Foot Care in Disability Support: Understanding the Critical Line Between Support and Podiatry

When discussing personal care support with potential participants in Melbourne, foot care often comes up as a seemingly straightforward task. You might assume that if a support worker can assist with showering and dressing, they can certainly help with feet. But foot care in disability support work involves critical distinctions, significant liability risks, and a clear boundary between what support workers can do and what requires a qualified podiatrist.

As a Certificate III qualified support worker, I want to explain exactly where that boundary lies, why it exists, what can go seriously wrong when it's crossed, and how to ensure your feet receive appropriate care without putting either you or your support worker at risk.

The Deceptively Simple Task of Foot Care

Feet seem uncomplicated. Most people manage their own foot care without much thought—washing, drying, trimming nails, dealing with calluses. But when disability affects your ability to reach your feet, see clearly, or sense pain properly, foot care becomes significantly more complex and risky.

The key issue is that feet have a rich blood supply, and even minor injuries can lead to serious complications—particularly for people with diabetes, peripheral vascular disease, reduced immunity, neuropathy (nerve damage causing reduced sensation), or circulatory problems. An infection that would be minor on your arm can become limb-threatening on your foot.

This is why there are strict boundaries around what support workers can do with foot care, and why violating these boundaries isn't just bad practice—it's potentially dangerous and creates significant liability.

What Support Workers CAN Do

Within the scope of Certificate III training and personal care support, support workers can assist with basic foot hygiene and inspection:

Washing feet: Using warm (not hot) water and mild soap to wash feet during showering or bathing assistance. This is part of general hygiene support and presents minimal risk when done properly.

Thorough drying: Carefully drying feet, especially between toes where moisture can lead to fungal infections. This is crucial for preventing skin breakdown and infections.

Applying prescribed moisturizer: If a doctor or podiatrist has prescribed foot moisturizer, a support worker can apply it to the tops and bottoms of feet (but not between toes, where moisture retention could cause problems). This must be a prescribed product, not just any lotion.

Visual inspection: Looking at feet for any signs of concern—cuts, blisters, redness, swelling, changes in color, or unusual odor—and reporting these observations to the participant and, with permission, to family members or healthcare providers.

Assistance with prescribed footwear: Helping put on properly fitted shoes, orthotic devices, or compression stockings if prescribed. This doesn't include advising on what footwear to buy—that's the podiatrist's role.

Assistance with foot elevation: If advised by a healthcare provider for swelling or circulation, helping position feet in an elevated position.

These tasks are supportive, not clinical. They assist with hygiene and allow observation but don't involve any procedures that could cause injury or require clinical judgment.

What Support Workers CANNOT Do

The following foot care tasks are outside the scope of support work and require a qualified podiatrist:

Cutting or trimming toenails: This is the most common misunderstanding. Many people assume that if they can cut their own toenails, surely a support worker can help. But cutting toenails, especially for people with diabetes or circulatory issues, requires podiatric training. The risk of cutting too short, causing injury, or introducing infection is too high.

Filing or shaping toenails: Even filing nails involves risk if done incorrectly—creating sharp edges that can cut adjacent toes, filing too aggressively and exposing nail bed, or failing to notice ingrown nails that require treatment.

Removing calluses or corns: Using pumice stones, callus files, or any implement to remove hard skin requires knowing how much to remove without causing injury. Over-removal exposes vulnerable tissue; under-removal doesn't address the problem.

Treating ingrown toenails: Ingrown toenails require podiatric intervention. Attempting to "dig out" an ingrown nail can cause serious infection.

Treating fungal infections: While a support worker can wash feet and apply prescribed antifungal cream, diagnosing fungal infections and determining appropriate treatment requires podiatric assessment.

Removing plantar warts or any foot growths: Any growth on feet should be assessed and treated by a podiatrist, not removed by a support worker.

Foot massage or manipulation: Therapeutic foot massage requires understanding of contraindications (when not to massage due to medical conditions). Support workers aren't trained in therapeutic massage.

These tasks involve clinical judgment, specialized equipment, knowledge of foot pathology, and risk of causing harm if done incorrectly. They're podiatry services, not support work.

