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Anytime sharp or abrasive tools are used on a client during a pedicure, there's a possibility of inadvertently causing a nick or cut that bleeds. When this occurs, what do you do? Along with an apology, you might, out of habit, apply a topical antibiotic and a light dressing — a routine response. However, I would encourage you to reevaluate your protocol for this type of bleeding.
The client now has a wound on the foot, which should be managed differently than a similar wound elsewhere on the body. Specifically, it has to do with the use of a topical antibiotic ointment. If your instruments have been properly disinfected or sterilized and the foot has been cleaned in freshwater, bacterial infections should not be an issue. Bleeding is the first step in wound healing. It washes away tissue debris and any bacteria that may be present.
A topical antibiotic ointment, although well intended, may very well interfere with its initial critical step in the healing process. If you review the website for Neosporin, it indicates that their products are only to be used to prevent infections, but it does not indicate that they are designed to treat or cure an infection. The ointment will interfere will the natural washing (draining) process. This draining process is especially important in individuals who have diabetes or are smokers as they often have poorer blood flow to the toes.
What is the better alternative? At your workstation, keep a solution made from water, salt, and vinegar. I recommend 1 gallon of room temperature water, 2 cups of Epsom salt, and 1/2 cup vinegar. The salt will encourage the draining process and the vinegar will kill bacteria that may be present. Wash the wound liberally with the solution and then apply a gauze bandage. Be sure that any tape applied is latex-free. Then have the client soak the foot in the same formula. A single 30-minute soak should be all that is needed.
This protocol is even more important if there is an infection present at the time of caring for the client. An infection means that bacteria are already present. At this point, a referral to a podiatrist or family doctor (who will most likely refer to podiatry) is strongly recommended. But if you find yourself in a situation where you must take care of the client, I suggest following the steps outlined above. Again, a topical antibiotic ointment is specifically not recommended.
With over 30 years of experience treating every type of foot and ankle issue, Bruce A. Pichler, DPM, MD, recently reitred from his North Georgia podiatric practice. Now based in Asheville, N.C., he currently teaches health science classes at area colleges.
