Dr. Jodi S. Politz, a podiatrist who owns Mountain Podiatry in Las Vegas, was tired of seeing clients come in to her salon with foot issues related to pedicures. She realized the potential danger of infection posed a great risk for her diabetic patients. It bothered her so much that she expanded her practice and created a spa where clients could feel confident they were safe and well-protected. “My diabetics needed a spa,” says Politz. “I autoclave my instruments already, so I thought I could buy a couple more for the spa implements. We also give each client her own flip-flops, files, etc. They come packaged in their own bags and we open them right in front of the client.”
The July 2008 issue of Diabetes Forecast, a magazine for diabetics, cautions women and men about getting pedicures. It warns readers to scrutinize the salon “as if their lives depended on it.”
Dr. Politz’ story and the warning in Diabetes Forecast is a wake-up call for techs. It may come as a surprise to some of us, but diabetics are getting a consistent message about pedicures — and about the salon experience in general: It can be dangerous, so proceed with caution, if at all. With that message resonating in the diabetic community, techs have a unique opportunity to service a niche market.
THE DISEASE TAKES A TOLL
Diabetes is a “disease in which the body does not produce or properly use insulin,” according to The American Diabetes Association. The body needs insulin to convert food into energy to fuel the body. Because the body depends so heavily on insulin, it is weakened when the insulin is disrupted. Diabetes can take a terrible toll on the body, causing other health issues to develop, such as neuropathy. Diabetic neuropathy is an abnormality in the nervous system that results in poor circulation. Poor circulation can cause loss of feeling, and it also prevents the body from nourishing the cells properly, which slows or prevents healing. Improper healing is worsened in the extremities — which brings us full circle to why pedicures pose a risk for diabetics. If a diabetic has poor circulation and has lost some feeling in her toes, she won’t know if the water is too hot, if she has a cut or nick, or even if a technician is filing her foot too hard. Diabetics need technicians to see themselves as client advocates, professionals who will educate themselves on the particular needs of this clientele and then create a clean, safe environment where diabetic clients can relax and enjoy spa services.
The first step in creating this environment is to know your facts — and make the client aware that you know them. “When a client comes in for a pedicure, ask her if she has diabetes,” says Stephanie Spatar, a nail tech at fützpah118, an extension of Mountain Podiatry. “The client will be able to tell the tech that she has diabetes, and she should know the extent of her neuropathy,” says Spatar. Also ask if her doctor has given her permission to get nail services. Once a tech knows that a client has diabetes, she can assure the client of the steps she is taking to protect her health. Let her know you use a hospital-grade disinfectant to clean the basin and the chairs. Make her aware of how you’ve sterilized or disinfected the implements. Techs may want to consider one-use implements for diabetic clients so they can open a personal-use package in front of the client.
Also, keep a client record with all the pertinent facts. The next time the client comes in, the tech can pull the card, ask the client if she had any reaction to the products that were used last time, and update the card with the client’s condition.
Once a tech learns the severity of a client’s diabetes, the tech can proceed with personal care. If a client is a mild diabetic, a tech can take the minimal precautions: never clip the nail, the cuticles, or the skin, no matter how mild a client’s diabetes. Never use a Credo blade, even if they are legal in your state. Be sure the water is tepid (about 90 degrees). Be extremely careful about pushing back the cuticles. Do not perform a pedicure if the skin is lacerated or compromised. Talk with the client during the service to let her know the precautions and protections you have put in place for her.
If a client has severe diabetes, techs need to take further precautions. “Don’t scrub or file too much,” says Spatar. “It could cause burning that the client may not even be aware of for a number of days.”
Dr. Colleen Schwartz, a podiatrist from Pleasanton, Calif., issues a strong caution: “I have seen so many foot ulcerations that lead to loss of part of the foot. Most started with a very minor foot irritation from shoes rubbing or an overzealous pedicure — most of the time performed at home or by a friend or neighbor. Many diabetics lose their protective sensation or pain threshold. This is the main cause of the foot ulcer leading to amputation and sometimes loss of life.” Spatar suggests techs use a mild sloughing lotion instead of a scrub to avoid possible irritation.
