1. Personal Footcare Education Programme Sections 6 - 8 Developed by the Scottish Government Personal Footcare Working Group, January 2013. With acknowledgment for the content of these slides to the Podiatry Services of NHS Dumfries & Galloway, NHS Lothian and Cardiff and Vale UHB.

2. Content of the Programme This education programme contains 8 sections:  Section 1: What is personal footcare  Section 2: Keeping feet clean  Section 3: Skin care and Checking feet  Section 4: Footwear  Section 5: What to do if you spot a problem  Section 6: Nail cutting and filing  Section 7: Nail conditions  Section 8: Frequently Asked Questions (FAQs)

3. Section 6: Nail cutting and filing  Consent, privacy and dignity for the person  Wash your hands  Clean the feet  Seating  Lighting  Personal footcare equipment  Place paper towel under feet

4. Nail structure Image courtesy of Cardiff & Vale UHB Podiatry Service Direction for filing nails

5. How to cut/file a persons toenails

6. Cutting toenails  If right handed use left hand to hold the toe and with the left thumb add tension to the pulp of the toe pulling the tip of the toe down away from the nail plate  Check for vascular skin tufts under the nail plate

7. Filing toenails  Filing the nails should either be side to side for thick nails or down across the free nail edge Image courtesy of NHS Lothian Podiatry Service

8. Bleeding points Adopt regular ‘first aid’ procedures  Apply pressure to stop bleeding  Apply sterile plaster or dressing  Keep plaster / dressing on for no more than 2 days after which the area should be checked  Record on the care plan  Contact Podiatry or the persons GP if concerned

9. Section 7: Nail Conditions The next series of slides will show examples of toenails you may not feel confident to attempt to cut  Deciding some toenails are beyond your capabilities can be the right decision to make  Some of the following will require a referral to the podiatrist

10. Nail conditions Thickened toenail Nails compromised by poor circulation Ingrown toenail Fungal nail Images courtesy of NHS Dumfries and Galloway Podiatry Service

11. Neglected toenails Images courtesy of NHS Dumfries and Galloway Podiatry Service

12. Challenging toenails  Most of the previous nails were examples of nails requiring initial assessment by a podiatrist or podiatry assistant  Tackle only those toenails that you feel you are confident to cut and which have been assessed by the Podiatry Service  As a guide, the nails you should treat are those which an individual would normally do themselves

13. Section 8: Frequently asked questions  When should we cut nails?  How often do we cut them?  What if they are too hard?  Can we use scissors to cut toenails?  How do we know whose nails to cut and whose not to?  What to do if redness, pain, swelling or pus is evident?  Why doesn’t the podiatrist cut toe nails?  Where can I buy footcare equipment?

14. Review of Learning Outcomes By the end of this programme you should be able to:  Explain the importance of good personal footcare  Clip and file toe nails safely  Recognise why feet need to be checked on a regular basis  Explain the importance of good skin care  Describe the correct features of good fitting footwear  Be aware of the referral criteria/pathway to their local NHS podiatry service and recognise when to make a referral

15. Local Contact Details  Trainer contact details  Local NHS podiatry service Further information  Feet for life: www.feetforlife.org  Age Scotland: www.agescotland.org. uk  Diabetes UK www.diabetes.org.uk

16. Image courtesy of Cardiff and Vale USB Podiatry Service Thank You