Author: Rosie Moore

  • Why Dementia-Friendly Foot Care Matters (And How to Spot Hidden Foot Pain)

    Why Dementia-Friendly Foot Care Matters (And How to Spot Hidden Foot Pain)

    When a loved one is living with Alzheimer’s or another form of dementia, foot care is rarely the first thing on family or a caregiver’s mind. Between managing medications, meal times, and daily hygiene, inspecting toenails and soles can easily fall to the bottom of the priority list.

    However, as a Nurse Practitioner specializing in in-home senior care, I often see how minor foot issues can quietly derail a senior’s mobility, comfort, and overall well-being.

    Because individuals with cognitive decline may lose the ability to articulate physical discomfort, foot pain often goes unnoticed. Knowing what to look for—and how to make routine dementia friendly foot care a gentle, stress-free experience—can make a world of difference.

    1. Decoding the “Behavioral” Signs of Foot Pain

    When a person with dementia has a painful ingrown toenail, a severe callus, or an undetected blister, they won’t always say, “My foot hurts.” Instead, pain manifests in subtle behavioral shifts:

    • Unexplained Agitation or Aggression: Sudden mood changes during standing or transferring.
    • Refusal to Walk: Resisting daily walks or refusing to get out of a chair.
    • Changes in Gait: Limping, shuffling, or sudden loss of balance.
    • Restlessness or “Pacing”: Wandering continuously to try to escape discomfort.

    Clinical Tip: If you notice a sudden change in behavior or a reluctance to walk, start by removing their shoes and socks. The culprit is frequently an easily treatable foot issue.

    2. Creating a Calm, Environment for dementia-friendly foot care

    In-home foot exams and nail trimmings can feel overwhelming or intimidating for someone with memory loss, especially if sharp clippers or unfamiliar tools are brought out.

    To keep the experience reassuring:

    • Incorporate Routine into Hygiene: Combine foot checks with soothing daily habits, like warm washcloth wipes before bed or applying a gentle moisturizer after a bath.
    • Use Distraction: Schedule care during a favorite TV show, while listening to music from their youth, or while they hold a comforting object.
    • Keep Tools Out of Sight: Keep clippers, files, and lotions staged out of direct view to avoid triggering anxiety.
    • Focus on Communication: Speak in a slow, reassuring tone, explaining what you are doing before you touch their feet.

    3. Essential Preventative Care at Home

    A few simple practices can prevent common complications before they start:

    • Inspect Daily: Check the soles of the feet and between the toes for red spots, cracks, or moisture buildup (using a handheld mirror makes this much easier).
    • Moisturize, But Mind the Toes: Apply a thick lotion or urea-based cream to dry heels and soles, but avoid putting lotion between the toes to prevent fungal growth.
    • Check the Inside of Shoes: Inspect footwear for pebbles, torn linings, or bunched-up insoles that could create pressure points without the wearer realizing it.
    • Ditch the “Special Event” Shoes: Opt for supportive, non-slip, velcro-closure shoes or adaptive slippers that are easy to slide on and off without forcing the foot.

    When to Call a Professional

    While basic daily hygiene can be handled at home, conditions like thick fungal nails, diabetic ulcers, severe calluses, or ingrown toenails require specialized care. Attempting to trim thickened nails at home can lead to accidental cuts and infection, particularly for seniors with poor circulation or diabetes.

    At Circle City Foot and Medical Care, we bring specialized, non-surgical podiatric care directly to your living room. We work at your loved one’s pace in a familiar, comfortable setting—taking the stress out of clinical foot care for both the patient and the family.

    Need extra support managing a loved one’s foot health? Contact us today to learn more about our mobile, senior-focused clinical services.

  • Partner Spotlight: How KSS Insurance Helps Our Patients Protect Their Health

    Partner Spotlight: How KSS Insurance Helps Our Patients Protect Their Health

    At Circle City Foot and Medical Care, our mission is to deliver medical-grade, non-surgical podiatry and healthcare directly to your door. We spend our days inside our patients’ homes, where we see firsthand how crucial overall wellness, mobility, and peace of mind are to maintaining independence.

