- Diabetes Forecast
- Know When to Skip It
- Stake Out the Salon
- Examine the Foot Bath
- Inspect the Tools
- Take the Right Steps
- Give Instructions
- Plan Ahead
- Use Your Judgment
- I Have Diabetes…Can I Get Pedicures?
- Best Nail Polish for Diabetes #3
- 9 Pedicure Safety Tips for People With Diabetes
- Is It Really Possible To Get A Safe Pedicure for Diabetics?
- Manicure and Pedicure Tips for People With Diabetes
- Diabetic Nail Care
- How to Safely Service Diabetics
It’s a simple act of bliss: sinking into a fat massage chair and surrendering to an adept technician who rubs away tension, kneading lotion into thirsty skin. In fact, the process of getting a pedicure often has less to do with perfectly polished nails and more to do with taking time out of your day to relax (preferably in the company of a tasty gossip magazine). If you have diabetes, the need to pamper yourself—and forget for a few moments about the hard work of managing your condition—is all the more crucial.
But before you kick off your shoes, consider the potential downsides of pedicures. “People with diabetes are at risk for a number of complications. Foot infections are common. If they develop a break in the skin, it can be a life-threatening complication,” says Lee J. Sanders, DPM, chief of podiatry service at VA Medical Center in Lebanon, Pa. “I would caution individuals with diabetes not to receive a pedicure because of the sanitary conditions of the salon, the skills of the individual performing the pedicure, and the cleanliness of the instruments used.”
Still, women (and, yes, even men) with diabetes are heading to salons and spas. The reason? Aside from being an indulgent way to spend an afternoon, pedicures can ensure that feet are clean and hydrated, which is important when you are managing diabetes. That’s why doctors, such as Jodi S. Politz, DPM, a podiatrist with her own practice in Las Vegas, say pedicures are possible—if you’re picky about your salon. ” can get a pedicure anywhere,” she says, “as long as the nail technician is using very clean instruments and they know what they’re doing.” At her own practice, Politz has created a spa that provides sanitary, medically supervised pedicures. “Women are going to get whether they’re diabetic or not,” she points out, adding that people with diabetes do “have to be more conscious about it.”
So read on to learn how experts advise you can keep your feet safe.
Know When to Skip It
If you are healthy and complication-free, getting a pedicure doesn’t pose a threat the way it does for people with the foot complications of diabetes. But if you have an infection, ulcer, cut, or neuropathy, don’t book an appointment. An open wound is an open door for any bacteria that may be in the foot basin’s water, and nerve damage will make it hard for you to tell if you’ve been cut or if the bath’s water is too hot.
Stake Out the Salon
Scheduling a pedicure at just any old nail salon is a bad idea. “The most important thing is that wherever people go, they need to make sure they’re using clean practices,” says Donna Perillo, owner of Sweet Lily Spa in New York City. As podiatrist Sanders puts it: “We don’t know how clean the basin is. We don’t know how clean the water is.” He urges women to look into the place’s sanitation practices, the technician’s training—make sure she’s licensed—and how the tools are cleaned. “If a woman is going to seek out this service, it is important address these issues,” he says.
If the salon looks clean but you’re still unsure about the sanitization process, don’t be afraid to ask. “Ask them how they clean their things,” says Perillo. “We get asked all the time, and I’m happy to answer.” According to Lisa Tep, owner of Sesen Spa in Vienna, Va., after each service, foot baths should be cleaned with a hospital-grade, EPA-registered disinfectant made specifically for pedicure chairs. If a spa doesn’t clean as often or with the proper chemicals, walk away. “I wouldn’t take a chance,” says Perillo. “There are so many things you can catch. Fungus is the number one thing you see.”
Carroll Klingbile of Damascus, Ore., who was diagnosed with type 2 diabetes three years ago, inspects new nail places by getting a manicure first before leaping into the pedicure chair. “I’ve walked in and sat around and waited” in order to check a salon out, she says. “There are a couple places I’ve walked out of.”
Examine the Foot Bath
Sure, sinking your feet into a pool of warm, bubbly water is relaxing. But did you know that bacteria may be introduced into your bath thanks to the pipes that carry the water? Avoid soaking in someone else’s bacteria by being picky about your foot bath. Some spas, such as Sesen, use “pipeless” pedicure chairs, which reduce the area in which bacteria can hide. Others, like Sweet Lily, opt for easy-to-clean individual buckets or bowls. Before you book your service, ask the spa which type of basin it uses. And remember, regardless of basin type, the technicians should still clean between each client.
Inspect the Tools
Before you let a pedicurist touch your feet, find out how her tools are sanitized. Like foot baths, implements should be cleaned between each use. But, be warned: Just because tools were pulled from a sterilization pouch or drawn from a jar of blue liquid doesn’t mean they’re safe, says Tep. Dirty instruments used on past customers may soak in unchanged fluid or open containers. Ask if the salon operates an autoclave (a hot, pressurized chamber used to sterilize medical instruments), and make sure packages of uncontaminated tools aren’t opened until the minute you sit down—otherwise they may be compromised, she says.
Another tip: Pick a salon that uses stainless steel instruments, which are easier to clean than porous nail files and those wooden sticks used to push back cuticles. If emery boards and nail buffers are used, they should be thrown out after each client to prevent the spread of bacteria.
Some people even tote their own tools as an extra precaution. But then cleanliness becomes your responsibility: “You have to, as an individual, make sure you wash your tools,” says Perillo. “You can infect yourself. As long as you go home and wash them really good … that’s a great solution.”
Take the Right Steps
You should wash and inspect your feet daily. Turn the chore into a treat.
- Wash. Clean feet are healthy, so perform this task daily—not just for a pedicure.
- Exfoliate. Get rid of the dry skin that prevents full moisture absorption with a pumice stone.
- Moisturize. Rub a thick moisturizer into feet, avoiding the area between toes.
- Clip. Cut toenails straight across to prevent ingrown nails.
- Soften. Stop cuticles from cracking by rubbing them with a soothing oil.
- Polish. Go ahead, have fun.
“I always tell people: If they have diabetes they should let us know,” says Perillo. “The massage should be gentler.” Though you may feel nervous saying something, nail technicians actually want you to speak up. “I tell my pedicurist, ‘You know, I can’t have too hot,'” says Klingbile. “I have never found anyone to be nonresponsive to that. They’ve always been very, very nice.”