The Diabetes Factor: Why the Rules Are Stricter

If you have diabetes, the restrictions on support worker foot care become even more important. Diabetes affects feet in several ways that dramatically increase risk:

Peripheral neuropathy: High blood sugar damages nerves, reducing sensation in feet. You might not feel a cut, blister, or injury. Without pain signals, minor injuries can progress to serious infections before you notice.

Poor circulation: Diabetes damages blood vessels, reducing blood flow to feet. This means injuries heal more slowly and infections spread more easily.

Increased infection risk: High blood sugar creates an environment where bacteria thrive. Foot infections in people with diabetes can progress rapidly and lead to serious complications.

Risk of ulceration: The combination of reduced sensation, poor circulation, and infection risk means that minor foot injuries can develop into diabetic foot ulcers—open sores that are difficult to heal and can lead to amputation if not properly managed.

The statistics are sobering: according to Diabetes Australia, people with diabetes are 15 times more likely to undergo amputation than people without diabetes, and the vast majority of diabetes-related amputations are preventable with proper foot care.

This is why podiatric foot care for people with diabetes isn't optional—it's essential. And this is why support workers absolutely cannot perform tasks like nail cutting for people with diabetes. The consequences of a small mistake are too severe.

The Liability Question: What Happens When Things Go Wrong

Understanding the liability implications helps clarify why these boundaries exist:

Scenario: Infected Toe from Nail Cutting

A support worker, wanting to be helpful, cuts a participant's toenails despite this being outside their scope. The support worker accidentally cuts too short, creating a small wound. The participant has diabetes and reduced sensation, so doesn't notice the injury. Within a few days, the toe is infected. The infection spreads, requiring hospitalization and intravenous antibiotics. In a worst-case scenario, the infection leads to toe or foot amputation.

Liability issues: The support worker's professional indemnity insurance may not cover this incident because the support worker was performing a task outside their scope of practice. The participant (or their family) could sue the support worker personally for damages—medical costs, pain and suffering, loss of mobility. The support worker could face disciplinary action from the NDIS Quality and Safeguards Commission if registered, or loss of employment if working for an agency. The participant suffers serious, preventable harm that affects their health and independence.

This isn't a hypothetical scare tactic. These scenarios occur when support workers exceed their scope, usually with good intentions but insufficient understanding of the risks.

The "But I've Always Done It" Problem

Sometimes participants or their families say, "But my previous support worker always cut my nails—can't you do the same?" This puts current support workers in a difficult position, but the answer must be no.

Just because a previous support worker exceeded their scope doesn't mean it was safe or legal. It means the previous worker was taking inappropriate risks. A responsible support worker must maintain appropriate boundaries regardless of what previous workers did.

The Clinical Delegation Question

You might wonder: can a podiatrist delegate nail cutting to a support worker, similar to how nurses can delegate some clinical tasks?

The answer in most Australian states, including Victoria, is no. Unlike some clinical tasks that can be delegated with proper training and oversight, nail cutting for at-risk clients (those with diabetes, circulatory issues, or neuropathy) is considered a podiatric procedure that cannot be delegated to unqualified persons.

Even if a podiatrist were willing to "give permission," this doesn't change the support worker's scope of practice under their Certificate III qualification, doesn't provide the support worker with adequate training or insurance coverage, and doesn't eliminate the liability if something goes wrong.

Some aged care settings have specific programs where care workers receive additional specialized training in low-risk nail care under clinical supervision, but this is not standard for NDIS disability support work and requires formal training programs beyond Certificate III.

Foot Care for People Without Diabetes or High-Risk Conditions

What if you don't have diabetes, have good circulation, normal sensation, and healthy feet? Is nail cutting still off-limits?

Technically, the risk is lower for people without complicating factors. However, the scope of practice boundaries still apply. Certificate III training doesn't include nail cutting regardless of the participant's health status. The distinction isn't about your individual risk level—it's about what tasks fall within support work versus podiatry.

Additionally, support workers generally can't assess which participants are truly "low risk." You might not know you have early circulatory problems or pre-diabetes. Making individual risk assessments requires clinical judgment that support workers don't have.

The safest approach is maintaining the boundary for all participants: support workers provide hygiene and inspection; podiatrists provide nail care and treatment.