    True health, however, extends beyond clinical care—it also means having the right safety net in place when life changes. That is why we are proud to spotlight one of our trusted community partners: KSS Insurance.

    Why We Partner with KSS Insurance

    When we visit patients throughout Central Indiana, one of the most common sources of stress we hear about isn’t just physical pain—it’s navigating the complex world of Medicare, health insurance, and long-term coverage.

    Finding the right plan can feel overwhelming, especially for seniors or families managing complex care needs. Steve Boone, Karl Downey, and the KSS Insurance team take the confusion out of the process. They don’t just sell policies; they act as dedicated advocates who take the time to understand each client’s unique medical and financial situation.

    The Independent Agency Advantage

    What sets KSS Insurance apart is their commitment to personalized, local service. As independent insurance agents, they aren’t tied to a single carrier. Instead, they evaluate options across multiple top-tier providers to find the exact Medicare Advantage, Medicare Supplement, or health plan that fits your life.

    Here is what makes KSS Insurance an invaluable resource for our patients:

    • True Advocacy: They walk you through every line of your coverage options, ensuring you maximize your benefits and avoid costly coverage gaps.
    • Simplifying Medicare: Whether you are turning 65 or re-evaluating your current coverage during enrollment, they break down complex jargon into clear, actionable advice.
    • Family-First Approach: Like us, Steve and Karl treat every client like family, offering honest guidance grounded in integrity and respect.
    • Ongoing Support: They don’t disappear after you sign up. When healthcare needs shift or plans change, KSS is right there to help you adapt your coverage.

    Supporting Your Health from the Ground Up

    In-home medical care and proper health insurance go hand in hand. While Circle City keeps you mobile, comfortable, and safe in your home environment, KSS Insurance ensures that your healthcare decisions are financially protected and stress-free.

    When our patients have reliable coverage, they can focus entirely on what matters most: their health, their recovery, and enjoying their independence.

    A Message from Rosie Moore, NP

    We only align Circle City Foot and Medical Care with professionals who reflect our dedication to compassionate, high-quality care. Steve and Karl at KSS Insurance share our deep commitment to serving the Central Indiana community with heart and expertise.

    If you, a parent, or a loved one have questions about navigating Medicare, evaluating your current health coverage, or ensuring your insurance plan truly supports your healthcare needs, we highly recommend reaching out to KSS Insurance.

    Connect with KSS Insurance:

    As always, if you or a family member are in need of specialized, in-home non-surgical foot care or medication management, Circle City Foot and Medical Care is here to help keep you moving comfortably at home.

  • Pressure Prevention at Home: Turning, Floating, and Protecting the Bedbound

    Pressure Prevention at Home: Turning, Floating, and Protecting the Bedbound

    When a loved one becomes bedbound, the bed–which should be a place of rest–can quickly become a source of risk. As an in-home Nurse Practitioner, I see many families who are doing their absolute best but aren’t aware of the small, specific techniques that prevent skin breakdown.

    Pressure injuries, specifically Stage 1 injuries (where the skin is still intact but not damaged), can develop in as little as two hours! The good news? With a proactive routine, many of these are entirely preventable. Here is how you can protect your loved one’s skin at home.

    The Power of the “Turn”

    The most effective way to prevent pressure injuries is to move the body. In the hospital, we use a “Two-Hour Turn” schedule, and I recommend the same for home care.

    When we say “turning,” we don’t mean flipping someone completely over. It’s about shifting the weight off the bony prominenes–the tailbone (sacrum), hips, and shoulder blades. 

    • The 30-degree Tilt: Instead of laying someone flat on their side (which puts all of the pressure on the hip bone), tilt them to about 30 degrees and support their back with a long body pillow or wedge.
    • The Clock Method: Many families find it helpful to keep a “turning log” or set a phone timer. Even a slight shift in position can restore blood flow to compressed skin.

    “Floating” The Heels: A Non-Negotiable

    The skin on our heels is surprisingly thin, and the heel bone is quite sharp. If a patient lies on their back with their heels resting on the mattress, the weight of the entire leg is concentrated on that tiny point. 