Request that the technician not clip your cuticles or file your heels or calluses. Make sure the basin’s water is warm, not hot, and that your toenails are cut straight across. Ensure that moisturizing lotions are thoroughly massaged into your feet to prevent excess lotion collecting between the toes. And insist that the pedicurist avoid a credo blade—that’s the one that looks like a razor—on your feet. The tool is illegal in many states.
As lovely as freshly shaven legs are, in this case they can do more harm than good. Stop shaving your legs two days before your scheduled pedicure to prevent skin from getting irritated or bacteria from entering any tiny nicks or cuts.
Use Your Judgment
These measures may seem extreme, but consider the alternative: Unsterilized instruments can pass bacteria and infections between clients. So, what do you do if you suspect a salon isn’t practicing safe sanitization? “I would say get up and leave,” says Tep. “You’re risking a lot for a pedicure. If you’re not sure, and you’re not comfortable, it’s better to be safe than sorry.”
I Have Diabetes…Can I Get Pedicures?
When Ruth Nichols decided to get a pedicure a year after her type 2 diabetes diagnosis, she knew she needed to take extra care. Ruth, 59, had watched her father become wheelchair-bound after years of living with diabetes, so she understood the importance of caring for her feet. But when she checked out several salons three years ago near her home in Gulfport, Florida, she was horrified to see their lax sanitation.
“They spritzed those little tubs for just a few seconds before filling them up for the next customer,” she says. Fortunately, Ruth discovered a local salon owned by a nurse that specializes in pedicures for people with diabetes (PWDs). She now confidently gets her feet pampered and toenails polished, sometimes experimenting with shades of joyful yellow and suede blue.
Some diabetes experts tell patients to skip pedicures because of the risk of complications. “I’ve had many people who have gotten infections from pedicures, and because of their diabetes they are often slow to heal,” says Katherine Lai, D.P.M., a podiatrist at the Center for Podiatric Care and Sports Medicine in New York City.
Yet caring for your feet is key in managing diabetes, and many PWDs do enjoy regular pedicures. Talk to your health care provider before getting a pedicure. Extra-thick skin, curved nails, or circulation problems require some people to forgo a pedicure and have their nails trimmed at a podiatrist’s office.
Before you go, read our pedicure checklist and suggestions for what to take with you.
— Ditch your razor. Shaving your legs creates tiny nicks that can allow bacteria to enter, so it’s best to avoid shaving for at least two days before an appointment.
— Ask about cleaning procedures. Call ahead or stop in to ask the manager how the salon is sanitized. At Adam & Eve Day Spa in Seminole, Florida, owner Anna Marie Stewart, LPN, treats her tools like medical equipment. She scrubs them in soap and water, soaks them in disinfecting liquid, and heats them in a surgical autoclave. If you can’t find a salon that takes similar precautions, consider providing your own tools.
What to Take with You
Bring your own tools. Providing your own tools at the salon is the best way to ensure foot safety. Many shops even allow you to store your tools on-site in a container labeled with your name. Here’s a good list of what to take:
— Nail clipper
— Nipper (to be used only to remove dead skin)
— Foot paddle or pumice stone (to gently slough off dead skin)
— Nail file (disposable wooden ones are best)
— Buffing brick (to ready nails for polish)
— Orange stick (to clean under the nail or gently push back cuticles)
— Moisturizer or cuticle oil (to soften skin)
— Polish (many salons use the same bottles and brushes for different patrons)
During your appointment
Tell the technician if you have nerve damage. You might say, “My feet don’t feel as much, so please make sure the water won’t burn me,” Stewart says.
Leave cuticles alone. The live skin around your nail bed should never be clipped because it opens a door to infections, Stewart says. Ask the technician to gently push back cuticles with a stick, which makes them look just as good, she says. If you trust the technicians not to cut your toenails too short, it’s OK for them to clip; otherwise, ask for your nails to be filed.
Beware of overzealousness. Well-meaning technicians might vigorously scrape — or worse, cut — areas of calloused skin, but that can lead to sores, podiatrist Katherine Lai says.
Vew source: http://www.diabeticlivingonline.com/complications/feet/pamper-yourself-pedicure-tips-people-diabetes
Now, on with the service.
Step 1: Gently wash her feet with an antibacterial soap and tepid water then pat dry.
Explanation: All three podiatrists recommend against foot soaks, even in tepid water. While the primary concern is that a diabetic is more easily burned because of the loss of sensation, Dr. Sanders stresses that soaking in water may worsen the dry skin so typical to diabetics.
“We’re also concerned now about cross-contamination,” notes Dr. Albreski. “The fungi that cause skin infections are everywhere, and while most people may not pick it up from a contaminated whirlpool, the diabetic just might because her immune system isn’t as strong.”
Step 2: Trim and shape the nails as desired, being especially careful not to nip the skin.
Explanation: Most diabetics are advised to file down their toenails to the desired length, but Dr. Shakula says pedicurists can trim them with care as long as the nails are not misshapen or excessively thickened.
“Don’t dig under the nail plate or gauge at the corners,” she advises. “And never use a drill on the feet.”
Step 3: Apply a mild cuticle treatment to soften cuticles. Do not, however, trim or push back the cuticles, warns Dr. Albreski.
Explanation: “The cuticle serves as a protective structure to keep bacteria and fungi from getting under the nail fold,” Dr. Sanders notes. Remember, diabetics are more prone to bacterial and fungal infections of the skin and nail. Once present, these types of infections take longer to heal and are more likely to spread and cause a serious health problem.
Step 4: Next, apply a hydrating lotion to the tops and bottoms of the feet —but avoid the spaces between the toes.
Explanation. Poor circulation can also cause problems with healing. Normally, the body keeps a steady supply of fresh blood flowing to heal damaged tissues. Poor circulation means a poor flow of blood, which slows healing. Even a small cut or ingrown nail may take a long time to heal, which increases the likelihood of an infection. However, the spaces between the toes typically trap moisture, regardless of how dry the rest of the foot is. Applying a cream orlotion between the toes only traps more moisture and may cause the skin to break down, which in turn invites infection.
As for what type of lotion to use, Dr. Albreski and Dr. Sanders recommend lotions containing lactic acid or 10% urea. Dr Shakula, on the other hand, thinks pedicurists can use most mild exfoliating creams. However, she agrees that moisturizers containing lactic acid are most effective at softening the hard, dry skin so common to diabetic feet.
