“Feet are a very good intro into the health of an individual,” believes faith community nurse Marlene Feagan, MA, BSN, RN-BC. “Every person's feet tell a story about them: Can you care for yourself? Are the socks clean and do the shoes fit appropriately? Are you capable of the activities of daily living (ADLs)?”
Foot care is a high priority for Feagan, interviewed specifically for this column, whose work as Health Ministries Coordinator for St. Elizabeth Healthcare in northern Kentucky includes Hope for Soles, two weekly foot care clinics—one in an urban setting and another for suburban community residents.
Since the clinics launched in 2021, Feagan and five volunteer registered nurses (RNs) have grown the outreach so they meet with 10 to 15 clients each week. The team follows a medical model, with a podiatrist overseeing the ministry. “This model includes physical assessment of the condition of the feet, pedal pulses, checking for the presence of swelling, noting how clean the feet are. We work though a list for a complete foot and skin assessment from the lower leg down.”
While the foot clinics take place in the community—on bus lines, with one close to a homeless shelter—Feagan considers this health ministry. She and the volunteer RNs build relationships with clients, making time to listen to their stories. “Our patients don't just have a foot problem. Some of the people are employed, most are marginalized. Some are living in their cars.” She said a large number of clients have substance use disorders or mental health challenges; they've burned many bridges with family and community. “Many of these people have no one else who cares, so we express care and love as we care for their feet,” she said.
In addition to assessment, the nurses clean each person's feet, trim toenails, and remove corns and calluses. Each individual is given 30 minutes of personalized, hands-on care. For those with diabetes, there is extra assessment and, as needed, wound care. With regular and early assessment, these clients may be able to avoid decubiti or loss of toes due to neuropathy, Feagan said. The nurses offer teaching to help clients understand their physical situation and learn how to improve it. “We're increasing their awareness, and through this non-stop teaching, we're starting to see inroads where the people are doing better.”
The volunteer nurses are members of the American Foot Care Nurses Association (AFCNA); they have completed extensive continuing education on foot care and attend the organization's monthly webinars. One RN volunteer also is certified in wound care. The team follows AFCNA protocols and national standards (AFCNA, 2022).
In addition to the care and assessment, clients receive a new pair of socks at each visit; annually they receive a pair of shoes funded by a grant. The healthcare system subsidizes the cost of supplies for the foot care clinics; healthcare system employees donate the socks.
Feagan said it's a humbling experience to provide a pair of new shoes to their clients. Most wear out their shoes faster than is typical due to being outside most of the time along with the effects of the climate. “We consider it an important part of the ministry to be able to give them new, correctly fitting shoes,” Feagan said. The volunteer nurses particularly appreciate the immediate gratification of doing something that brings results, and being able to hear clients' stories while giving care.
While the clients who attend the clinic don't always need foot care, they all crave a little bit of attention and conversation, leaving with the feeling that someone is looking out for them. “It's our ministry to be present, open, and accepting of every person who comes, to actively listen to their story, and provide the best care we can. If the person is interested in prayer, we may pray with them.”
“As with our other health ministries,” Feagan said, “we try to see Jesus in the face of everyone we serve, to remain judgement-free, and to have them know there's no place else we want to be while they're with us.”
American Foot Care Nurses Association. (2022). Welcome to the American Foot Care Nurses Association