    To “float” the heels:

    1. Place a pillow lengthwise under the calves.
    2. Ensure the pillow ends just before the ankle, allowing the heels to hang freely in the air (like they are “floating”).
    3. Pro-Tip: Never place a pillow directly under the heels or the backs of the knees, as this can increase pressure or even cause blood clots.

    Identifying Stage 1 Early

    A Stage 1 pressure injury is your “final warning.” At this stage, the skin is not yet broken, but the tissue underneath is stressed.

    • In light skin: Look for a red spot that stays red even after you remove the pressure for 30 minutes.
    • In dark skin: Look for a spot that appears purple, bluish, or “shiny,” or has some of the texture changes discussed in the last blog post.
    • The touch test: The area may feel warmer than the surrounding skin or feel “boggy” (squishy) like a bruised plum.

    Practical Tips for Caregivers

    • Check the Sheets: Wrinkles in bedsheets can act like tiny saw blades against fragile skin. Ensure the bottom sheet is pulled tight and smooth.
    • Watch the Head of the Bed: If the head of the bed is raised higher than 30 degrees, the body tends to slide down. This creates “shear,” which tears deep layers of skin. Keep the bed as flat as the patient can safely tolerate.
    • Skin Hygiene:  Use moisture barrier creams if the patient struggles with incontinence, but avoid vigorous rubbing. Friction from massage can actually cause more damage to stressed skin. 

    Preventing pressure injuries is a marathon, not a sprint. By implementing a turning schedule (while YOU are awake) and floating the heels today, you are preventing a painful and complex wound tomorrow. Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.

  • The “Iceberg” Wound: Understanding Deep Tissue Injuries 

    The “Iceberg” Wound: Understanding Deep Tissue Injuries 

    When we think of a skin injury, we usually think of something that happens from the outside in, such as a scrape, a cut, or a blister. As an in-home nurse practitioner specializing in wound care, I often see a much more deceptive type of wound: the Deep Tissue Injury (DTI). 

    Unlike a typical scrape, a DTI happens from the inside out. To help my patients and their families understand this I often use the “Iceberg Analogy.” Just as most of an iceberg’s mass is hidden beneath the ocean surface the most significant damage of a DTI is hidden beneath the skin’s surface.

    What Exactly is a Deep Tissue Injury?

    A deep tissue injury is a unique type of pressure injury. It appears as a localized area of skin that is deep red, maroon, or purple. Sometimes it looks like a dark, blood-filled blister. 

    While the skin might still be intact, the tissue underneath (the muscle and fat layers) has been damaged by intense or prolonged pressure. Because muscle is more sensitive to a lack of oxygen than skin is, it actually begins to break down first. By the time you see that “bruise” on the surface, the damage underneath has already begun. 

    Identifying the Warning Signs

    Because DTIs can evolve quickly into more serious wounds, early detection is everything. If you are caring for a loved one at home keep an eye out for these three signs in areas where bone meets the bed. The more obvious places are the heels, hips or tail bones. Some other places that are often overlooked include the elbows, the back of the head, and the shoulder blades. 

    1. Color Changes: Look for persistent deep red, purple, or maroon discoloration that doesn’t “blanch” (turn white or return to normal skin color) when you press on it. See the last blog post for how pressure injuries look different on different skin tones.
    2. Texture Shifts: Feel the skin. Does it feel mushier, firmer, warmer, or cooler than the surrounding area?
    3. Pain: Patients often report a deep, aching soreness in the area before the color even changes.

    Why Do they Happen

    Pressure is the primary culprit, but it’s rarely acting alone. Usually it is a combination of:

    • Pressure: The weight of the body squeezing tissue against a hard surface like a mattress or a chair.
    • Shear:  The skin stays in place, but the bone and deep tissue slide, common when someone “slumps” down in a recliner.
    • Microclimate: Moisture and heat on the skin can make it more vulnerable to breakdown. 