Step 5: Massage each foot gently but thoroughly, stroking toward the heart.
Explanation: A favorite with most clients, diabetics in particular can benefit from massage because it improves circulation, albeit temporarily.
Step 6: Polish the nails as desired.
While a monthly pedicure is enough to maintain foot health for most clients, diabetics require daily foot care. But, as Dr. Albreski notes, “Most diabetics are aware of the need and they’ll tell you they’re on top of it, but they don’t quite follow through in practice.”
Remind these clients to carefully wash and visually inspect their feet for injuries each day. Advise them to finish their self-inspection with a liberal slathering of moisturizing lotion on the tops and bottoms of the feet to help heal and prevent dry skin.
If, after all these precautions, you accidentally nick or cut a diabetic client, Dr. Albreski urges you to admit the mistake and take action to prevent the injury from becoming serious. “It’s not malpractice or faulty workmanship to nick someone,” he says. “What will get you into trouble is not addressing the situation correctly.” Citing two lawsuits he’s aware of against pedicurists, Dr. Albreski emphasizes the need for honesty and professionalism with clients.
He recommends immediately stopping the service and performing basic first aid care: Use a styptic pencil to stop any bleeding, apply a triple antibiotic cream such as Neosporin, then lightly bandage the site. Explain to the client what you did to treat the wound, then recommend that she notify her primary care physician of the injury and seek his opinion on whether she needs a doctor’s care.
“Write down everything you did and said to the client and keep it in a file in case anyone comes back to you later,” Dr. Albreski says. You might even consider developing an accident or injury report similar to those used by some child care centers. In this case, you might briefly note the injury, how it was treated in the salon, and repeat in writing the recommendation that the client seek her primary care physician’s advice on further treatment of the injury.
Best Nail Polish for Diabetes #3
I know that coping with diabetes on a daily basis can not only be stressful but it can also be more time consuming especially in the morning. Sometimes you need a little ‘pick me up’ to get you through the day.
Self-pampering is a great way to reward yourself for being proactive about managing your diabetes and there’s no better way to treat yourself than by giving yourself a safe manicure!
I want to help you ‘Makeover Your Diabetes’ by sharing the best products in beauty/fashion, diabetes self-care and exercise to help you “GLAM MORE, FEAR LESS” with less stress this year!
For people with diabetes, it is vitally important that they learn to care for their nails. Your nails protect your fingers and toes from injury and trauma.
Did you know people with diabetes are prone to developing a fungal infection known as onychomycosis? This fungal infection accounts for approximately 50% of all nail infections.
To avoid infections go ‘natural’ and don’t use artificial nails. Artificial nails trap water under the nails and this moisture will promote fungus growth. The good news is there are still plenty of safe, fun and colorful ways to flex your attitude with natural nails!
“Our nails are an expression of who you are, you should have the ability to have nail art that accentuates your personality, says Jennifer Dye, a licensed nail technician at Studio 26 in Santa Cruz, CA.
If you wear nail polish, you might be applying more than glossy color to your fingertips.
A study led by Duke University and the public health advocacy organization Environmental Working Group suggests that we absorb at least one potentially hormone-disrupting chemical every time we get a polish. While the impact of this chemical on our health is still unclear, the fact that our body can absorb chemicals through nail polish is cause for concern.
The chemical in question is triphenyl phosphate, or TPP. Companies add it to nail polishes to make the product stick more strongly to the nail.
The good news is that there are plenty of nontoxic nail polishes to choose from!
A few years ago, the ‘three-free’ polishes (meaning formulas that contain no formaldehyde, toluene, or dibutyl phthalate) used to be the gold standard. But then companies began offering polishes that free of other potentially harmful ingredients, like formaldehyde resin, camphor, ethyl tosylamide, and xylene.
Here’s a breakdown of what the terms ‘five -, seven-, eight- and nine-free’ mean and clarification on what toxic ingredients they’re missing:
Five- free (Free of: Formaldehyde, toluene, DBP, formaldehyde resin, and camphor.)
Seven-free (Free of: Formaldehyde, toluene, DBP, formaldehyde resin, camphor, ethyl tosylamide, and xylene.)
Nine-free (Free of: Formaldehyde, toluene, DBP, formaldehyde resin, camphor, xylene, ethyl tosylamide, parabens, and acetone.
Our pick for the best Nail Polish for Diabetes is Acquarella Nail Polish (shown in Hot Chocolate shade above). Acquarella is water-based and doesn’t contain: Formaldehyde, formaldehyde-like derivatives, toluene, ketones, petrochemical solvents, DBP, phthalates, polyurethane, polyurethane film-formers, parabens, camphor, mercury, lead, FD&C, coal tar, gluten, wheat by-products, aromatic hydrocarbons. Retails: $18.
Keep in mind, water-based nail polishes have some drawbacks beside their steep price tags. According to the Fig + Sage blog, “water-based (nail polishes) don’t perform like regular nail polish; meaning they chip, flake & disappear.”
Why go natural?
“Your natural nails are easier, and more cost effective to maintain on a regular basis than artificial nail enhancements. No regular fills needed,” says Jennifer. “By focusing on enhancing your natural nails you minimize your exposure to the abrasive or harsh chemicals necessary in artificial nail treatments.”
If you choose to stick with your current brand and/or buy a nail polish without at least five- free then make sure to avoid products that contain toluene, formaldehyde or dibutyl phthalate. And don’t inhale! That strong, recognizable nail polish smell can be a sign of airborne toxic chemicals. Apply polish in a well-ventilated room.
Research provided by Allure magazine
Enjoy Diabetes Late Nite inspired by George Michael featuring our first-ever Valentine’s Day Party with guests Chef Ward Alper aka ‘The Decadent Diabetic’, ‘Rich In Love‘ fashion blogger Doris Hobbs, the Charlie’s Angels of Outreach, Poet Lorraine Brooks and Mama Rose Marie This podcast is part of Diabetes Podcast Week in support of the ‘Spare A Rose, Save A Child’ campaign. Please join us! #Dpodcastweek
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Lee Sanders, DPM, responds: The medical term for the toenail fungus that you refer to is onychomycosis. This condition is a very common infection of the toenails caused by a mold or yeast. Onychomycosis is often associated with a chronic athlete’s foot condition. A 2006 study published in the journal Acta Dermato-Venereologica showed that 22 percent of patients with diabetes have toenail onychomycosis. Many people live with this condition for their entire lives; however, onychomycosis can negatively impact your quality of life. In addition to the cosmetic effects, the toenail fungus can cause nail deformity, pain or discomfort while wearing shoes, odor, or recurrent ingrown toenails. In people with diabetes, onychomycosis can lead to serious foot complications such as foot ulcers and infections. Although topical antifungal medications are effective for treatment of fungus infection of the skin, they are relatively ineffective for infection of the toenails. The medication is unable to penetrate the nail plate to get to the fungus. For some people, oral antifungal medications can provide a cure for onychomycosis, when used appropriately.
