How to Give a Great Foot Massage

Touch and caring are often inseparable.

G L O R I A J O A C H I M

Among all age groups and in all settings, foot massage is an impor- tant and much neglected aspect of nursing care. More than just a component of complete care, foot massage has physiological and psy- chological benefits for the whole person. While massaging, the nurse can assess the feet, st imulate circu- lation, decrease edema, and provide a local form of passive exercise.

As the feet and body relax, heart and respiratory rates decrease. In

Gloria Joachim, RN, MSN, SSB, an assist- ant professor at the School of Nursing, Uni- versity of British Columbia, Vancouver, has found foot massage especially useful in her practice with aged patients.

this relaxed state patients feel greater ease in expressing them- selves and are more receptive to teaching. Foot massage can be used to relax patients before procedures and at bedtime. On these occasions a foot massage can decrease the need for pain and sleeping medica- tions. Patients receive attention and t o u c h - - v i t a l elements of care that promote comfort and well-be- ing.

Usually, but depending on the purpose, massage follows complete foot care. First, you make a general assessment. Examine the feet for swelling, color, ulcerations, areas indicating pressure, toe deformi- ties, cleanliness, odor, and condi- tion of the nails and skin. Note problems amenable to nursing in- tervention and those that must be referred to a podiatrist.

As you assess, make additional nursing diagnoses that will contrib- ute to improving foot health. Foot massage is contraindicated when skin lesions, blood clots, fractures, or extreme arthri t ic pain are pres- ent.

Before massaging, cleanse and soak the feet in warm water. When the toenails have softened, dry the feet well and trim the nails straight across. Do not t r y to trim thick curved nails or ingrown na i l s - - these need a podiatrist 's attention.

Now you are ready to begin the massage. Help the patient into a comfortable position, usually lying in bed with a small pillow under head and knees. This position is comfortable for both patient and nurse because it results in a pelvic tilt for the patient and allows the nurse to raise the height of the bed

' i t

Begin by holding the foot gently but firmly in both hands.

Using the thumb make circles over the entire sole of the foot.

Spread the sole with your fingers. This relaxes muscle tension.

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28 Geriatric Nursing January/February 1983

and stand a t t h e foot. I f the pat ient prefers to sit, the nurse should also sit and support the foot on her knees.

Wash your hands with warm w a t e r - - a cold touch is not relaxing. Take a momen t to achieve a ca lm feeling and block out external prob- lems; this is called centering. This necessary step enables you to give your full at tention to the pat ient and to the work of massage.

Rub lubr ican t - - lo t ion or baby o i l - -be tween your palms and make contact with one foot by holding it in both hands. Hold the foot gently b u t firmly to let the patient feel your presence before you begin. This initiol contact prevents the ticklishness or jumpiness that often results when a foot is first stroked.

.Pause for a momen t while holding the foot.

Holding the foot in both your hands and using your thumbs, make circles over the sole of the foo t . Cover the entire sole with these circular motions.

Next , spread the sole with your fingers. This relaxes muscles that are t ightened f rom tension. Using your fingers to open the sole relaxes the entire ball of the foot.

S teady the foot in one hand and use the knuckles of your other hand

to stroke the sole with an up-and- down motion. This stretches the muscles of the sole and applies fric- tion to the skin.

Suppor t the base of each toe in one hand and with the other ro ta te each toe like a corkscrew. This massages all aspects of the toe as well as touching the surface be- tween the toes. While you massage and stretch the toe itself, examine interdigital surfaces thoroughly.

Use one hand to lift the foot off the bed. With the other hand, knead the heel and ,mkle between your thumb and for "finger or rub in a circular motion, using your fin- gertips.

Massaging the heel requires grea ter pressure than other parts of the foot because the heel skin is thicker and coarser. When you 've a t tended to the heel, finish the mas- sage b y holding the foot firmly be- tween your hands as you did when you began. You are now ready to massage the other foot.

During the massage, be alert to cues f rom the patient about what feels good and what, if anything, causes discomfort . The nurse gen- erally keeps conversation at a mini- m u m to enhance relaxation, but at t imes a pat ient may become very talkative. Perhaps the pat ient is so

relaxed that he or she now feels comfor tab le voicing concerns that were difficult to express previously. The nurse must use j udgmen t to be therapeut ic during massage.

Following foot massage, patient response varies. Some wish to be left alone to enjoy the relaxed feel- ing. Some like to walk because "i t feels like walking on air ." Others, because they feel so cared for and nurtured, want the nurse to stay and be close to them.

Since the pat ient is so receptive to the nurse at this time, it may be a golden opportuni ty to explain a diagnostic test or discuss a diet that ' s hard to follow. Individual as- sessment will help you determine the best use of the t ime following foot massage.

Having given a foot massage may make the nurse special to the patient and foster invaluable rap- port. Using this knowledge thera- peutically enables the nurse to meet the pat ient ' s needs more fully. For example, an anxious or suspi- cious man m a y now trust his spe- cial nurse to know that he fears he may never be well again.

Foot massage is an essential non- essental function much appreciated by patients and still another thera- peutic tool for nurses. G N

With the knuckles of one hand stroke the sole with an up-and-down motion.

Knead the heal and ankle between your thumb and forefinger.

Finish the massage by holding the foot firmly again with both hands.

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