Toe swelling is something that many people naturally experience with lower extremity lymphedema, yet it can also be the result of badly applied compression bandaging that leaves the toes and foot area without any kind of compression. Toe bandaging is a great way to control and reduce the swelling in the toes and improve the quality of your skin. If not managed properly, toe swelling can lead to bacterial or fungal infections. This can lead to more serious complication such as skin breakdown or cellulitis.
Before bandaging your toes, as with any type of compression, vascular assessment should be carried out to exclude occult arterial disease (Clinical Resource Efficiency Support Team, 1998). This may include: Doppler/ankle brachial pressure index assessment, pulse oximetry or toe pressures/toe brachial pressure index¹. It is important to also observe and record any colour and/or temperature change, tissue condition and if there are any leg ulcers or wounds that need addressing before starting any type of compression.
People with peripheral neuropathy (eg: diabetes) which have numbness in their feet should only bandage their toes if they can be closely monitored. Likewise, people with reduced mobility may not be suitable for toe bandaging as they may have trouble removing the bandages independently if they are causing friction or injury to the area.
General rules for beginning bandaging
- Make sure your skin is clean and dry
- Apply moisturiser to your skin to help avoid irritation, skin break down and itchiness
- Have all your supplies ready before you begin bandaging (so you don’t need to move during the process)
- A 4cm bandage that is specially designed for toe and finger bandaging is ideal
Step for bandaging your toes
- Apply the cotton stockinette to your leg and pull back the foot area to allow clear access to bandage your toes
- Start by making two turns proximal to the ball of the foot to anchor the bandage
- Bandage each toe individually, starting at the big toe
- Work distally to proximally (biggest to smallest)
- Ensure the nail bed is left exposed so that you can observe any changes or problems in the toes
- Apply the bandage using a light tension- it should not be too tight around the base of the toe or make your toes lift up unnaturally.
- Reanchor each toe bandage behind the ball of the foot, ensuring even coverage is maintained.
- To manage shorter toes, the bandage can be folded in half to ensure conformability and even coverage
- The fifth toe may be left free if there is no oedema present. If oedema is present, the fifth toe can be bandaged individually or with the fourth toe.
- Cut off any excess bandage and secure with adhesive tape
- Confirm that the bandage is comfortable and ensure that the toes are evenly covered and no bulky areas of bandage.
Materials you will need for toe bandaging
There are a wide variety of bandages that are specifically designed to suit fingers and toes that have oedema. We have included a selection below of different brands you may like to try. Remember that no two lymphedema limbs are the same, so if one product doesn’t work well for you, try changing to another.
A few tips and tricks to help you master the technique!
- For left-handed people, it may be easier to start your bandaging on the fourth toe, rather than the big toe.
- Make toe bandaging more comfortable by adding small pieces of cotton wadding underneath the toes and then bandaging on top.
- Bandages should not be applied with too much tension- if your toes are lifting up unnaturally, it’s a good indication that your bandages are too tight.
- To check for correct application, wiggle your toes – you should be able to move freely and easily.
- If you really struggle with toe bandaging, try using a toe glove under the bandages. These are usually made of light and silky material and can be customised to the size of your feet.
1: Elwell, R. (2014) Ten top tips for toe bandaging for chronic oedema/lymphoedema. Wounds Essentials, Vol 9 No 2, UK
Clinical Resource Efficiency Support Team (1998) Guidelines for the Assessment and Management of Leg Ulceration. CREST, Belfast