However, clinical cure frequently takes close to a year, and recurrence of the infection is common. You should discuss treatment options with your physician or podiatrist. Prior to treatment, your physician should perform a careful medical history and a visual inspection of your nails, perform a fungal culture, and order a blood test to determine whether your liver function is normal.
Good foot care is essential for all people with diabetes. You should keep your feet clean and dry, wear shower shoes when bathing or when at the local swimming pool or health club, and wear socks made of a blend of absorbent fibers. Acrylic fiber socks transport moisture more efficiently from the surface of the foot than do cotton socks. And remember, inadequate laundering of clothing can be a source of reinfection following therapy for onychomycosis and athlete’s foot.
9 Pedicure Safety Tips for People With Diabetes
Summertime is beach and sandal weather, which means your feet and toes are more frequently on display. Professional pedicures can help your toes look their best and pamper your feet, but too often poor sanitation practices, shared tools, and the work of overzealous nail technicians can result in skin injuries or infections.
Pedicure problems can happen to anyone, but if you have type 2 diabetes, you need to be especially careful about protecting your feet. An infection can raise your blood sugar levels, which, in turn, can interfere with proper healing and increase your risk of serious complications like ulcers or even amputation.
Before you schedule a pedicure, check with your physician to make sure it’s okay to have one. Once you get the green light, do your feet a favor and learn what to look for — and what to avoid — at nail salons. Taking a few basic precautions can significantly reduce infection risks and lead to a safer, more pleasant experience.
- Know when to postpone a pedicure. If you currently have any infections, cuts, or open sores on your legs, feet, or toenails, skip the salon since these will make you even more vulnerable to problems. Instead, contact your physician for a referral to a podiatrist or other professional who is medically trained to care for feet.
- Avoid shaving your legs for a day or two before your pedicure. Shaving can leave tiny nicks in your skin (even if you can’t see them) and increase the chance of infection. It’s fine to shave afterward.
- Stick with a salon that is clean and practices impeccable sanitation. Tell the manager you have diabetes and ask about their sterilization procedures; reputable salons will be more than happy to show you how they operate. Foot baths should be cleaned and disinfected between customers. Clippers and other tools should be washed and sanitized in a disinfecting solution or a surgical autoclave, which uses pressurized steam to sterilize instruments.
- Better yet, invest in your own nail kit and bring it with you. Though it’s unlikely that you will get an infection from shared nail polish, play it safe and bring your own.
- Make a morning appointment. If you can, schedule your appointment early in the day so that you are one of the first customers.
- Let your technician know you have diabetes before the pedicure begins. Ask them to be very gentle and avoid doing anything that can scratch or injure the skin. Don’t hesitate to speak up if you don’t like what the technician is doing — your health is too important.
- Keep the technician informed of protective practices. Ask the technician not to cut nails too short, as this can encourage ingrown toenails and lead to infection. Make sure toenail edges are not sharp; they should be rounded off with a file.
- Skip any services that can injure the skin. Never allow the technician to cut your cuticles or use any sharp instruments on your skin or under your toenails. Instead, after your feet have been soaking for a few minutes and the skin around your toes is soft, cuticles can be gently pushed back with an orange stick.
- Request gentle pampering. Pumice stones or abrasive tools are okay for calluses and rough areas, but ask the technician to be very gentle. Vigorous scrubbing is not necessary and can easily scratch or leave microscopic tears in the skin, making you more susceptible to infection.
After your pedicure is finished, keep an eye on your feet and legs for any signs of redness or infection. If you notice anything unusual, call your doctor right away.
Athena Philis-Tsimikas, MD, is an endocrinologist and the corporate vice president for the Scripps Whittier Diabetes Institute at Scripps Clinic in San Diego.
Manicures and pedicures are wonderful, relaxing treats, but if improperly done they can open the door to a vast array of infections and maladies. This is especially true if you have diabetes because even a minor nick or cut can easily escalate into a life-threatening condition. In this article, we will share some smart practices to help you evaluate the quality of manicure and pedicure salons and take proper precautions to ensure a safe and enjoyable experience. Read on to learn more.
Is It Really Possible To Get A Safe Pedicure for Diabetics?
Many diabetes experts recommend that their patients avoid having a pedicure because the risk of complication is so high. Lots of people contract viral, bacterial or fungal infections from the pedicure experience. For diabetics, these problems can take a long time to resolve because people with diabetes often heal slowly. If you have problems such as neuropathy, very thick calluses or curved nails, it’s probably smarter to have your nails trimmed by your podiatrist.
On the flip side of that coin, good foot care is very important for diabetics, so having regular, professional pedicures could contribute to excellent diabetic care. To determine whether getting a professional pedicure is the right decision for you, have a talk with your doctor or podiatrist. He or she will be able to evaluate your situation and give you sound advice.
Choosing the Right Spa or Salon
When looking for a good facility to provide professional foot care for diabetics, you are always better off choosing a “medi-spa”. These salons are supervised by a podiatrist or general practitioner. The treatments are administered by trained nurses or nursing assistants. All equipment is cleaned using standard medical sterilization procedures.
The professional medical personnel you will find at a medi-spa are knowledgeable in manicure and pedicure procedures for people with diabetes. This includes gentle massage techniques and correct skin cleansing and moisturizing techniques.
Another very good reason to choose a medi-spa over a standard salon is that your insurance may very well cover your treatment. Be sure to check. It may just be a matter of getting a referral from your doctor or your podiatrist.
Investigate the Spa Before Making An Appointment
Take a little time to visit spas, look them over and ask lots of good questions. You’ll want to be well-informed regarding the licensing policies, cleaning techniques and chair-side manner of the staff at the spa you choose.
