Nursing Self-Care: Keep Feet Feeling Their Best Before, During and After Shifts

A day in the life of a nurse requires many long hours of standing, walking and lifting, which can cause stress on lower extremities – especially feet. In fact, studies have found that most nurses take at least 9,000 steps per shift with other research indicating that some of the most common foot problems among nurses are corns and calluses, lesser digital deformities and foot pain, with both high and low arched foot types.

To avoid work-related health and foot problems, it’s important for nurses to take proper care of their feet. Judi Bar, E-RYT 500, C-IAYT, Cleveland Clinic’s Yoga Program Manager and Stephen Smik, DPM, a podiatric medicine physician at Cleveland Clinic offer nurses the following foot care tips.

1. Wear supportive footwear.

Both Bar and Dr. Smik agree that wearing supportive footwear is at the top of the list. They say shoes that are comfortable and supportive can help prevent aches and pains from developing in the feet and contribute to improved circulation. In addition, wearing the wrong shoes can cause problems, such as:

• Bunions: a bony knob forming at the base of the big toe.
• Corns: skin that calluses and forms hard lumps on toes.
• Hammer Toe: toes that curl up or bend when shoes are too tight.
• Crossover Toe: toes that cross another toe due too little space.
• Ingrown Toenail: inflammation and pain in a toenail toe caused by one toe pressing against another toe for too long.
• Plantar Fasciitis: heel pain/tears and strain on the plantar fascia due to inadequate foot support.

A proper shoe should hug the foot (specifically, the heel) comfortably, but allow the toes to wiggle freely. Shoes should not slide up and down while walking. Dr. Smik says the best shoe type for a nurse is a running shoe.

“Running shoes are the way to go,” he says. “Compared to walking shoes, for example, which generally feature more leather in the exterior, running shoes have an upper mesh nylon and liner so they are lighter in weight and have the shock absorption needed for nurses’ long 8- or 12-hour workdays.”

Dr. Smik also advises against foam clog-type shoes, which he says are often a favorite of nurses. Contrary to the shoe’s ‘cut-out hole’ appearance, Dr. Smik says the rubber exterior does not breathe well. He also notes these shoes offer no heel counter and little arch support, which is another important factor when seeking the right shoe.

To determine good arch support, he recommends when nurses fit themselves for a shoe, they take out the insole, place it on a flat surface and apply hand pressure. The arch of the insole should not collapse under the pressure.

In addition, he says the insole can also help a nurse determine their best shoe fit. He advises nurses to put the insole on the floor and step on top of it: “If parts of the insole are extremely hidden under the ball of your foot, for example, that shoe isn’t wide enough,” he comments. “If your toes hang over the length of the insole, the shoes are too short. Also, make sure you have enough width.”

1. Enhance shoes with inserts or orthotics.

In addition to the shoe itself, shoe inserts or orthotics are good solutions for helping nurses avoid or relieve foot pain. Inserts can be purchased over the counter and typically provide added relief for pain caused by nurses standing on their feet for extended periods of time. Orthotics are prescription-only and must be ordered through a physician’s office; however, in addition to pain relief, orthotics can help solve more severe foot problems, such as plantar fasciitis or arthritis.

Dr. Smik says custom inserts, while more costly, are always best. He also says to avoid soft, squishy insert options as they are too forgiving, which makes them inadequate for the functional aspect of standing on your feet all day. “Nurses need a firmness and stiffness to the arch, so a more rigid material like thermoplastic is ideal,” he notes.

1. Perform stretches and exercises.

Smik admits that given the nature of the nursing profession, it may be challenging for nurses to perform foot exercises while at work. However, simple stretches such as ankle rolls or calf raises during breaks can get the blood flowing to the feet and help alleviate tension that may cause aches or pains. “Stretching gets circulation going and removes lactic acid from the body, preventing muscle spasms,” he says.

Off the nursing floor, Dr. Smik recommends repetition of a select few stretches in the morning and in the evening. He says nurses should spend about 10 seconds (or 10 repetitions) stretching each foot before bed and when they wake up with calf stretches and toe curls.

