12.2 Foot Care and Diabetic Foot Cautions (Skill 19)
Key Takeaways
- Skill 19 requires you to check water temperature and have the client verify comfort, then wash, rinse, and dry the foot including between the toes.
- Apply lotion to the top and bottom of the foot, excluding between the toes, and remove the excess with a towel — leftover lotion between toes causes maceration and fungus.
- Support the foot and ankle throughout; place the basin on a protective barrier; empty, rinse, and dry the basin into the designated dirty supply area.
- Do not cut toenails unless facility policy allows it and you are trained; diabetic nails are typically handled by the licensed nurse or podiatry.
- Inspect every time and report breaks, redness, cold or blue toes, and ingrown nails. No hot water bottles on diabetic feet. Socks and shoes that fit; no barefoot walking.
12.2 Foot Care and Diabetic Foot Cautions (Skill 19)
Quick Answer: Credentia Skill 19 — Provides Foot Care on One Foot is explain, privacy, check the water and have the client verify comfort, basin on a protective barrier, gloves, bare foot in the water, soap, then wash, rinse, and dry including between the toes. Apply lotion to the top and bottom of the foot, excluding between the toes, and remove the excess. Support the foot and ankle the whole time. Empty, rinse, and dry the basin into the dirty supply area; linen to soiled; gloves off; wash; call light in reach. For diabetic feet, do not cut nails unless policy and training allow — usually the nurse or podiatry. Never lotion between the toes. Never use a hot water bottle. Inspect every time. No barefoot walking.
Why foot care is an exam skill
Feet are I.A.1 grooming and they are also data collection. A break between the toes, a cold blue toe, or an ingrown nail can become an infection, especially when the person has diabetes and cannot feel the injury. Colorado may assign Skill 19 as one of the four random skills. The official Colorado handbook does not print a bold critical-element line on Skill 19, but graders and written stems still treat lotion off the toe webs and wash-rinse-dry between the toes as the steps candidates fail. Miss too many remaining steps and the skill still fails, because you must pass five of five.
Skill 19 — handbook steps in order
| Step | What Credentia Colorado requires |
|---|---|
| 1 | Explain the procedure, clearly, slowly, face to face when possible |
| 2 | Provide privacy with a curtain, screen, or door |
| 3 | Check water temperature for safety and comfort and ask the client to verify |
| 4 | Basin in a comfortable position for the client and on a protective barrier |
| 5 | Clean gloves before washing the foot |
| 6 | Client’s bare foot goes into the water |
| 7 | Soap on a wet washcloth |
| 8 | Lift the foot and wash including between the toes |
| 9 | Rinse including between the toes |
| 10 | Dry including between the toes with a dry cloth towel or washcloth |
| 11 | Lotion on the top and bottom of the foot, excluding between the toes; remove excess with a towel |
| 12 | Support the foot and ankle during the procedure |
| 13 | Empty, rinse, and dry the basin |
| 14 | Place the basin in the designated dirty supply area |
| 15 | Used linen into the soiled-linen container |
| 16 | Gloves off without contaminating yourself; wash hands |
| 17 | Signaling device within reach |
Notice what Skill 19 does not list as its last printed step: bed in low position. Many other skills do. Still lower a raised bed before you walk away on the unit. On the skills card, do every printed Skill 19 step, including the call light.
Water. You check it and the client checks it. A basin that feels fine on your thick palm can burn a thin, diabetic, or vascular foot. Never guess. Never fill from the hot tap only.
Barrier and gloves. The basin sits on a protective barrier, not on a bare sheet and not on the floor. Gloves go on before you wash. The foot is bare in the water — remove the sock and any tight shoe first.
Between the toes is for water and towel, not for lotion. Soap and rinse must reach the webs. Moisture left there macerates skin. Dry each web. Then lotion the dorsum and sole only. Wipe off extra lotion so the foot will not slide into a sock and so cream cannot creep into the webs.
Support the foot and ankle while you lift, wash, and dry. A dangling foot strains the back of the knee and can cramp. Hold the heel and lower leg the way you would for ankle range of motion — gently, no force.
Dirty side. Empty, rinse, and dry the basin; it goes to the dirty supply area. Linen to soiled. Gloves off. Wash. Call light in reach. The floor is never a shelf for a used basin.