Look the establishment over and get a “feel” for it. Observe a pedicure if possible. Find out how often foot baths are cleaned and how this is done. Ask about the general cleaning of the establishment and especially the cleaning of manicure and pedicure tools.
The very best establishments treat their tools as medical equipment. They are cleaned thoroughly between clients by being scrubbed with soap and hot water, soaked in disinfectant and sterilized with heat in an autoclave. For complete information regarding how manicure and pedicure equipment should be sterilized between uses, see this interesting article:
Bring Your Own Kit
If you are unable to find a spa that follows the practices described above, you should bring your own manicure and pedicure tools and equipment. Here’s what you’ll need:
- High quality, stainless steel nail clippers.
- Diabetic front nail nippers for toenails and thicker nails.
- Diamond file for foot calluses. This is better than a pumice stone because it can be sterilized.
- Packet of disposable emery boards for single use or diamond nail file to be sterilized between uses.
- Buffing brick for nails to be sterilized with thorough brushing and 5 minutes immersion in rubbing alcohol following each use.
- Packet of disposable orange stick cuticle pushers for single use or stainless steel cuticle pusher to be sterilized between uses.
- Your favorite hand and foot cream and/or cuticle oil.
- Your own polish. This is important as many salons share containers of polish and brushes amongst their clientèle.
If you’d prefer not to bring your own equipment, seek out a salon that uses entirely new tools and equipment for each customer. This equipment should come in sealed packaging that is opened in front of you.
Be Very Careful About Broken Skin
As you are probably well aware, a tiny cut or nick can end up causing very serious infection for people with diabetes. This is why it is so important that all implements used in manicures and pedicures be thoroughly sterilized between uses.
It is important to avoid getting nicked, and it is important to avoid going to the spa or salon with an existing injury. Be sure that your technician knows that you are diabetic. Don’t allow the tech to aggressively clean under your nails or to clip your cuticles. Nails should be cleaned gently and cuticles pushed back gently to prevent injury.
Be sure the tech does not clip or file your nails too short as this may cause irritation. Your technician should trim your toenails straight across rather than curving the corners. This helps prevent ingrown toenails, which can be very painful and are subject to infection.
Never let your technician cut calluses away or use a shared implement to file away your calluses. Always bring your own diamond foot file or insist on individual use implements. Don’t allow the use of any chemical callus removers as they can burn your skin deeply and this may cause serious complications.
Don’t be shy about asking your tech to be gentle. Many are quite vigorous in filing calluses, cleaning under nails and so on. This is not appropriate and could cause you real injury. This is also true of very vigorous massage. Let your tech know that you prefer a gentler technique.
If anything about your foot spa treatment causes discomfort, speak up. Remember that you are the customer and this experience is meant to be pleasant, relaxing and safe for you. If it doesn’t fulfill your expectations, leave.
What About Foot Spas?
In general, it is not a good idea to soak your feet because long exposure to warm water can make your skin more susceptible to picking up bacteria and fungus. If you are going to go for a foot soak, it’s a good idea to schedule for the first appointment of the day so that you know the foot spa has been cleaned and left to air out overnight. It’s even better to reserve your foot spa experience for home and use your own foot spa that no one else has ever used.
If you absolutely must have the foot spa experience at the salon, avoid shaving your legs for a couple of days before your appointment. A small shaving nick may go unnoticed, but it could severely compromise your skin’s ability to keep out germs and fungus. If you have any injury on your feet or lower legs, postpone your appointment until it has healed.
If you experience peripheral neuropathy, be sure to tell the tech and ask him or her not to make your foot bath too hot. It should be 90-95 degrees Fahrenheit. Before putting your feet into a foot bath, feel the water with your fingertip to make certain it is not too hot for your feet.
If the salon has a built-in foot spa, don’t use it. It’s better to use basin or pipeless foot baths because they can be more thoroughly sterilized. Another option is a “hot towel pedicure”. In this procedure, your feet are wrapped in hot, wet towels, which can be thoroughly washed and dried between uses. This is a very safe option. Just be sure the towels are not too hot.
Maintain Your Feet Between Spa Visits
In between professional treatments be sure to take good care of your feet. This will make your spa visits more effective and less likely to be potentially dangerous. Remember to follow best practices to keep your own foot care equipment safe and clean.
Be sure to keep your feet clean and moisturized with high quality, hypoallergenic products. Avoid using moisturizer between your toes as this can lead to fungal infection. Generally speaking, it’s best to use unscented, hypoallergenic products to avoid the potential for irritation which could lead to skin damage and complications.
If you use a foot spa at home, be sure to give your feet plenty of time to air out afterward to avoid the development of foot fungus. Keep your foot spa clean, too, by washing it thoroughly, taking it apart and leaving it in the open air and light to dry thoroughly before storing it away.
Have a Safe, Relaxing Experience!
Getting a professional pedicure can be a very relaxing and positive addition to diabetic foot care. Play it safe by taking the time to find a spa that has impeccable hygiene practices and a professional, licensed staff. Advocate for your own preferences and needs and take good care of your feet between sessions. These smart practices will help you have the most enjoyable, most beneficial and safest professional pedicure experience.
Sharing The Fashion
Opt for a gentle exfoliant, such as a mask, rather than a salt or sugar scrub, which can be abrasive on the skin.
We don’t hear about the dangers of diabetes as often as we should, because, for the most part, it can be managed effectively through medicine. However, according to the 2010 National Diabetes Statistics Report, diabetes was the seventh leading cause of death in the U.S. In 2015, 1.5 million new cases of diabetes were diagnosed, half in adults ages 45-64.
Diabetes affects more than the body’s ability to metabolize sugary sweets. A multi-system disease, diabetes taxes the immune system, increases the risk of renal failure and arterial compromise, and creates issues with blood flow.
A client who suffers from diabetes may experience numbness in the feet (neuropathy), chronic swelling, discoloration in their skin, and changes in body temperature. Dr. Michael S. Kerzner, a podiatrist at Duke University Medical Center in Durham, N.C., says a difference in temperature can often be felt from the ankles to the toes. When circulation is poor, the toes are significantly colder.
All this means that when clients with diabetes sit down to get a pedicure, their body will respond differently to everything from water temperature to cuticle care. They won’t be as sensitive to discomfort as a healthy client would be, which means the onus of responsible care is on the nail tech. Know how to protect yourself and your client, because even a small nick or abrasion can develop into a serious health issue.
