Before Starting Your Reflexology Session, Why Pause for a Visual Foot Assessment?
It's easy to start touching the feet before getting a good eyeball-view of the foot, but if you do, you may have already made contact with a fungus, bacterial infection or open skin. Follow this order with your interview, assessment and foot cleanse: Listen! Look! Touch!
First, listen to your client...during the initial and follow up interviews at the start of each session. You should have already asked whether there are known foot conditions you may need to avoid or accommodate. Then, look! Did your client forget to mention something, or were they unaware of a condition they could not see? These are very real possibilities, especially with elderly clients, diabetic clients, or those with limited mobility. Finally, only when safe, touch.
What to Look for
Color and condition. When you are doing your visual inspection, start by observing the overall color and condition of the skin. For any particular client's skin type, does the color of the foot look like it should? For example, for Caucasian feet, the skin should look slightly pink - not white, ashen, blueish, purple or red. For olive to dark skin, its normal for the top of the feet to look a little darker and the soles to look a little lighter, but overall the foot should not look very different from the color of skin on rest of the body.
Certain conditions may cause skin to thicken and appear darker (on the fingers or toes it's called digital sclerosis), or skin may thin and appear lighter, even silvery (psoriasis). Circulation problems could lead to dark purple or even whitish feet, as in foot conditions like Raynauld's syndrome. Diabetes can cause feet to darken, and inflammatory conditions with thin skin and red coloration could indicate a lymph problem or infection.
Toe Nails. Look for a lighter skin color under the nail bed, and the presence of an even-lighter half-moon shape by the cuticle. This is typical and healthy. There should not be any noticeable strong lines across the nails, especially not a dark line as it could indicate a more serious condition such s cancer. Check for deep ridges or thickness of the nail, as these could indicate a fungal infection or damaged nail bed. Aging nails on elderly feet may have some thickness and ridges as part of normal aging processes. Also check for dark color under the nail, which could indicate a fungal infection, or a skin lesion for diabetics.
Bruises, cuts, fresh scars. Any lesion or opening can act as a port of entry for germs to enter through the skin. You'll need to know if a fresh scar is "sealed and healed" before touching it, to avoid reopening a recent injury. you'll also need to know if touching a bruise would cause discomfort; fresh bruises are usually darker brown or purplish, and become lighter brown or yellowish as time passes and the body heals the affected tissue.
Markings such as red spots or rashes. Have your client tell you what they know about it. Eczema, psoriasis and dermatitis are not contagious to touch, but be sure the skin integrity is intact, with no visible cracks. If a rash is scaly, remember a crack may exist under a scaly patch. Treat any rashes of unknown cause as suspicious, as rashes can be indicators of other, systemic (and sometimes contagious) especially if the rash accompanied by a fever.
Diabetes? Give special visual attention to your clients who have diabetes, as skin discoloration or ulcers on the feet can change rapidly and be slow to heal. Make note of changes in skin and coloration for any related diabetes conditions of the skin, such as hyperpigmentation (too much keratin, darker) or hypopigmentation (too little pigmentation, lighter) conditions, fungal infections (athlete's foot, toe fungus, ringworm), and scaly skin patches (necrobiosis lipoidica). Be very aware of the possible development of dark reddish-brown or black lesions, indicating dead tissue called gangrene, as this could be a serious indicator of amputation.
Foot conditions. Now look for any other foot condition covered in your training, from warts, bacterial or fungal infections, corns, callouses, blisters, etc., paying special attention to whether it can be treated as a partial contraindication (just avoid or use a protective barrier on the site of concern), or a full contraindication that prevents you from touching the foot entirely.
When the Reflexologist Is the Problem
Regularly examine your own hands for nicks, cuts, hangnails, or small infections. Nail fungus or bacterial infection can happen on the fingernails as well, so it's possible that a reflexologist could have a contagious condition that their clients could catch.
What to Do, and Universal Precautions
If you've noticed something on either your client's or your own skin, you need to be cautious and follow your training for determining if its a local contraindication (don't touch) or a partial-contraindication (use a barrier), then use "the universal precautions" in health care, which outlines protocol for dealing with body fluids in a health practice.
An infection or wound in any stage of healing could leak some blood, lymph fluid, or puss, and in any case, it's better to act 'as though' that could happen, and 'as though' the blood/fluid could be contaminated. For reflexologists touching feet, observing universal precautions protocol means wearing medical-grade gloves in these cases.
Therefore, when it's time to touch, have medical gloves, finger cots or toe caps on hand if necessary, or switch to working at a different reflex map at another body site, when you encounter a suspected contagious or vulnerable condition on the feet.
Finally, don't forget to take accurate notes in the "Local Conditions" section of your foot reflexology health record! Your commitment to safety and attention to detail will instil confidence in your professionalism.
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