We all learn early in our nail education to use caution when it comes to diabetic clients, since diabetes affects both the circulation and the nerves in the extremities — especially the feet. In diabetics with poor circulation, even a small nick or an ingrown toenail can lead to serious health problems. And a lack of sensation in the feet from nerve damage means the client may not even feel an injury when it occurs, leaving them vulnerable to serious injury. Diabetics are also more prone to certain bacterial and fungal infections of the skin and nails. Foot ulcers, especially over the ball of the foot or on the bottom of the big toe, also are common.

For all these reasons, it’s important to get an OK from your client’s doctor before performing a pedicure. Even if your client is relatively healthy, with complete feeling in her feet, good circulation, and no signs of foot infections or deformities, you should exercise extreme caution in caring for her feet. Doctors advise against using chemical or mechanical exfoliants on the feet — including razors or blades, pumice stones, foot files, or exfoliants such as glycolic acid or sea salt scrubs. Any of these tools carry the risk of breaking or otherwise injuring the skin. Despite all these warnings, there is no need to turn most diabetic clients away. The following pedicure procedure is designed to safeguard the diabetic client’s health:

Step 1: Gently wash the client’s feet with an antibacterial soap and tepid water, then pat dry.

Step 2: Trim and shape the nails as desired, being especially careful not to nick the skin.

Step 3: Apply a mild cuticle treatment to soften cuticles. Do not trim or push back the cuticles. The cuticle serves as a protective structure to keep bacteria and fungi from getting under the nail fold.

Step 4: Next, apply a hydrating lotion to the top and bottom of the feet — but avoid the spaces between the toes. Applying a cream or lotion between the toes only traps more moisture and may cause the skin to break down, which in turn invites infection.

Step 5: Massage each foot gently but thoroughly, stroking toward the heart.

Step 6: Polish the nails as desired. Remind your client to carefully wash and visually inspect her feet for injuries each day. Advise her to finish her self-inspection with a liberal slathering of moisturizing lotion on the top and bottom of the feet to help heal and prevent dry skin.

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