For stretching calves, nurses should place the ball of their foot on a stair and let their heel drop down. “Another good calf stretch is the classic runners stretch. This keeps the calves loose and limber,” he adds. Dr. Smik says toe curls, which offer a slight contracture of the toes and stretch out the extensor tendons, can easily be completed with ‘towel crunches’ by grabbing a towel with the toes.

Bar, who has developed an inclusive style of yoga known to help with chronic pain, disease and physical conditions, recommends nurses perform the following daily foot care exercise routine at home (in socks or barefoot for optimum results):

• Face a chair with feet hip-distance apart in ‘mountain pose.’ To assume ‘mountain pose,’ stand up tall and straight. Prance feet, bending toes on one foot and switching to the other fairly quickly to warm up the feet and obtain circulation.
• Slow the pace and push into bent toes on one foot. Hold for one to two breaths, then switch to the other foot. Repeat one to two times.
• From ‘mountain pose,’ bend at the knees. Ensure toes and knees face forward and press heels down to stretch the Achilles tendon and calf muscles. Hold for three breaths and/or repeat a few times.
• From ‘mountain pose,’ transfer weight to heels. Keep the balls of the feet on the ground and lift toes only. Hold for a few seconds and repeat to strengthen arches.
• From ‘mountain pose,’ lift one leg a few inches in line with hip. Circle ankle one way, then the other. Wiggle toes. Point and flex foot. Repeat sequence on the other side.
• Sit forward in a sturdy chair in a seated ‘mountain pose.’ Extend legs straight out in front with heels on the ground and knees straight. Sitting tall, hold onto chair and lean forward slightly with a lengthened back. Hold for at least three breaths.
• Remain in the extended leg position and move feet to the right, then to the left with heels on the ground (like windshield wipers).
• Resume seated ‘mountain pose.’ Shift body to the right side of the chair. Hold onto the chair with both hands and drop right leg off the side of the chair while sliding to the edge with only the left buttocks and hands remaining on the chair. Ensure knee is pointed down and ankle is straightened so toenails are also pointing down. Hold for three breaths. This stretches the ankle and front of thigh. Repeat sequence on other side.

1. Elevate, soak and moisturize.

After work, if nurses are experiencing swelling or pain, they should spend significant time relaxing and elevating their feet above their heart, as well as soaking feet in a warm Epsom saltwater bath for 10 to 15 minutes. Massage therapy either by hand, with a gentle foot massager, or rolling the foot across a tennis ball will also aid with associated heel pain and planter fasciitis, notes Dr. Smik.

Dr. Smik also recommends nurses check their feet daily for cracked or dry skin, especially those living in colder geographic locations and during winter-climate months. He suggests applying lotion every day, two times per day: “Skin builds on itself so applying lotion one to two times a week won’t cut it. Nurses should develop the habit of moisturizing daily,” he comments.

Other foot-care considerations

Since nurses work in a fast-paced environment with minimal breaks or sitting time, something else nurses may want to consider are compression socks (or stockings), which have proven successful in helping prevent stiff, sore legs and feet.

Compression socks are made of snug-fitting stretchy material that gently squeezes the skin, muscles and vascular structures beneath. They are primarily used for venous diseases, such as Edema, venous insufficiency, varicose veins, deep vein thrombosis, lymphedema and phlebitis, as well as during pregnancy. According to Dr. Smik, compression socks improve leg circulation preventing venous accumulation and lymphatic drainage. This prevents pain in the legs, and reduced fluid accumulation. So, there is also less heaviness which lessens tiredness/leg fatigue. This will reduce the risk of varicose veins, deep vein thrombosis, and stasis leg ulcerations.

“Nurses who stand much of their shift would greatly benefit from the use of compression stockings,” Smik says. “Also, the old days of white or beige compression stockings are over. Today, stockings come in as many varied colors as the rainbow has.”

Nurses should also keep in mind that it is important to address foot-related problems or issues right away to keep them from worsening and improve the chance of reversing possible damage. For example, Dr. Smik says if a nurse is developing calluses on a big toe, they should consider an orthotic solution to accommodate for the deformity. In this case, a podiatric medicine physician would create a pocket under the ball joint to balance weight more appropriately and take pressure off the problem area.