Toes

Specific risks

Although not an area usually classed as a pressure injury, toes are at risk of physical injury. The wounds tend to be at risk of delayed healing due to impaired circulation in the lower extremities. If toe injuries deteriorate, it can lead to osteomyelitis resulting in possible amputation.

Other risks of injury are secondary to impaired sensation and can include fractures, scrapes and bruising from direct injuries. These include items being dropped on the toes or the toes being caught between the footplate and a firm surface.

Other contributing factors may include:

• heavy bedding and firm-fitting sheets on the bed
• no foot protection including no padding on metal or plastic footplates
• placement of the feet in relation to the footplates e.g. externally rotated legs
• person’s awareness of their environment in relation to their feet. This may be especially important with power drive chair use. Speed, miscalculation of the turning circle or delayed stopping and hitting objects increase the risk
• injuries during transfers such as contact with the mast and/or motor of a hoist or bumping the feet on other surfaces
• surfaces in the bathroom and the home such as under sink pipes or the base of cupboards
• contractures of the toes and forefeet leading to poor positioning of feet
• poor toenail care which can cause loss of nails and/or potential ingrown nail infections
• oedema and ill-fitting compression stockings
• These areas should be assessed by palpating for ‘boggy’, soft, or tender areas.