Pedicure risks are higher in clients with diabetes because the disease can cause a loss of sensitivity in the feet. A healthy client will reflexively pull away to warn a tech she’s being too rough. A diabetic client with neuropathy won’t. Any time a nail tech accidentally cuts the skin or breaks the cuticle seal, she increases a client’s risk of infection. But in a client with diabetes, small nicks and cuts can go unnoticed and untreated — and develop into much larger problems.
Nearly 10% of the U.S. adult population suffers from diabetes, a statistic that should motivate techs to educate themselves on proper anatomy and on the severity of their client’s condition.
“What we view as the half-moon of the big toe is actually the end of the long bone. In fact, if we were to peel back the eponychium of the big toe, we would see that bone,” says Dr. Kerzner. “Two to three times a year, I see patients in the high-risk population come in with bone infections. These patients have to be put on drugs that suppress the immune system. A bone infection becomes very hard to heal.”
Techs can learn to recognize silent signs that alert them to the severity of a client’s diabetic health. “Look for hair on the toes,” says Dr. Kerzner. “Absence of hair indicates a higher risk. Press on the skin. If the color doesn’t return in 3-5 seconds, it’s a sign of distal pooling, another risk.”
In clients with known diabetic conditions, ask about their health at each appointment. Don’t assume because they indicated they have diabetes on the intake form that the condition is static. Practice asking health questions so it becomes a natural part of the conversation: How have you been feeling? Is your sugar well controlled? Do you get cramping when you walk? Do you experience tingling or numbness in your toes?
Their answers warn you of risks. Cramping can indicate vascular compromise. Numbness and tingling are indicators of neuropathy. “More than 50% of wounds in diabetics will become infected,” says Dr. Kerzner. With statistics like that, it’s vital for nail techs to communicate with clients throughout the entire pedicure service.
Submerge your whole hand and wrist into the pedicure water to check that the foot bath is not too warm.
Once you know a client has diabetes, offer assurance that you’re educated about proper foot care. Let them know you’re committed to working with them to reduce risks and increase safety. Part of that is keeping the lines of communication open. Be comfortable asking about their health and providing tips to maximize their pedicure experience.
Let diabetic clients know you’re diligent about sanitizing all implements, files, buffers and bowls. Assure them absolute care and attention has been given to cleaning the bowl before their appointment. (This should be the standard regardless of whether the client has diabetes or not.)
Warn them to avoid shaving before a pedicure appointment. Give them the freedom to reschedule without consequence should they discover a cut or abrasion on their skin. Finally, let them know what precautions you will take as you provide the best care.
Neuropathy restricts a person’s ability to feel. That means your client might be unaware of discomfort from a deep massage, pain from a cut, or heat from the water temperature. Every step of the pedicure service can be modified to increase the comfort of a client with diabetes.
- Choose a water temperature that is comfortable but not too warm. Submerge your whole hand and wrist into the water. Your fingertips may not give an accurate feel for the deeper water of the foot bath.
- Smooth the skin using a less abrasive buffer rather than a pumice stone. Delicate skin could peel more easily than you realize. Be extraordinarily gentle, especially in seniors with diabetes.
- Take special care when you shorten the nails and clean under the free edge. Work slowly to avoid digging too deep or cutting the nails too short. Often, a straight nail shape is preferred to an oval, to avoid any risk of the nail growing into or cutting the skin as it grows.
- Avoid digging into the sidewalls of the nail. Use gentle pressure when you scrape the cuticle from the top of the nail plate. Do not push the cuticle back, as any compromise of the cuticle can cause serious health problems to develop.
- Opt for a gentle exfoliant, such as a mask, rather than a salt or sugar scrub, which can be abrasive on the skin.
- Use a smooth moisturizing cream that can spread easily with soft strokes during the massage. Avoid deep pressure, which could easily bruise the skin. Instead use a light, therapeutic touch.
Out of Scope
A visit to the salon can be an excellent alternative for elderly clients. A pedicure can be a welcome experience for those who have a difficult time bending over to cut their nails, or who have deteriorating eyesight that makes filing nails difficult. However, sometimes a client’s needs extend beyond the scope of a nail license.
It can be difficult to recognize when and how to decline a service. First, it’s understandable that a tech wouldn’t want to lose the income from the hour that’s been booked. Second, it can feel rude to refuse to care for a client. But the situation can be handled delicately to end with a win-win for both the client and the tech.
When a client has compromised skin, an open wound, or clear signs of infections, it’s important to set a precedent and inform the client of the need to reschedule the service. To continue puts the client at a health risk and you at risk for future liability issues. With gentle professionalism, let them know you can’t continue until the area has healed. In rare circumstances, you may want to require a physician’s release.
It would be easy for a client to feel insecure if a service is denied, so it’s important to make sure the client feels respected. One suggestion on how to ease the discomfort of rescheduling their appointment is to offer an alternative service. For example, if an infection is somewhere on the foot, offer to perform a manicure in place of a pedicure. The client will leave feeling validated and pampered, and you’ll have an opportunity to recoup part of the service price.
Positioned as a Professional
Offering diabetic pedicures is an excellent niche market that could help grow your business. Position yourself as a well-educated professional by creating specialty pedicure services for diabetics. Promote the services through brochures that explain the precautions you take for diabetic clients. Make the brochures available so clients can hand them out to friends. Stop by local podiatrists offices to introduce yourself and to drop off your brochures. Become the name podiatrists think of when their patients ask for a pedicure referral.
Special care is essential when clients with diabetes come to the salon for a pedicure. But rather than viewing the extra attention as too much work, use it as a way to stand out in a busy, competitive market. By positioning yourself as an expert, you’ll not only be able to grow your business, you’ll also be offering a much-needed service to customers who need — and appreciate — your expertise.
Take Your Pedicure Services to the Next Level
Learn more about servicing clients with health issues at the Foot Forward Summit 2019, taking place August 11-13 in Atlanta. Sponsored by NAILS, this event offers a unique opportunity for nail techs and salon owners who are serious about foot care to offer safe, effective services to diabetics, elderly clients, and others requiring specialized care.
For more information, go to www.footforwardsummit.com.
