Foot Care Nursing is a specialized area within the Nursing profession that remains relatively unknown to many practicing Nurses. Foot Care Nurses are employed in various settings, including long-term care facilities, hospitals, outpatient clinics, and home health services, and may hold certifications in wound care. Foot Care Nurses primary focus is on lower extremities, conducting assessments of skin integrity, mobility, sensation, and circulation. Additionally, they take detailed health histories to identify factors that may impact the lower extremities, such as diabetes, peripheral arterial disease (PAD), or vascular conditions.
Foot Care Nurses play a vital role in preventive care, including foot hygiene, skin assessment, toenail management, and education on proper footwear to prevent diabetic foot ulcers. Individuals with diabetes mellitus face a 30-fold increased lifetime risk of amputation, with a 34% lifetime risk of developing a foot ulcer. Mortality rates reach 50% within two years following a lower extremity amputation.
Geographic location can further exacerbate amputation risk due to disparities in access to care for PAD, diabetes, and other conditions. Between 2007 and 2019, studies examining regional and racial/ethnic variations in amputations revealed significant disparities. Black and Hispanic patients experienced a 50% higher rate of disease compared to White patients. Native American, Black, and Hispanic individuals were also at higher risk of amputation within one and five years compared to their White counterparts. Notably, Black patients in areas with the lowest rates of PAD and diabetes still faced disproportionately higher amputation risks. Conversely, regions with higher prevalence rates of PAD and diabetes tended to report lower amputation rates.
Foot Care Nurses provide essential services to individuals with diabetes and PAD, who are at heightened risk for amputations. A critical component of their role involves addressing the impact of social determinants of health, defined by the World Health Organization as non-medical factors influencing health outcomes. These determinants include the conditions in which people are born, grow, live, work, and age, as well as the broader societal forces shaping these conditions. Nurses, trained to provide holistic care, focus not just on treating diseases but on addressing the overall well-being of their patients. This includes asking questions about food security, access to medications, transportation to medical appointments, and the safety of walking in their neighborhood—all factors that may affect diabetes management, PAD, and the risk of foot ulcers.
Certification in Foot Care Nursing is strongly encouraged and can be obtained through two professional organizations. The Wound, Ostomy, and Continence Nursing Certification Board (WOCNCB®) offers certification as a Certified Foot Care Nurse (CFCN), while the American Foot Care Nurses Association (AFCNA) provides certification as a Certified Foot Care Specialist. A recent milestone for the profession is the Centers for Medicare & Medicaid Services (CMS) policy, effective December 1, 2023, which allows Registered Nurses holding a CFCN credential to perform services eligible for Medicare benefits.