    How We Manage DTIs at Home

    If I visit a patient and identify a DTI, our goal immediately shifts to “offloading.” We have to get the pressure off that spot completely. This might involve specialized foam dressings, “floating” the heels with pillows or utilizing high-tech pressure redistribution mattresses.

    It is important to note that DTIs are unpredictable. Sometimes with excellent care and nutrition the body can reabsorb the damaged tissue. Other times the dark area may eventually open up to reveal a deeper wound. This is why professional monitoring is so vital. 

    The Takeaway

    If you notice a “bruise” on a bedbound or chair bound loved one that looks darker than usual or feels different to the touch, don’t wait. Deep tissue injuries are a race against time. Early intervention is the best tool we have to protect the skin and promote healing from the inside out. 

    Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.

  • Beyond Redness: Identifying Pressure Injuries on All Skin Tones

    Beyond Redness: Identifying Pressure Injuries on All Skin Tones

    In the medical world, we are often taught that the first sign of a pressure injury is “non-blancable erythema”–a fancy way of saying a red spot that doesn’t turn white when you press on it.  But there is a significant flaw in that standard: it primarily describes how a wound looks on light skin.

    As an in-home Nurse Practitioner, I see patients of all backgrounds. If we only look for “redness,” we are going to miss early warning signs in patients with darker skin tones. When a wound is missed in its early stages, it has a much higher chance of progressing into a serious, deep seating injury.

    To provide the best care, we have to look beyond color.

    The Challenge of Pigmentation and Pressure Injuries

    In darker-pigmented skin, the “redness” phase may not appear at all. Instead, the skin may take on different hues, looking purple, bluish, or even slightly grayish. Because the changes can be subtle, the injury is often much more advanced by the time it is “visible” to the naked eye.

    This is why “skin of color” assessments require a more holistic approach. We aren’t just looking with our eyes; we are “looking” with our hands, and listening to the patient’s experience. 

    “Big Three” Signs to Indentify Pressure Injuries

    If you are caring for a loved one with a deeper skin tone, I recommend focusing on these three indicators rather than searching for a red spot:

    1. Temperature Changes: Before the skin breaks or changes color significantly, it will often feel different to the touch. Early on, an injured area might feel significantly warmer than the surrounding skin due to inflammation. As the injury progresses and blood flow is restricted, it might feel noticeably cooler. 
    2. Texture and Consistency: These are often the most reliable “early warning” signs. When you palpate (gently feel) the bony areas, like heels, sacrum, or hips, pay attention to the “give” of the tissue. 
      • Does it feel “boggy”  or mushy, like an overripe fruit?
      • Does it feel unusually firm or hard compacted to the surrounding skin?
      • Is there a “shiny” or taut appearance of the skin in that specific spot?
    3. The Patient’s Report of Pain: Never underestimate the patient’s “localized” pain. If a patient or loved one says a specific spot on their heel or tailbone feels “sore,” “burning,” or “throbbing,” treat it as a pressure injury until proven otherwise–even if the skin looks perfectly normal.

    Why Inclusive Assessment Matters

    Health disparities in wound care are a real concern. Statistics show that patients with darker skin tones are often diagnosed with pressure injuries at more advanced stages. This isn’t because their skin is “harder to care for,” but because the traditional tools for assessment weren’t designed with them in mind.

    By shifting our focus from color to consistency, temperature, and sensation, we can catch these injuries in Stage 1, where they are still reversible.

    Advice for Caregivers

    If you are monitoring a loved on at home:

    • Check in good lighting: Natural light or “cool” LED light is better than warm, yellow, indoor lighting for seeing subtle color shifts
    • Trust your touch: Your hands will often find a wound before your eyes will. 
    • Advocate: If a healthcare provider dismisses a spot because “it isn’t red,” don’t be afraid to point out changes in temperature, firmness, or the change from their normal skin tone! 
    • Color changes still happen! They just might look different than someone else’s. 

    Early detection is the best medicine. Whether skin is porcelain, olive, or deep ebony, the goal remains the same: keep the pressure off and the tissue healthy. 

    I’m currently accepting new patients in Marion and the surrounding donut counties. Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.