Manicure and Pedicure Tips for People With Diabetes
Going for a manicure and pedicure sounds like a relaxing treat, especially for people with diabetes who are always busy with self-management. A manicure and pedicure can help you feel and look better but it is important to be cautious about where you go and how it is done. Discover manicure and pedicure tips for people with diabetes to ensure a positive experience with no complications.
Pedicure and Manicure Tips – Know Where to Go
The first step to a successful manicure and pedicure is to know where to go. Inexpensive salons often have unlicensed technicians who are not educated about proper hygiene and cleanliness. Inspect the spa before you make an appointment. Ask about their cleaning and sterilization procedures. See if all of the technicians are licensed since they need to display their license by their station. Often it is wise to bring your own implements to the salon to ensure the highest level of cleanliness. Know the difference between a medi-spa and a regular salon. A medi-spa is supervised by a doctor or podiatrist. Well-trained nurses or assistants perform the pedicures and manicures. They follow medical cleaning and sterilization procedures. They also know how to do manicures and pedicures for people with diabetes, including cleansing, moisturizing, and massage techniques. Ask your insurance provider if a pedicure at podiatric office or medi-spa is covered by your policy. You may simply need a referral from your doctor to enjoy this healthy benefit. Have your feet examined by your physician and get approval before scheduling a pedicure. If you have peripheral neuropathy, avoid pedicures and only go to a podiatrist for foot and nail care. You should visit a salon for massage and polish only.
Be Aware of Nicks and Cuts
When you have diabetes, a small nick or cut can lead to a serious infection. A cuticle or foot cut may easily become infected. It is essential for the instruments to be properly sterilized before each use. Stainless steel implements are more sanitary than wooden ones and porous files. Some salons use new implements for each customer. Make sure the sterilized packages are opened in your presence. To be safe, bring your own nail clipper, nipper, pumice stone, file, cuticle stick, and buffer. If you use polish consider bringing your own since salons use the same bottles for multiple customers. Have the technician sterilize the foot bath before you put your feet in the water. You can bring tea tree oil and add a few drops to the foot bath which works well as a disinfectant. Let the salon know you have diabetes before they get started. If you have cuts, ulcers or scrapes on your feet or legs, put off your pedicure until they heal. Do not allow them to push an orange stick under the nail which may increase your risk of nail fungus. Schedule pedicures 2 or more days after shaving your legs in case you have fine nicks, cuts or razor burn.
Caution When Trimming
Often the technician clips your nails and cuticles during a manicure and pedicure. Advise the technician to gently push back your cuticles rather than clipping them. Make sure your toenails are clipped straight across to avoid painful ingrown toenails that can lead to infections. Advise the technician not to cut into the corners of your toenails. If you are concerned, you can clip your own toenails or have a podiatrist do it before getting a pedicure. Have the technician gently file your nails rather than clipping them. Make sure they are not clipped too short which may cause irritation.
A foot bath can be a relaxing experience during a pedicure. You will have greater peace of mind if you verify it was sterilized. Make sure the foot soaks and solutions are changed for each customer. Test the temperature of the water with a finger before putting your foot in. This is especially important if you have peripheral neuropathy and cannot feel extreme heat. If the water is too hot, let the technician know. The ideal temperature is between 90 and 95 degrees Fahrenheit. Inquire about the type of foot bath used at the salon. Pipeless or basin foot baths have fewer places for bacteria to hide. If you are unsure about using the foot bath, get a hot towel pedicure instead. Hot towels are used rather than a foot bath.
Getting Rid of Dead Skin
Eliminating dead skin and calluses is another part of a complete pedicure. It is important to tell the technician to be gentle. Provide your own pumice stone. Avoid the use of liquid callus removers that can burn the skin or metal scrapers that can cut the skin.
Moisturizing Your Hands, Feet, and Legs
Bring unscented diabetic skin creams to the manicure and pedicure appointment. Some salons use scented lotions that may irritate sensitive skin. Tell the technician not to put lotion between your toes. Often a massage is part of the moisturizing process. If the technician is rough, let the person know you need a gentler touch. Most technicians are responsive and adjust the massage to suit your comfort zone.
During a manicure, your hands are often soaked in a bowl of warm water. Check the temperature and let the technician know if it is too hot. Make sure the bowl is clean and sterilized or request a hot towel instead. Your nails should be clipped straight across and filed gently. The cuticles should be moisturized and pushed back slightly with no clipping. You can also clip and file your own nails and go for just a hand massage and a basic polish change.
More to Know About Feet and Hands
If you feel uncomfortable during a manicure or pedicure, speak up right away. If your concerns are not addressed immediately, walk out. It is better to leave than face getting an infection. Keep up with your own hand and foot care after the manicure and pedicure. Wash your hands and feet daily in warm water with mild, unscented soap. Do not make a habit of soaking feet which may lead to nail fungus. Use a pumice stone on your feet to gently get rid of dry skin. Moisturize your hands and feet daily, avoiding the area between your toes. Rub your cuticles with oil to stop them from cracking.
Sitting in a massage chair for a manicure and pedicure can be a wonderful way to unwind, maintain healthy feet and hands, and improve circulation. Get the most from the experience by being well-prepared, taking note of sanitary conditions, and clearly communicating your needs with the technicians. Once you establish a routine at a local medi-spa or salon, you can simply sit back and enjoy the experience.
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Diabetic Nail Care
For people that have diabetes, it is vitally important that they learn to care for their nails. Your nails protect your fingers and toes from injury and trauma. Diabetics have decreased sensation in the fingers and toes, so it is critical that the nails are kept in good condition.
The condition of your nails can be a great indicator of health problems. Healthy fingernails and toenails will be smooth, slightly curved and somewhat pink. If your nails are not healthy looking, this may indicate some type of underlying disease.
Diabetics are prone to developing a fungal infection known as onychomycosis. This fungal infection accounts for approximately 50% of all nail infections. Onychomycosis will produce thick, brittle nails that can develop sharp points and do injury to the surrounding skin. Unnoticed small cuts on the fingers and toes can be a portal for bacteria that leads to fungal infections.
To keep the nails from developing fungal infection, it is important that all diabetics learn proper nail care. If the fungal infections go untreated they can lead to foot ulcers and gangrene. Many diabetics have lost part of a foot or even a whole foot from diabetic foot ulcers.
- The best way to keep nails free from fungus is to have good hygiene. Keep the fingernails and toenails clean and make sure to dry the feet thoroughly before putting on socks and shoes.
