such as a razor blade, knife or nail clipper; one slip of the hand can lead to a lesion or worse. This is a job for a foot health professional.
- Wear properly selected and fitted padded socks that provide terry fabric under the fat pads beneath your toes, the ball of the foot and the heel. Peer-reviewed, published studies have shown that wearing clinically tested padded socks can actually help protect against injuries to the skin/soft tissue of the foot, which is a major cause of diabetic ulcerations.
- Some padded socks made of acrylic or acrylic-blend fibers have been demonstrated by scientific research to reduce impact, pressure and shear forces. They also move (“wick”) moisture away from the foot, making it less vulnerable to fungal infection, irritation and other skin damage. By contrast, 100 percent natural fibers such as cotton and wool retain moisture, thereby losing their shape and resilience and offering significantly less protection.
- Wear shoes with non-slip outsoles that fit properly so that your foot can’t move around in the shoe and become irritated. To get the best possible fit, IPFH suggests following its integrated approach: Wear the padded socks you intend to wear in the shoes, as well as any inserts or orthotics prescribed or recommended by a doctor or foot health professional, when you select and purchase shoes; that way, you are unlikely to have fitting problems afterward.
- Select shoes and padded socks that are made for the specific activity in which you will be involved; for example, padded walking socks and shoes are not the same as padded socks and shoes made for running or hiking. Make sure the shoes are shaped like the shape of your feet (no pointy tips) and correctly sized, as described above.
- Try not to wear the same pair of shoes every day. Rotating shoes every other day allows your shoes to dry out from the perspiration absorbed from your feet the day before.
- Change your padded socks daily or more often if you are very active.
For more preventive foot health advice, see How to Practice Good Foot Hygiene.