DON'T FILE THE SKIN
Filing the nails to shorten them is allowed, but in clients with severe diabetes, don’t take the risk of filing the skin, even at tough spots like the outside of the big toe or the heel. It could compromise the skin. Since the body can’t provide adequate oxygen to heal the damaged cells, a small adhesion could become a major infection.
Think of a pedicure for a diabetic patient more of a gentle massage on the legs and feet. Nails can be gently filed, but not too low because of the risk of ingrown toenails. Nails can be shaped, buffed, and polished, but the main work of the pedicure will be the massage. Warm wax is okay to use, as are warmed lotions.
Once a tech is confident she is well-informed about how to care for diabetic clients, she can get the message out a number of ways. Educate diabetic and non-diabetic clients during pedicures so you gain their trust and confidence not only in your ability to make them beautiful, but also to protect their health. Advertise diabetic-specific pedicures so clients know you are an advocate for diabetic clients.
Contact a local Diabetes Association, local podiatrists, and even general practitioners. Let them know you are aware of the dangers pedicures pose to diabetics, and you offer a safe option so their clients don’t have to gamble when they want spa services. You may even want to ask the doctor if she has a room where you can perform pedicures on site to clients coming in to the podiatrist’s office. Once the doctor and the clients realize you are serious about their health, they’ll be willing to refer their friends to your salon.
The concept of blending podiatry and pedicures is catching on. Piedmont Podiatry in Atlanta offers spa pedicures to its clients. Dr. Sylvie Wolkowisky, a Beverly Hills podiatrist, opened a nail salon in Beverly Hills because she saw the number of infections her clients were getting from salons. Techs can offer doctors a safe place to refer their diabetic patients, and the relationship can benefit everyone — the doctor, the tech, and especially the client.
OFFER DIABETIC-SPECIFIC PEDICURES
A pedicure for diabetic clients doesn’t need to differ radically from those offered to non-diabetic clients, but small changes go a long way. Here are suggested steps for a diabetic pedicure:
1. Begin by looking the foot and calves over, ensuring there is no broken skin, open cuts, or infections. Under no conditions would a tech perform a pedicure on a diabetic client who has an open cut or infection.
2. Soak the feet in tepid water, no hotter than 90 degrees. Gently rub the client’s feet and calves as they soak to keep the blood moving.
3. Exfoliate her skin with a sloughing lotion, using steady gentle motions in the application. Continue moving your hands around her feet and calves for circulation.
4. Gently manicure her cuticles and file her nails. Do not cut her cuticles or nails. File the toenails to shape them, and be sure to leave a small free edge to reduce the risk of cuts, infections, and ingrown toenails. Even if Credo blades are allowed in your state, don’t use them.
5. Rinse feet to clean nail beds and apply moisturizer. Make this step indulgent, applying gentle, even pressure on the foot, heel, and calf.
6. Dry feet completely. Apply the perfect coat of polish.
7. Apply oil to the cuticles before the client leaves to prevent drying or cracking after a pedicure.
RECOGNIZING A HYPOGLYCEMIC REACTION
Clients with diabetes not only need special care during their services, but they also may need your attention in another way. If your client exhibits signs of confusion, disorientation, or excessive sleepiness, or she starts to talk incoherently she may be experiencing a hypoglycemic reaction. Hypoglycemia is the condition that occurs when a diabetic’s blood sugar level drops to a dangerous level. This drop can be caused by illness or bad eating habits. One of the most important things diabetics need to do is to eat small meals several times during the day and eat nutritious snacks so their blood sugar levels stay constant throughout the day.
How can you tell if your client is in trouble? A few of the signs are excessive thirst or hunger. She can also seem tired and disoriented. If she starts to talk about odd things and can not hold a coherent conversation she is in real trouble. Other symptoms of hypoglycemia include an alcohol smell to the breath, called ketosis. Hypoglycemia can be mistaken for being under the influence of alcohol when in fact it is a dangerously low blood sugar level.
If this occurs, the first thing you should do is try to determine when she has eaten last. Get her some orange juice and have her drink it. Give her a small hard candy to suck on. This will raise her blood sugar level. If you can, get her something solid to eat. This will bring her blood sugar level back up. If these steps don’t help or she passes out, call 911 immediately. She will need immediate medical care. The ability to recognize the symptoms of hypoglycemia may save your client’s life. — Kathryn Pless, Back Door Nails and Hair Care Salon, Dade City, Fla.
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