• Email:
  • Password:
  • Remember Me
 
Print   Subscribe    Share
RD,CDE
Epsom Salts
keywords: epsom salts, feet
Section:  Wound Care

A patient told me today that his surgeon recommended he soak his foot in Epsom salts four times daily to help facilitate healing a wound on his left big toe. His toe is now healed, and he had two questions for me. First, he's noticed that hair has started to grow on his left foot again since he's been soaking it, and he doesn't have hair on his right foot. He wonders if the Epsom salts could be the cause of the hair growth. Second, he wants to know if it would be beneficial to soak both of his feet daily in Epsom salts since the skin on his left foot is much more smooth and supple. Thanks in advance for your suggestions on how to reply to him.

MEMBER COMMENTS
Re: epsom salts

Hi Lynn,

My first question to ask is, did the patient have some type of re-perfusion procedure?  I don't believe the Epsom Salts helped hair grow back, I think it may have more to do with the warm water he soaked his feet in.  The warm water may have dilated the tiny microvasculature in his toe, thus bringing more oxygenated blood to his feet, so it did two things, it healed the toe and then may have "woken up" the hair follicle, thus hair grew again. It would be interesting to see if the hair stops growing again if he were to stop soaking his feet.  I always get nervous about instructing people with diabetes to soak their feet. Their insensate feet scare me. I am always afraid that the water will be too hot, they will not check before hand and then the next thing you know we have a patient with two blistered feet sitting in the waiting room of either the emergency department or the wound care center.  Believe me, I have seen it happen more times than I would like to admit. I, like I am sure everyone else does, stress the importance of daily foot inspection. I think that if you keep feet well moisturized, and keep an eye on them for blisters or cracked skin, they are well ahead of the game. Personally I would not recommend feet soaking, even for folks who don't have diabetes. Just too much risk. How do you know the basin is thoroughly cleaned after each use? Especially if the patient has a resistant organism such as MRSA.  Hope that helps!

Re: epsom salts

Thanks Judy. I never recommend folks soak their feet, but he was adamant that his surgeon told him to do it, and that it works for him. I never thought about the possible effect of the warm water - that's why I love this forum because it gives me new ideas and fresh perspectives.

Re: epsom salts

Thanks so much for responding Judy. I knew you'd come through. For those who don't know, and missed her, Judy's been a tad busy, besides working, getting promoted,  working on her PhD, selling her house, and more, I appreciate this response. I agree Judy, I had the same thoughts as you, but wanted to hear what you had to say. There's nothing like confirmation from an expert like you. Thanks again.

 

EnJOY!

Joy

 

 

Re: epsom salts

Hi Lynn

 

Epsom salt or magnesium sulphate is a an osmotic agent commonly used as a soak to draw moisture out of draining areas, ie. wounds. Any salt, including common table salt dissolved in water has a similar effect. It is also used for it's mild anti-inflammatory effects as a general foot soak. Diabetics do lose hair follicles below the knees, as do patients with any vascular insufficiency...and this is often used as a quick screening exam sign of poor circulation, followed by temperature assessment and feeling for pulses. As Judy LaJoie so aptly points out, a patient with severe vascular insufficiency that has a re-perfusion procedure (endoscopic endarterectomy or open bypass) can demonstrate new hair growth...a sign of success of the re-perfusion.  But soaking in epsom salts isn't known to cause new hair growth. If it were, you can be sure more would be soaking their head than their feet !

 

As far as the issue of patients with diabetes soaking their feet, it is not in itself harmful, but can be dangerous if proper precautions are not taken.  If the patient has sensory neuropathy in their feet, they are advised to test the water temperature with their hands or their elbow, since they are unable to sense temperature accurately with their feet.  You only have to see one 2nd degree foot burn from soaking (or walking barefoot on the beach) to be very cautious about this.  There is also the issue of interdigital maceration.  We advise patients with diabetes to pay special attention to drying between their toes.  In patients with diabetes, the most common trigger for the cascade of events that eventually results in an amputation, is an interdigital tinea infection, the common "athletes foot". They don't feel the itching or pain, get a skin fissure, a secondary bacterial infection, ascending cellulitis or a plantar space abscess, and very quickly lose tissue that cannot regenerate  What is trivial in healthy person, quickly becomes dangerous in the presence of diabetic peripheral neuropathy.

 

Alan

Re: epsom salts

Thanks for the explanation and additional information. It's very enlightening!

Re: epsom salts

I have to agree that soaking a diabetic foot is fine innately,  but that it is dangerous if patients are not going to follow directions 100%.

 

I wrote down explicit instructions for one patient to: 1) buy a candy thermometer 2) heat water to 95F (and NO MORE), using the thermometer to measure the water temp 3) feel water first with fingers, and then soak foot.  What did she do?   She put some water in a bowl, stuck it in microwave, took it out and plopped her foot in it. That caused a third degree burn across half her foot.  But, since it didn't hurt after a little bit, with all the nerves being destroyed, she only came to me 1 week later, with her foot looking very unhealthy, as you can imagine.  Then we had problems getting her to the only burn center in town, although I called the center and told them I was referring her to them.  My patient went, but didn't like the wait, so went home.  Later that night she went to her ER (which I had told her would not help her and would only refer her to the burn center), which.....referred her to the burn center.  She finally went back there and got some serious burn care.