How to Access Appropriate Foot Care

If you need assistance with foot care beyond what support workers can provide, here are your options:

NDIS-Funded Podiatry

Podiatry services can be funded under your NDIS plan in the Capacity Building - Health and Wellbeing budget category. Your podiatrist can provide nail cutting and shaping, removal of calluses and corns, treatment of ingrown toenails and infections, assessment of foot health and risk factors, prescription of orthotics or specialized footwear, diabetic foot care and ulcer prevention, and education about foot self-care.

If you don't currently have podiatry funded in your plan but need it, this should be raised at your next plan review or discussed with your support coordinator.

Medicare-Funded Podiatry

If you have diabetes, you may be eligible for Medicare-funded podiatry through the Diabetes Cycle of Care. Your GP can organize this. Medicare provides up to five allied health visits per year for people with diabetes under chronic disease management plans.

Private Podiatry

If you're not eligible for NDIS or Medicare-funded podiatry, you can pay for podiatry services privately. Costs vary, but basic podiatry (nail cutting, callus removal, general foot care) typically ranges from $60-$90 per session in Melbourne.

Many podiatrists offer mobile services, coming to your home to provide treatment—particularly valuable if you have mobility limitations.

Coordination Between Podiatrist and Support Worker

Ideally, your podiatrist and support worker work together: the podiatrist provides clinical foot care (nail cutting, treating conditions), the support worker provides hygiene support and reports concerns, and both contribute to keeping your feet healthy through their respective roles.

For example, during personal care sessions, a support worker might notice and report: "I saw some redness between your toes today that wasn't there last week—you might want to mention that to your podiatrist." This observation and reporting is within scope and valuable for early problem detection.

The Inspection Role: What Support Workers Should Watch For

While support workers can't treat foot problems, visual inspection during bathing/showering assistance is an important preventive measure. Support workers should look for and report:

Skin changes: Redness, unusual warmth, pale or blue discoloration, dry, cracked skin (especially on heels), or blisters or sores.

Nail problems: Discolored nails (yellow, brown, black), thickened nails, ingrown toenails, or separation of nail from nail bed.

Structural changes: Swelling, bunions or other deformities developing or worsening, or changes in foot shape.

Signs of infection: Open wounds or ulcers, pus or discharge, foul odor, or red streaks extending from feet up legs.

Fungal infections: Peeling, scaling skin (especially between toes), itching or burning, or white, soggy skin between toes (athlete's foot).

Early detection through regular inspection can prevent minor issues from becoming serious problems. This is particularly important for participants with reduced sensation who might not notice problems themselves.

Special Considerations for Aged NDIS Participants

Many NDIS participants over 65 have additional risk factors for foot problems including age-related circulatory changes, arthritis limiting ability to reach feet, vision changes making self-inspection difficult, and often diabetes or other chronic conditions.

For older participants, the combination of support worker hygiene assistance and regular podiatric care is especially important. The support worker ensures daily hygiene and reports concerns; the podiatrist provides regular preventive care and treats problems.

This is also where the distinction between NDIS and aged care funding can become relevant. If you're over 65 and transitioning from NDIS to aged care supports, ensure podiatry continues to be funded—it's essential preventive care, not optional.

Cultural Considerations in Foot Care

In some cultures, feet are considered private or there are specific practices around foot care and touching feet. Support workers should be aware of cultural sensitivities and ask about preferences.

If you have cultural or religious practices around foot care, communicate these to your support worker. For example, if you prefer that feet are covered except during washing, if there are specific times or methods for foot washing, or if you prefer same-gender support workers for tasks involving feet.

Respectful, person-centered care means adapting support to your cultural needs while still maintaining safety boundaries around clinical tasks.

When Support Workers Are Pressured to Exceed Scope

Support workers sometimes face pressure from participants, families, or even agency supervisors to provide foot care beyond their scope:

"It's just cutting nails, it's not that hard." The apparent simplicity doesn't eliminate the risk or change scope of practice.

"I can't afford a podiatrist." While this is sympathetic, it doesn't make it safe or legal for a support worker to provide podiatry services. The solution is accessing NDIS-funded or Medicare-funded podiatry, not exceeding scope.

"My previous worker did it." The previous worker was working outside their scope and taking inappropriate risks.

"I'll sign a waiver saying you're not responsible." Waivers don't override scope of practice or eliminate liability. Insurance won't cover incidents arising from out-of-scope practice regardless of waivers.

