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The Industry’s Issue With Ingrown Nails

A little bit of knowledge is a dangerous thing and can potentially cause a lot of trouble, as in the case of ingrown nails. Do you know how to respond to this common problem?   

Let’s start with the obvious: The scope of a nail tech’s license doesn’t allow them to treat ingrown toenails.

But wait — there’s more.

Techs are restricted from working on a client’s toe when it is warm, red, inflamed, or infected. “No matter how much a client begs you, don’t do it,” says Vicki Malo, president of the North American School of Podology and vice president of education for Footlogix. “Don’t work outside the scope of your practice.”

Let’s assume you’re not diagnosing or treating ingrown toenails, and that you don’t work on toes that are red, warm, inflamed, or infected. Things can still get dicey.

“One of the biggest misconceptions I see among techs is what qualifies as an ingrown toenail. Many times, it’s actually an involuted or curved nail that has callus or corn buildup in the nail groove area,” says Malo. “Just because a client experiences discomfort and pressure, it does not necessarily indicate she has an ingrown nail.”

This confusion could lead a tech to respond incorrectly. First, she may ignore the buildup for fear of “treating” an ingrown nail, or, perhaps worse, she may respond too aggressively and actually cause more problems. An ingrown toenail is when the sidewalls grow up over the nail and the nail pierces the skin. “If the nail has pierced the skin and is infected, it is out of our scope of practice, and we are not to work on the nail,” says Malo.

Nail tech Kimberly Kennedy has seen the confusion Malo mentions. “From what I’ve observed, there are two kinds of nail techs, those with a passion for foot care and those with a passion for art,” says Kennedy, a Raleigh, N.C.-based podologist and Certified Master Pedicurist. “Some focus on the client’s aesthetics and experience by offering art, luxury products, and a relaxing spa-like service. Others are passionate about the health of the nail and foot.”

To complicate matters, the clientele coming into the salon has shifted. No longer is it a females-only sanctuary. Today, we expect to see men and women of all ages, and many of them come in with autoimmune diseases and diabetes. Often, this requires that techs have advanced training to develop a better understanding of the diseases and disorders they may encounter.

The divide in focus is raising uncertainty among techs that could become a real problem in the industry, says Kennedy. A larger number of techs graduating from school don’t have a comprehensive understanding of the potential risks of pedicures. “Many techs graduate and just want to do manicures and enhancements to make their clients look and feel pretty, but once in the salon, they are forced to perform pedicures on clients with problem nails or health issues,” says Kennedy. “They may not realize the products they use aren’t meant for all types of skin.” She points to the use of callus remover and salt or sugar scrubs, which can dehydrate and abrade the skin and create a plethora of other health problems if used on geriatric clients, those who are immunocompromised, or diabetics.

A tech who is focused on the “beauty” part of our industry may have invested in advanced product, application, or art training. However, she would likely not be educated on how best to care for the client with excessive build up under the nail that is causing pressure against the nail wall. “Often techs really don’t know how to deal with it,” explains Kennedy.

Techs may default to referring clients to a podiatrist, which seems like a safe decision. The trouble is, the client may pay for a long-awaited doctor’s visit only to hear the problem isn’t an ingrown nail at all. The doctor might relieve the pressure by cleaning the nail in the office, but the insurance company could deny the claim, leaving the client to cover the cost of the visit.

“We definitely have a conundrum,” says Kennedy. She suggests two solutions.

 

Increase Awareness

We often speak of increasing awareness among clients, but this awareness is for techs. While nail licensing helped standardize the education process, we lost an essential learning stage techs enjoyed in the past with trainee situations. It used to be that a seasoned, experienced tech sat one-on-one with trainees, teaching, commenting, and grooming the newbie for weeks before that tech was turned loose on a client. In the process, the newbie received direct and immediate feedback on what she was doing right and wrong.

