1. Purpose

To ensure consistent, safe, and evidence-based assessment and treatment of foot and lower-extremity conditions by an independent LPN, in accordance with ANBLPN standards and provincial regulations.

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2. Scope

Applies to all foot care assessment and treatment services provided by the LPN in community, clinic, or home settings in New Brunswick.

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3. Definitions

• Routine Foot Care: Nail trimming, filing, callus/corn care (non-invasive), hygiene education.

• Assessment: Collection of subjective and objective data to identify risk factors, pathology, or contraindications.

• Treatment: Interventions within LPN scope, e.g., trimming, filing, moisturizing, simple wound first aid.
   

 

4. Assessment Guidelines

1. Client History

   • Medical history (e.g., diabetes, peripheral vascular disease, neuropathy).

   • Medications affecting skin integrity or circulation (e.g., anticoagulants).

   • Mobility, footwear habits, self-care ability.
      

2. Subjective Data

   • Client-reported symptoms: pain, burning, itching, tingling.

   • Onset, duration, aggravating/relieving factors.
      

3. Objective Data

   • Inspect skin: color, temperature, moisture, lesions, fissures.

   • Inspect nails: thickness, brittleness, ingrown edges, fungal changes.

   • Palpate pulses (dorsalis pedis, posterior tibial).

   • Sensation screening (e.g., monofilament if trained).
      

4. Risk Stratification

   • Low Risk: Intact skin, good circulation, no neuropathy.

   • Moderate Risk: Callus/corn build-up, mild nail deformity, age >65.

   • High Risk: Diabetes with neuropathy or vascular disease, immunocompromise, active ulcer.
      

 

5. Treatment Guidelines

1. Routine Care (All Risk Levels)

   • Nail trimming and filing to safe length/shape.

   • Callus and corn reduction using sterile files or paddles.

   • Skin hydration: application of emollients.

   • Education on daily foot inspection, proper footwear, and hygiene.
      

2. First-Aid Wound Care (Low/Moderate Risk Only)

   • Clean superficial breaks with saline.

   • Apply non-adherent dressing.

   • Advise on signs of infection and need for medical follow-up.

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1. Contraindications to Treatment

   • Active infection (redness, swelling, purulence).

   • Deep or non-healing ulcers.

   • Severe vascular compromise (absent pulses, cool skin).

   • Uncontrolled diabetes or other systemic conditions without medical clearance.
      

2. When to Refer

   • High-risk clients (see risk stratification).

   • Any condition beyond routine care or first-aid (see Scope & Referral Policy).

   • Suspected fungal/nail infections unresponsive to OTC measures.

   • Pain not relieved by conservative measures.
      

 

6. Documentation

• Use DARP format for every client encounter (see Documentation Standards Policy).

• Record: assessment findings, treatments performed, client response, referrals, and follow-up plan.

• Sign with date, time, full name, and designation.
   

 

7. Infection Prevention

• Follow MDR Sterilization Policy for instruments.

• Adhere to PPE Use Policy and Infection Control & Outbreak Response Policy.
   

 

8. Client Education

• Provide verbal and written instructions on:

  • Foot hygiene and nail care techniques.

  • Shoe selection and fitting.

  • Recognition of warning signs (infection, ulceration).

  • When and how to seek additional care.
     

 

9. Responsibilities

• LPN: Conduct assessments and treatments within scope, maintain competency, document accurately, and refer appropriately.

• Client: Follow care instructions, report new or worsening symptoms promptly.
   

 

10. References

• ANBLPN Standards of Practice & Code of Ethics

• Canadian Nurses Protective Society (CNPS) Foot Care Guidelines

• New Brunswick Health Professions Act
   

 

11. Review

This policy shall be reviewed annually or when new evidence, standards, or regulations emerge.