A professional support worker must maintain boundaries even under pressure. The response is: "I understand this is frustrating, but nail cutting is outside my scope of practice as a support worker. Let me help you arrange access to a podiatrist who can provide this safely."

Documentation of Foot Care

When providing foot care within scope (washing, drying, inspection), support workers should document what was done and any observations:

"Assisted with foot washing during shower. Feet thoroughly dried including between toes. No cuts, blisters, or redness observed. Both feet appear healthy with no concerns noted."

Or: "Assisted with foot washing during shower. Noted small blister on left heel that participant wasn't aware of. Advised participant to avoid tight shoes and monitor the area. Suggested mentioning to podiatrist at next appointment."

This documentation creates a record of foot health monitoring and ensures concerning observations are noted and communicated appropriately.

Foot Care Equipment: What Support Workers Use

For foot care within scope, support workers use basic hygiene equipment: mild soap (not harsh antibacterial unless prescribed), soft washcloth or bath sponge, clean towel for thorough drying, and prescribed moisturizer (if applicable).

Support workers should NOT have in their kit nail clippers, nail files or emery boards, pumice stones or callus files, corn removal tools, or anything designed for clinical foot care.

If you see a support worker carrying nail clippers, this raises questions about whether they're working within scope with other clients.

Footwear and Foot Protection

While support workers can't prescribe footwear, they can assist with proper footwear use as part of community access support by ensuring shoes fit properly and are appropriate for the activity, helping put on and remove shoes, ensuring orthotics (if prescribed) are properly positioned in shoes, and checking that shoes are in good repair without worn-out soles or broken supports.

If a support worker notices you're wearing shoes that seem ill-fitting or causing problems, they can suggest you discuss footwear with your podiatrist, but they can't diagnose foot problems or prescribe shoe modifications.

The Role of Family in Foot Care

Sometimes family members provide foot care including nail cutting. While families are not bound by the same scope of practice rules as support workers, they should be aware of the same risks—particularly if the participant has diabetes or circulatory issues.

Family members who wish to provide nail care for relatives with diabetes should ideally receive training from a podiatrist on safe techniques, understand warning signs of problems, and have clear instructions about when to seek professional help.

However, many podiatrists advise that even family members shouldn't cut nails for people with high-risk feet. The risk of serious complications outweighs the convenience of at-home nail care.

Questions to Ask Support Workers About Foot Care

When interviewing potential support workers, you might ask:

What foot care can you provide as a support worker? You want to hear about washing, drying, inspection, and applying prescribed products—not nail cutting or callus removal.

What would you do if you noticed a blister or cut on my foot during personal care? You want to hear about alerting you, documenting the observation, and suggesting you contact your podiatrist or GP.

Can you cut my toenails? The correct answer is no, this is outside support worker scope and requires a podiatrist.

I have diabetes—what extra considerations are there for foot care? You want to hear about importance of thorough drying, daily inspection, reporting any concerns immediately, and the critical need for regular podiatry.

If a support worker indicates they can or will cut nails, this is a red flag suggesting they may not understand or respect professional boundaries.

Why I Won't Cut Your Toenails (And Why You Shouldn't Want Me To)

As I begin providing personal care support in Melbourne's inner south, I will encounter participants who need help with foot care. I can and will assist with foot hygiene—washing, drying, inspection, applying prescribed products. I will monitor your foot health and report concerns that should be assessed by a podiatrist.

But I will not cut your toenails, file your nails, remove calluses, or perform any other task that belongs to podiatric practice. This isn't because I'm unwilling to help or don't care about your needs. It's because doing so would put your health at risk, exceed my scope of practice and training, potentially void my insurance coverage, and violate my ethical obligation to provide safe, appropriate support.

Instead, I'll help you access appropriate podiatric care—whether that's through NDIS funding, Medicare funding, or connecting you with mobile podiatry services in Melbourne. Your feet deserve care from someone with proper training, not good intentions without adequate expertise.

Foot care isn't simple when you understand the risks. Maintaining appropriate boundaries protects both of us and ensures you receive the right type of care from the right professionals.

Related Resources

• Personal care services including hygiene support
• Diabetes Australia - Foot Care information and resources
• Better Health Victoria - Diabetic Foot prevention and care
• NDIS support budgets including Health and Wellbeing for podiatry
• Contact me to discuss your personal care needs