The biggest cause of ingrown toenails is incorrectly cutting and shaping the toenail.
<p>The biggest cause of ingrown toenails is incorrectly cutting and shaping the toenail.</p>

Today, unless a salon has an exceptional training program, techs are expected to learn as they go or find classes to get the training they need. But a class isn’t the same as immediate feedback. Consequently, we find techs who, if we’re honest, could still use instruction on the most basic services, such as polishing and filing. Salon owners expect a new tech to have the knowledge to perform pedicures on clients with health issues and common foot problems, such as calluses, corns, thick and heavy buildup under the nail, rogue spicules, pincer nails, etc. It’s no wonder there’s such confusion about ingrown toenails.

Despite their best intentions, techs without the knowledge and the right tools can actually put a client at risk of developing ingrown nails. As the nail industry grows, more and more techs without the necessary skills are confronted with this risk. “If we don’t pull it together, we’re going to lose the privileges of an already limited license,” worries Kennedy. “It’s time for techs to starting building bridges between each other and the medical community.”

 

Building Bridges

Techs often prefer one of two types of pedicures: the cosmetic pedicure or the medical pedicure. It’s important to recognize the distinction. Both are essential to the industry and both offer value to the client. But make no mistake: There is a difference, and the sooner nail techs begin to differentiate between the two, the sooner we’ll be able to send a uniformed message so clients can locate the proper nail tech for their needs. (That’s not to say that a nail tech couldn’t be trained in both.)

Nail techs who specialize in cosmetic pedicures should be proud of the therapeutic benefits they provide. A calm retreat, an escape, self-confidence, beautiful hands and feet — all these are satisfying aspects of our job as professionals. These techs serve their clients best by building bridges with techs who have chosen to specialize as medical nail techs. This way, they can refer their clients to a nail tech who is equipped to give the pedicure the technical attention it deserves. Of course, it’s also a good idea to have a referring relationship with a local podiatrist for more serious cases.

Medical nail techs have advanced training that expands their tool kit. This allows them to more effectively trim and file those thick, curved nails, and also to clean under the nail and in the sidewalls. Many times, a medi tech will build a symbiotic relationship with a particular podiatrist, referring clients to one another.

Brace yourself for what you’re about to read next. These relationships are peer relationships. Nail techs and doctors can learn from each other. This sounds radical in a society that is so medically minded. It’s easy to elevate doctors as the final word on every conversation. But keep in mind that they have a narrowly focused perspective. In general, they default to medicine and surgery. Careful filing rather than surgery may be the answer to a curved nail. As techs build bridges, it’s essential they are educated as masters at their craft. Only then can they gain the respect of doctors who value their input.

 

Where Do We Start?

The good news is we have the power to remove the confusion in the industry, serve our clients better, and still work within the scope of our license. As techs understand the importance of proper technique and tools, we can distinguish ourselves as knowledgeable professionals who are trained to maintain the health of the nail.

Malo offers these practical suggestions about technique and tools:

> Technique: The biggest cause of ingrown toenails is incorrectly cutting and shaping the toenail. Cutting the nails too short, rounding the corners, or narrowing the sides of the nail plate in the groove area can cause ingrown nails. The corners of the nails should have no points that could irritate or pierce the skin, nor should they be rounded deep down the sides of the nails. With specific training, techs can learn to properly cut a nail that is prone to becoming ingrown. Without extra training, it’s common for techs to leave a spicule behind, which can cause an ingrown nail.

> Tools: Many nail techs use the same tools during a pedicure as they do during a manicure. Instead, take classes to learn how to use advanced tools. Three essential ones are flat-edge nippers, toenail cutters, and a Blacks file (rasp). Specialized bits are also extraordinarily helpful. A brace kit, which helps correct the growth of a curved nail, is also beneficial as a way to prevent ingrown toenails.

As our industry continues to expand, let’s recognize the breadth of opportunity for nail techs. Some will gravitate toward producing astounding artwork. Others will specialize in the business side, creating helpful resources for the rest of us to implement. Many will be therapist, friend, and confidant to clients coming in to look and feel beautiful. And, others, like Kennedy and Malo, will focus on the opportunity to continually learn new techniques that better equip them to keep nails as healthy as possible — well within the scope of their license. 

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