- If using a public shower facility or at a public pool, always wear shoes or sandals.
- A person with diabetes should only wear comfortable fitting shoes that are not too tight. Diabetics should only wear synthetic socks that will wick moisture away from the skin of the feet.
- Do not use artificial nails. Artificial nails trap water under the nails and this moisture will promote fungus growth.
- Nail care tools should be kept very clean and sterilized with alcohol before each use.
Diabetics should learn diabetic nail care to not only preserve the integrity of the nails, but to also be able to determine the presence of other underlying diseases. When caring for the nails, take note if they look unusually pale or white. Pale looking nails could indicate anemia. If the nails are shaped like the back of a spoon, this could indicate lung disease, cancer or an infection. If any changes in the nails are noticed, it is critical to let your doctor know right away.
Diabetics will also find that nail care of the lower extremities will also help to improve their health and well-being. Because diabetics often suffer from peripheral vascular compromise it is easier for them to suffer from infections which can lead to drastic measures – including amputation. By caring for the feet and nails carefully diabetics can often find problems early before such drastic measures must be taken.
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How to Safely Service Diabetics
Woman taking her own blood sugar
More than 1 in 10 Americans over 20 are diabetic, which means that there are probably a number of diabetics among your clientele. These clients are prone to infection and heal more slowly, so cuts and nicks can be devastating to them. Unfortunately, the health risks involved with servicing diabetics can make nail salon owners and techs feel hesitant to work with them. But you can safely service diabetics by taking a few simple precautions. Here’s what you need to know.
Put simply, diabetes is a metabolic disease in which the body’s blood glucose, or sugar, is too high. The body uses insulin, which is a hormone produced by the pancreas, to get glucose from the food we eat into our cells in order to convert it to energy. The disease develops when the body isn’t making enough insulin—or isn’t producing any at all. Without proper insulin function, the body’s glucose just sits in the blood. “Think of it like having sugar in the gas tank of your car; the gas won’t flow as well,” says Dana Canuso, DPM, a podiatric surgeon in New Jersey. “Diabetes impairs your blood flow because you literally have sugar in your blood slowing it down.”
Diabetics commonly have additional health complications that include high blood pressure and heart disease, but there are a few other issues that are important for those working in the salon to understand. White blood cells, crucial for wound healing, don’t tend to work as well as they should in diabetics, says Athena Philis-Tsimikas, MD, a clinical endocrinologist and vice president of Scripps Whittier Diabetes Institute in La Jolla, California. This makes cuts and nicks in the salon even more dangerous for these particular clients. If someone with diabetes gets a cut, the impaired blood flow means that there isn’t enough healthy blood—containing nutrients, oxygen and white blood cells—getting to the injury to help it heal.
Over time, high blood sugar can essentially poison your nerves, adds Christina Teimouri, DPM, a podiatrist at the Beaver Valley Foot Clinic in Pittsburgh. This can lead to neuropathy—nerve damage that causes a loss of sensation or numbness and commonly affects the extremities. A diabetic with neuropathy might cut the bottom of her foot but not feel it and keep walking on it, increasing her exposure to bacteria and subsequent chances of infection, Teimouri says. An infection raises blood sugar levels even more and can get really bad before a diabetic knows it’s happening.
Ask About Health Issues
It’s smart to ask all clients about their health history, whether they have diabetes or any other health issues, before doing their nails. Make sure to include a section in your client record cards where they can list what medications they’re taking, including aspirin, which many people don’t realize is a blood thinner that can make them bleed more if cut. Not only do questionnaires help nail techs create customized services for each and every client, but they can also be an important line of defense to protect techs from lawsuits if anything goes wrong during a service. If a client doesn’t note on the questionnaire that she’s diabetic, at least the nail tech asked and could potentially be covered from a legal standpoint, Teimouri says. If a client indicates that she is diabetic, however, and a nail tech sees cuts or signs of infection on the client’s skin, she should refer her to a doctor and discontinue the nail service. “Nail techs are in a position of power and are experts in their field,” Teimouri says. “If you’re looking at clients’ feet and say, ‘you need to see a podiatrist,’ maybe they will listen.”
Proceed With Caution
In general, you may need to rethink the services and products you use on your diabetic clients. For instance, your client might not realize that she has neuropathy, which is commonly underdiagnosed, Dr. Philis-Tsimikas says, and the root of potential problems servicing this client base. If she does have neuropathy, she won’t realize when the water is too hot, so make sure to test the water for her and err on the side of warm/cool water, not hot. These clients also shouldn’t soak very long because it makes the skin more vulnerable to nicking, Canuso says.
Another side effect of diabetes is swollen feet, which makes these clients more susceptible to ingrown toenails. Use caution when dealing with ingrown toenails, as with any client. Cut the nail straight across so the nail is less likely to dig into the skin and cause infections. And, of course, if there’s any sign of infection present, discontinue the service and refer your client to a physician.
Be extremely careful when it comes to filing the nails and cutting the dead skin around a diabetic client’s nails because it’s not worth the risk of infection if you accidentally nip them. “People without diabetes might heal from a nick the next day, whereas with a diabetic, it could take four to five days, making infection more likely,” Canuso explains. Plus, infections love sugar, she adds, which makes them very difficult to control in diabetics.
It’s best to avoid using pumice stones and foot files as well. Diabetics’ skin is more sensitive, and roughing up the skin in any way can cause microabrasions that bacteria can get into. “Fungus likes trauma, and every rift you make in the skin creates more places for fungus to grab onto,” Canuso says.
While there’s nothing intrinsic in scrubs that might promote infection, Dr. Philis-Tsimikas notes, the problem with using this particular type of product on diabetic clients is that they can’t tell you when you’re scrubbing too hard because they can’t feel it. Diabetics have poor circulation, which makes their skin less pliable and resilient, so be delicate and use a light touch when massaging them, Teimouri says. Also, avoid getting lotion between diabetic clients’ toes; that area of the body is particularly vulnerable to bacteria and infection because it’s difficult to keep it dry and clean.
Although it requires taking some additional precautions, there’s no need to be afraid to see diabetic clients. Says Dr. Philis-Tsimikas, “As long as they have sensation and feel comfortable, they should be fine with some extra care.”
What’s your best advice on performing services on diabetic clients?
-Virginia Pelley is a freelance journalist and editor based in Tampa, FL.