Client Health

Feet Smarts: When to Refer Your Client to a Podiatrist

As a nail tech, you’ve probably seen your share of calluses, ingrown nails, fungi, and other yucky foot ailments. But how do you know when to declare “hands off” and refer your client to a podiatrist?   

Now more than ever, nail techs are seeing a wide variety of foot and nail ailments in the salon. Because of an aging population, increased rates of diabetes, and stressful lifestyles, more and more people are having foot-related problems. These people are coming to nail techs seeking advice and resolution. “I like to refer to these pedicurists as ‘first liners,’ because frequently they are the first to see these problems before any medical professional,” says Debra Bourque, BSc.Pod, CPod, CMP, executive director of member services for the International Pedicure Association (IPA).

Vicki Malo, president of North American School of Podology (NASP), concurs. “There are increasing numbers of diabetic, senior, and immune-compromised clients opting for pedicures,” Malo says. “It’s therefore imperative that technicians have advanced training and know how to proceed with a safe pedicure.”

Both Bourque and Malo agree it is vital for nail techs to understand and implement the 3R’s of safe pedicuring:

1. Recognize the issue being presented.
2. Recommend the proper pedicure service, products, and home maintenance.
3. Refer the client to a medical professional when necessary.

Here are the most common foot and nail ailments seen in salons, along with recommendations from Bourque and Malo for safe pedicuring and home management:

Problem: Tinea pedis (fungal infection of the feet, or “athlete’s foot”)
Description: Dry, rough, red, itchy peeling skin on the bottom of the feet and/or between the toes.
What to do:
Technicians should not diagnose, only recognize and recommend. If they suspect a client has a fungus, they must refer her to a physician. Do not perform salon service if broken skin is present. Advise your client to keep her feet clean and dry, and use a nonocclusive antifungal product daily or as prescribed by a doctor.

Problem: Onychomycosis (fungal infection of the nail plate)
Description: The nail can be thickened and/or crumbly and often has yellow, white, or brown discoloration. The cuticle may appear red, and there may be significant debris under the nail and the surrounding nail folds.
What to do:
Salon service is not recommended while the fungus is live/active. Advise your client to see a doctor, who will likely prescribe a topical antifungal, oral medication, and/or laser treatments.

Problem: Ingrown nails
Description: A condition where the nail penetrates the surrounding skin. An ingrown nail usually affects only one side of the finger or toe. Once the nail has penetrated the skin, bacteria can get into the cut and the area is at risk for infection.
What to do:
Do not perform service if the skin is broken or there are signs of infection; instead, refer your client to a doctor. If the condition is mild enough, use flat-edged nippers to remove the piece of nail cutting into the skin, and file. You can also apply a BS Brace enhancement to provide immediate pain relief. Advise your client to wear shoes that allow her toes to move around.

Problem: Pedal Keratosis (calluses and corns)
Description: A hard thickening of the skin on the bottom of the feet (callus) or on or near a toe (corn).
What to do:
Use a non-aggressive hydrating callus softener and carefully reduce the callus to a safe level. (Never use a credo blade, even if they are legal in your state.) Advise your client to use a non-occlusive moisturizing formula daily and wear proper fitting shoes with orthotic supports if necessary. Don’t attempt to reduce a corn.

Problem: Fissure (deeply cracked heels)
Description: A deep crack in the skin that penetrates the dermis.
What to do:
If no blood is present, soak with a moisturizing foot soak (no salts), carefully reduce the callus, and apply a non-occlusive moisturizing formula to keep the skin soft.

Problem: Bulla (blister)
Description:
A fluid-filled bubble between the layers of the skin
What to do:
Do not break or puncture; avoid the area during pedicure service. Advise your client to keep the area clean, avoid continued rubbing on the affected area, and wear proper fitting shoes.

Problem: Digital deformities
Description: Dropped arches, bunions, Haglund’s deformity (pump bump), hammertoe
What to do:
Bourque advises pedicuring as usual, using caution when massaging, as bones may be rigid and painful. Encourage client to use non-occlusive moisturizer daily, wear shoes with additional room to accommodate deformities, and possibly use orthotic support and toe props for comfort and stability.

 

Problem: Thickened toenails
Description: Thicker than average toenails caused by friction or trauma on the delicate matrix (where the nail grows from).
What to do:
Carefully reduce the nail just enough for a good esthetic. If the nails are fungal, refer the client to a podiatrist.

Technicians should never:

> Work on anything infected (red, inflamed, warm to touch, oozing)
> Work on any bleeding, broken skin or open wounds
> Work on or reduce a discolored / brownish callus
> Break or pop a blister
> Remove a foreign object from the foot
> Work on active mycotic/fungal nails
> Work on any client presenting with something they cannot recognize. (When in doubt send it out!)

If any of these situations are present, always refer to a medical professional for proper treatment to ensure the safety of clients and to prevent potential lawsuits. When it comes to what a technician can ‘safely’ work on, it depends on individual State Board rules and regulations, Bourque says.

To see a list of all State Board Rules and Regulations go to www.pedicureassociation.org under licensing. For more information about the IPA or to become a member, call 1-(866)-326-7573 or email [email protected].

For more information on the North American School of Podology, visit
www.northamericanschoolofpodology.com.

Product Roundup:

Footlogix Cracked Heel Formula: Designed for severely cracked heels and fissures, this formula moisturizes and protects extremely callused, cracked skin. The formula is permeable, allowing skin to return to its natural functions (important for diabetics).

Gehwol Med Lipidro Cream: Formulated with avocado oil, sea buckthorn oil, urea, glycerin, and algae extracts, this cream moisturizes the skin and helps protect against itching and fungal infections.

Cory Labs Triple XXX Pedicure Solution Tablets: Containing natural minerals, anti-inflammatory properties, and natural moisturizing and essential oils, this pedicure soak tablet soothes, hydrates, and deodorizes the feet.

Blaine Labs Vite 20 Antifungal Cream: Tea tree oil, lavender, and undeclynic acid work together in this concentrated cream to kill the fungi that causes fungal nails. It also soothes and moisturizes the skin

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