 

We all know that 10% of patients cause 90% of our troubles (and 100% of our grey hairs!)  ;-)

 

 

Re: Epsom Salts

You are absolutely correct, Mona...it is only by knowing our patients' learning capabilities, and assessing their judgement, that we can design learning communications that work for them and keep them safe.  It IS safer to tell all patients with diabetes, "never soak your feet" and "you can't go to the beach", but don't we pride ourselves, as diabetes educators, in giving our patients customer care plans and instructions, based on their particular needs ?  There are some patients whom we can trust to understand what we teach them and follow instructions - unfortunately, there are many whom we can't allow to use their judgement, and these patients need simpler right and wrong instructions.

 

We need to consider also that patients with peripheral neuropathy also have a certain denial factor that has been astounding to me throughout my career.  We based our understanding and trust in the world largely on our personal interaction with it...not on what other's tell us. Patients with diabetic neuropathy do not have what Paul Brand, MD, a seminal figure in our understanding of neuropathy called "the gift of pain".  the feel normal pain all over their bodies, except for their feet and later their hands.  When they sustain tissue loss from trauma or heat in their feet, often their first sign of it is the drainage from an abscess on the bottom of their feet.  It is SO HARD to get them to acknowledge the seriousness of that condition and it's poor prognosis, simply because THEY CAN'T FEEL IT.   Ask Judy LaJoie and Joy Pape..I'm sure they both have stories of exteme examples of this denial personality trait that patients with diabetic neuropathy have..

Re: Epsom Salts

Oh my! Can we tell you of our experiences! Since the cold weather is coming, let's not forget to remind our patients to NOT use heating pads, electric blankets, and to steer clear of space heaters. I remember a patient who had his foot against his space heater. Needless to say, he lost half of his foot. I dressed that huge open wound daily. He didn't need anything for pain because he didn't feel anything. And, he, like many, can't see. Many can't even see well enough to tell if there is drainage on their foot, sock, or around the house. Can you tell I was a home health nurse for 16 years?


I could go on an on, but suffice it to say, we need to be simple and direct. We need to check to see if our patient can actually see or reach their feet. If they can't feel, and they can't see there is even worse trouble.

When I go over foot care in class, I ask the class, "Of all the things I mentioned, which is most important? It's to look at your feet every day. If you can't see them make sure you have a loved one, or a neighbor, or hire someone if needed. At least you'll be able to pick up on a problem before it gets out of hand. And, don't worry about calling and bothering your doctor. Call him/her asap.

One more thing...In teaching we strive to not say, Do NOT or Don't, but rather tell people what they can do. Foot care is a place where I can't help but tell people don't. Oh, I can say "Always wear shoes" but in this case I don't think it has the impact of "Don't ever walk barefoot."


And I do say, "Always shake out your shoes, and put your hand in your shoes to make sure there isn't anything in them before you put them on." I'd hate to hear about another patient who walked on a mouse all day and didn't know it until he took off his shoes and smelled something.

Enough for now. Main point is...it's serious!

EnJOY!
Joy

Re: Epsom Salts


 Hello!
I'm joining this discussion somewhat late, but,  based upon my experiences-diabetics need to take caution when using Epsom salt because too much magnesium in the body, absorbed from the salt, can cause uncontrolled fluctuations in blood sugar.  Mg is known to lower blood pressure, increase muscle and nerve functions and increase the function of insulin.  Thank you. Isabella Wiznitzer, BA, BSN, RN, CDE

Re: Epsom Salts

Hello All.  I agree with everything that has been said.  I do not promote soaking for diabetics, nor really for any one.  A lot of faith is put into the minimal effects that can be anticipated through Epsom salts soaking. The concern for neuropathic patients is a great one.  I would however like to mention the dangers of soaking a wound.  If there is an open wound there is also colonization of the tissue.  "Infection" is a relative stage if colonization.  I would never allow any of my diabetic  patients to soak an open wound.  Bathing the exposed tissues to a soup of bacteria is only going to drive the microbes deeper into to tissue planes that weren't otherwise already infected.  Healing a wound requires off-loading, infection control and a moisture balance.  Soaking the wound would have negative effects of two if these protocols.  In short, never soak a diabetic wound.  There are better options for infection control than Epsom salts.  As far as Diabetics without any wounds I still steer away from advocating such a practice, but if they insist I also warn them of the dangers of burns.

Re: Epsom Salts

Joy, I could not agree more with everything you said. I also cannot stress the importance of shaking out your shoes. I had many a patient who came in with a bug attached to the bottom of their foot or a bottle cap because they had no feeling when they put a pair of shoes on. Also, how many folks came in with blisters they didn't even know they had because they couldn't wait to wear their new shoes that were too big or too small, causing terrible blisters on their feet. I am always trying to think of creative, fun ways for folks to realize how important their feet are. One day, while watching the news I saw a clip regarding how the undercarriage of cars were being inspected for bombs in underground parking lots. I saw that cool mirror on a pole they use and thought to myself, "Wow, how cool is that, we could use that for people with diabetes to check their feet. They would just grab the mirror on a pole and be able to check out their feet without bending or crunching over".  But then there is the problem of whether or not they can see the mirror on the pole, hey, you cant have everything!! 

At the end of the day my hope is that, after talking and talking about foot care, something stuck in their brain and not to the bottom of their foot and maybe they take the extra minutes to take a quick look at their feet, it would really go a long way!