Diabetic feet — the written-exam rules
Diabetes damages nerves (neuropathy) and blood flow. The person may not feel a blister, a hot-water burn, or a nail cutting into the skin. A small crack becomes an ulcer. An ulcer can become an amputation. The CNA’s job is inspect, wash, dry, protect, and report — not to perform nail surgery.
| Do | Do not |
|---|---|
| Inspect the tops, soles, heels, and between the toes every time you have the foot | Skip inspection because “the feet looked fine last week” |
| Wash with comfortably warm water the client has verified | Use a hot water bottle, heating pad, or extra-hot soak to “warm cold feet” |
| Dry including between the toes | Leave the webs wet, or pack lotion into the webs |
| Lotion top and bottom only; wipe the excess | Apply lotion between the toes (maceration and fungus) |
| Report breaks, redness, cold or blue toes, drainage, odor, ingrown nails, or a new open area to the licensed nurse now | Dig at an ingrown nail, pop a blister, or “just trim a little hook” |
| Do not cut toenails unless facility policy allows it and you are trained; diabetic nails are typically the licensed nurse or podiatry | Cut diabetic nails short and rounded after every bath |
| Help with socks and shoes that fit; no wrinkles, no tight elastic that leaves a deep groove | Let the person walk barefoot in the room or hall “to air the skin” |
Nail cutting is the classic trap. Many long-term-care policies take toenail care away from the aide for anyone with diabetes, poor circulation, or thick mycotic nails. Unless your facility policy and your documented training say otherwise, you do not cut. You wash, dry, lotion the safe surfaces, put on clean socks, and tell the nurse what you saw.
Heat is the other trap. Neuropathy means the person cannot tell you the water bottle is burning them. You already checked basin temperature. You do not add a hot pack after the soak.
Footwear. Socks should be clean, dry, and smooth. Shoes should fit — not borrowed slippers that rub the heel. Barefoot walking in a facility bathroom is how a diabetic foot meets a staple. If the person wants to walk, they wear shoes.
Inspect every time the sock is off. You are the staff member who actually sees the sole. Chart what you were taught to chart, and verbally report any new redness, break, coldness, color change, or ingrown nail. Do not wait for the next podiatry visit to mention an open heel.
Colorado scenario
You are assigned Skill-19-style foot care for Mr. Nguyen, 71, in a Grand Junction long-term-care facility. He has diabetes, says his feet “always feel a little numb,” and asks you to “cut these thick nails and put extra cream between the toes so they don’t crack. Then just set the basin on the floor and bring the heating pad — my toes stay cold.” A float aide shrugs: “If he asks for a trim, just do a quick clip. The podiatrist is not here until next month.”
You explain, pull the curtain, and check the water. He verifies it is comfortably warm — not hot. The basin sits on a protective barrier, not the tile. Gloves on. Bare foot in the water. You support the ankle, wash the foot including between the toes, rinse the webs, and dry the webs. Lotion goes on the top and bottom only. You wipe the excess. You do not put cream between the toes. You do not cut the nails. You do not plug in a heating pad or a hot water bottle. You notice a red streak on the left great-toe web and a cold, dusky fifth toe. Basin emptied, rinsed, dried, to dirty utility. Linen to soiled. Gloves off. Hands washed. Call light in reach. Then an immediate verbal report to the licensed nurse: red web, cold dusky fifth toe, client reports numbness, nails not cut, lotion not placed between toes. That one visit is Skill 19 plus the entire diabetic-foot written item.
Exam traps
- Lotion between the toes, or skipping the webs on wash, rinse, or dry.
- Cutting diabetic toenails “just this once.”
- Hot water bottles or unchecked scalding water on numb feet.
- Basin on the floor with no barrier, or a used basin left in a clean area.
- Letting a diabetic client walk barefoot.
- Ignoring redness, a break, an ingrown nail, or a cold blue toe because the person is not complaining — neuropathy is why they do not complain.
- Forgetting to support the foot and ankle, or forgetting the call light at the end.
After drying a client’s foot, which lotion step matches Credentia Skill 19?
A Colorado long-term-care client with diabetes asks the CNA to cut thick toenails after foot care. What should the CNA do?
Which Skill 19 sequence is correct for one-foot care?