My Mum Can’t Reach Her Feet Anymore: What Are the Options?

It usually comes to light by accident. You are helping with shoes and socks, or she mentions that her slippers feel tight, and you get a proper look at her feet for the first time in a year. The nails are long, thick and going in directions nails should not go. There is hard skin along the edge of the heel. Perhaps a toe is red where a nail has been pressing into it.

If you have found yourself thinking "my mum can’t reach her feet anymore", you are in extremely common company. It is one of the quietest reasons older people stop looking after their own feet, and one of the least likely to be mentioned out loud. Nobody rings their daughter to announce that they can no longer bend far enough to cut their toenails. They just stop cutting them, and hope nobody notices.

This piece sets out what is actually happening, what tends to go wrong when feet go unmanaged for months, what a foot health appointment involves for someone who cannot manage on their own, and where the line sits between routine foot care and something that belongs with a GP.

It is usually not illness. It is reach, bend and balance

The instinctive assumption is that something must be wrong. Often there is nothing newly wrong at all. What has changed is the mechanics of the job.

Cutting your own toenails is a surprisingly demanding physical task. It requires you to fold at the hip, hold a position for several minutes, keep your balance while one foot is off the floor or crossed over the other, see clearly at close range in poor light, and apply controlled force with your fingers at an awkward angle. Take away any one of those and the job becomes difficult. Take away two and it becomes unsafe.

The things that take them away are ordinary and gradual:

Stiff hips and knees. Arthritic change, a hip replacement, general loss of flexibility. If she cannot bring her foot up towards her, she cannot see what she is cutting.

Loss of balance. Leaning forward while seated shifts the centre of gravity. Plenty of older people have had a wobble doing exactly this and have quietly decided not to risk it again.

Eyesight. Cataracts, macular changes or simply needing more light than the average bathroom provides. Cutting nails you cannot see properly is how skin gets nicked.

Arthritis in the hands. This is the one families miss most often. She may be able to reach her feet perfectly well but no longer have the grip strength or thumb joints to work a pair of nail clippers, particularly on a thickened nail that has gone hard and horny.

Breathlessness. Bending forward compresses the chest. For anyone with a heart or lung condition, staying folded over for five minutes is genuinely unpleasant.

Weight and body shape. A perfectly healthy person can simply be unable to fold far enough to reach.

None of these is an illness that needs treating. They are reasons a task has outgrown the person trying to do it, which is a different problem with a different answer.

What tends to go wrong when feet go unmanaged

Feet are patient for a while and then they are not. Months of no nail care and no attention to skin usually produce some combination of the following.

Nails grow long and then start to thicken and change shape, partly from age and partly from repeated pressure inside a shoe. A thick nail is far harder to cut than a normal one, which pushes the job further out of reach and makes the situation self reinforcing. Long nails press against the front of the shoe, which is uncomfortable and can bruise the nail bed. They can also catch on bedding and socks.

Hard skin builds up where pressure is highest, typically the ball of the foot, the edge of the heel and the sides of the big toe joint. Left long enough, some of that hard skin concentrates into a corn, which can be sore to walk on. Heels can go dry and develop splits, particularly in winter or with open backed slippers.

The more important consequence is not any single one of these things. It is that walking becomes uncomfortable, so she walks less, so balance and leg strength decline, so she becomes less steady, which brings its own risks. Sore feet quietly shrink a person’s world.

There is also a real risk of injury from DIY attempts. Scissors used blind, corn plasters bought off the shelf and used on skin they are not suitable for, or a well meaning family member having a go with the kitchen scissors. Skin breaks on an older foot are worth avoiding.

What actually happens at a foot health appointment

For someone who has stopped being able to manage, a routine appointment is far less of an event than families expect.

She stays seated and fully supported. Nothing requires her to bend, balance or hold a position. Shoes and socks come off, or are taken off for her if that is easier, and the feet are looked at properly in good light: nails, nail folds, the skin between the toes, the pressure points, the heels.

The practical work is then done for her. Nails are cut back to a sensible length and shape, and thickened nails can be reduced so they take up less room in a shoe. Hard skin and corns are carefully reduced. Nail edges are smoothed so they do not catch or press into the neighbouring toe. Feet are usually finished with a cream or balm, which is also the point at which someone can show you which cream is worth using at home and where to put it.

Just as usefully, the appointment is a chance for someone to look at her shoes. Ill fitting slippers and shoes that have gone soft and shapeless cause a great deal of the trouble in the first place.

Expect the first appointment to take longer than later ones. Months of backlog takes more work than maintenance does. After that, most people settle into a rhythm that suits how fast their nails grow.

If getting out of the house is the obstacle

For a lot of families the real barrier is not the appointment, it is the journey. If she cannot manage a car, a waiting room or steps, ask about home visits when you enquire. Foot care at home works perfectly well: it needs a supportive chair, decent light and enough space for the practitioner to work.

When you ring, it helps to say upfront whether there are stairs, whether she needs help getting seated, whether she has dementia and would do better with a familiar face present, and what her general health picture is.

Clear signs it is time to book rather than keep trying

Stop persevering and book if any of the following apply.

• Nails are long enough to press on the front of her shoes, or are curling.
• Nails have thickened to the point where ordinary clippers will not cut them.
• She has stopped cutting them and is not saying so.
• You can see nicks, scratches or nail edges cut at odd angles, all signs of cutting blind.
• She has to hold onto something to lean forward, or gets breathless doing it.
• Her hands cannot grip or squeeze well enough to use clippers.
• There is visible hard skin, a corn, or a split heel.
• She has started wearing only slippers, or avoiding walks she used to enjoy.
• You have been doing it for her and do not feel confident, particularly with thick nails or skin close to the nail.

You do not need a referral and you do not need to wait until something hurts. Routine care is easier, safer and quicker when it is routine.

When it is not a foot health matter

This matters, so it deserves to be said plainly. Routine nail and skin care is not the answer to everything, and a foot health practitioner is not a substitute for medical assessment.

Contact her GP, her diabetes team or an HCPC registered podiatrist, rather than booking routine care, if there is:

• Any break in the skin, ulcer, wound or sore that is not healing.
• Heat, swelling, spreading redness, throbbing or discharge, which may suggest infection.
• Numbness, pins and needles, burning pain, or a loss of feeling in the feet.
• Sudden colour change, a foot that is cold and pale, or new pain at rest or at night.
• Diabetes combined with any foot concern at all. Diabetes changes healing and sensation, so it should always be declared when booking, and anything beyond routine care needs the diabetes team.
• A nail that is painful, discoloured or lifting and needs a diagnosis rather than a trim.
• Sudden changes in foot shape, or a foot that has become hot, swollen and misshapen.

If you are unsure which category you are in, say what you are seeing when you ring. A reputable practitioner will tell you honestly if what you are describing needs a GP first, and will be glad you asked.

Raising it without making it a loss

The reason this problem stays hidden is dignity. Feet are private, and needing help with them can feel like a line being crossed. It tends to land better if it is framed as outsourcing an awkward job rather than as evidence of decline. Plenty of perfectly capable people have their feet looked after simply because the task is easier when somebody else does it.

If you are weighing up the options for your mum, the sensible first step is a straightforward look at her feet by someone who does this all day, with the work done while she stays comfortably seated. Get in touch to talk through Foothealth & Therapy Clinic’s foot care in Burnley, including whether a home visit would suit her better than a trip out.