In 2011, Dr. Robert T. Spaulding wrote a book titled, Death by Pedicure, the dirty secrets of nail salons. In his book, he provides helpful hints on how to keep your feet and nails healthy and covers the full range of issues in the nail salon industry. This book is very timely as many people who are diabetic use the services of Pedicurists and may not realize that they may be taking an unnecessary risk to their foot health.
I have never met a person who said they wanted to lose a leg. Yet many diabetic patients unwittingly put themselves at risk for mold, yeast, fungus or bacterial infections that have resulted in serious and sometimes fatal consequences, all because of pedicures done in a nail salon. With fancy lighting, soothing muted colored walls, smoked mirrors and Enya playing in the background a person might think their nail boutique is sanitary. Some salon owners are extremely conscientious about sterilization of instruments and the foot baths they offer as part of their services, but unfortunately many are not. Regardless of the sanitation issue, a pedicure can expose your feet to risk because it physically disturbs the skin/nail complex and often the cuticle which serves as a protective seal around nail.
The level of foot care that is provided in a nail salon may be soothing, but when you realize that sharp cutting instruments like nail clippers and “potato peeling gadgets” are used to trim nails and calluses in every manicure and pedicure parlor in the world, you might want to ask yourself these questions:
· Are technicians appropriately trained to use these instruments?
· Are technicians trained to identify the risk factors that their clients may have, like diabetes or peripheral vascular disease?
· Do technicians modify their care to be consistent with that risk?
· Are the instruments they use sterile?
· If you are cut while having your pedicure, are you leaving yourself vulnerable to AIDS, HIV, or hepatitis during your brief spa holiday?
Why Do People Seek Professional Foot Care?
Over the past several years, there have been reports of deaths related to infections resulting from services in nail salons. Several podiatrists have made statements in national media outlets alerting consumers about the risks they take by seeking foot care at such establishments. Despite the negative publicity, people continue to use Pedicure services for a surprising variety of reasons. There are those who value the convenience and aesthetic value of the service. However, many people have real health related reasons for them to use the service. For instance, they may be unable to see or reach their feet, they may have a big belly or a bad back, they may lack the proper instruments to cut their nails, their eyesight may be poor, they may not know about the professional foot care services offered by a Podiatrist or they may lack access to a Podiatrist.
Doing my Due Diligence
In an effort to better understand the situation, I visited a school of cosmetology in Miami where pedicure services were taught. I was shocked to learn the low level of education these students received concerning the medical or health issues that related to their client’s feet and legs. The emphasis was on the aesthetics as one might expect, but these students had only the most rudimentary knowledge concerning diabetes, peripheral vascular disease, infections, and the concept of sterility of the instruments used on their clients. And when it came to medications, they knew little about the how Coumadin, Aspirin, Plavix, and other drugs affect the bleeding and clotting characteristics of their clients. I began to have serious concerns about the environment that a person with diabetes or “at-risk” patient might put themselves in while receiving a pedicure.
I wanted to be sure my evaluation of the issues concerning Salons and Pedicures was realistic, and not make up mind based on what I had seen and learned while visiting the cosmetology school. So, I then visited several pedicure salons to see how things were done in the real world. I asked the technicians how they sterilized their instruments. It seemed a bit peculiar to me that each salon performed this task differently and that there was no standard for sterilizing instruments used by all Salons. One proudly showed me a container of blue solution they soaked their instruments in; another showed me a “toaster oven” type contraption that the instruments were cooked in. One actually did individually pack their instruments in pouches and sterilized them in a medical grade autoclave.
I have since come to learn that there is apparently very lax supervision of these businesses, few or no legal standards and negligent inspections of many salons by the authorities. Organizations including the International Pedicure Association are working diligently to upgrade the education, training and continued education of Pedicurists. Despite the current issues, the pedicure profession is moving in the direction of being a real player in the area of foot health. Evidence of this can be seen in the Certification process for Medical Pedicure and Certified Foot Care Nurses.
Treating Diseased Toenails
Many people are unable to see or reach their feet, and many suffer from thick, deformed and painful nails and just don’t have the hand-eye coordination necessary to provide self-care. In fact, nearly 60% of the world’s population has some type of infection to their toenails, caused mostly by mold yeast or fungi. Toenail infections can be treated surgically, medically with oral medications and topical medications.
Podiatrists are specialists in treating toenail problems. They can perform surgical procedures under local anesthesia to remove a part of all of a diseased or painful toenail. Terbinafine or Lamisil and Itraconazole or Sporanox are the two oral medications most used to successfully treat toenail infections. Kerydin, Penlac and Jublia are topical medications that also can successfully treat toenail infections.
Minimizing Risks – Other Foot Care Providers
So, what is a person to do if they need professional foot care choose not to seek surgical or medical treatment want to minimize their risks? There are two other options for professional foot care services and they are Medical Pedicure Services and Foot Care Nurses. Some Pedicurists have specialized training and can provide a higher level of services. Their specialty is called Medical Pedicure. A Certified Medical Nail Technician (CMNT) is a state licensed nail technician or cosmetologist that has completed the Advanced Nail Technician Certification and ten additional modules of additional Medical Nail Technician training, relevant exams and an Internship to prepare to work with a Podiatrist or other physician. Their service focuses on the hygienic and aesthetic care of the toenails. It adheres to the highest levels of sanitation that meet or exceed OSHA (Occupational Safety and health Administration) for maintaining a clean environment and preventing the spread of bacteria, mold, yeast, and fungi. This is accomplished by individual sterilization of metal instruments by sealing them in sterile pouches and sterilizing them in an autoclave. Tools that cannot be autoclaved are used once and discarded. Additionally, masks and gloves are used by technicians to promote the cleanest environment.
Another professional provider of foot care services is the Foot Care Nurse. These foot health specialists are registered nurses who specialize in the area of foot health and foot care. They can be certified as a CFCS (Certified Foot Care Specialist). Foot Care Nurses will take a history of your underlying systemic medial problems, take a history of your foot health and review your current medications. They will examine your feet and document your foot structure, overall foot health and circulation. They will examine your shoes to ensure they are appropriate for your feet. Treatments they offer include trimming and filing of nails, de-bulking of the nails and trimming corns and calluses. You can find a foot care nurse near you at http://afcna.org/FindFootCareNurse/
Here’s What I Believe………
I believe that Podiatrists AND Pedicurists should work “hand in hand” in the care of their patients/clients. The Podiatrist provides the medical services and the Pedicurist provides the aesthetic services. I would prefer that diabetic and “at risk” patients who have nail or foot health issues receive professional evaluation and foot care by a Podiatrist. In this way, they will receive a professional diagnosis and learn about treatment options, receive education and not just have their nails trimmed and polished. However, for those who do use pedicure services, it is vital to know if their Pedicurist is certified and how their salon addresses the issues of instrument and foot bath sterility.
If you are in need of nail care and know you have risk factors like diabetes or neuropathy or Peripheral Arterial Disease (PAD), reduce your risks of contracting diseases by bringing your own instruments to your Pedicure and pass on the foot bath. Alternatively, consider using the services of a Certified Medical Nail Technician or a Foot Care Nurse for a higher level of professional foot care.