Web Development inMotion

Volume 18 · Issue5 · July/August 2008 | Download PDF

by Neil M. Scheffler, DPM, FACFAS 

Hazardous To Your Feet?

Pedicure 01What can be more comforting than a pedicure? You sit back and relax, your feet soaking in a bath of warm water and gentle bubbles soothing away the day’s troubles. The pedicurist applies a lubricant and gently massages your feet and legs. Ahhhhh! She may use a bladed instrument to scrape off those nasty and sometimes painful calluses that have been bothering you; then she trims, files and polishes your toenails. You leave feeling like a million dollars. So, what could possibly be wrong with that? Plenty!

Just search the Internet and you will see many reports of serious foot and leg infections contracted in nail salons and spas from coast to coast. From Beverly Hills, California, to Boca Raton, Florida, and right in your neighborhood, fungi, viruses and bacteria lurk in the soaking tubs and on the instruments of pedicurists, waiting for your unsuspecting toes.

The Usual Suspects

There are a number of kinds of infections that may be contracted at nail salons. One common infection is onychomycosis, a fungal infection of the toenail. This infection was made famous by “Digger the Dermatophyte,” seen in TV commercials for Lamisil, one of the medications used to treat onychomycosis. Toenails infected with these fungi look discolored and may become thick, brittle or flaky. The same fungi may also infect the skin, causing athlete’s foot. The skin may form blisters, itch or be dry and scaly. If the infection is between the toes, the skin may be moist.

Viruses are another possible source of infection. A common viral infection is a wart. More serious viral infections, such as hepatitis C and HIV/AIDS, can be potentially transmitted by careless pedicurists. Yes, if the skin is broken, even these deadly blood-borne pathogens can be caught during a pedicure!

There are many reports of infections from Mycobacterium fortuitum as well as the drugresistant bacteria MRSA (methicillin-resistant Staphyloccocus aureus) following pedicures. MRSA causes serious infections and can even lead to death. Some infections can start out looking like small insect bites but may enlarge into pus-filled boils, requiring strong antibiotics. These infections may leave permanent scars.

Risky Business

Pedicure 03Some people are at greater risk than others of getting infections from pedicures. People who have diabetes, neuropathy (numb feet) or peripheral arterial disease (PAD – poor circulation) have a much greater chance of serious problems if their feet get infected. People who do not have these ailments will generally heal with good medical care. People with neuropathy may not feel the pain of the infection, leaving them unaware of the problem until it’s too late. Those with diabetes or PAD may simply not heal at all. These nonhealing infections all too often result in amputation.

Does this mean that you should never get a pedicure? That’s a personal decision that should be made on the basis of how satisfied you are with your pedicurist’s practices. As you might have guessed by now, I’m really not a fan of pedicures. In my profession as a foot specialist, I’ve seen many women with infections that were contracted while getting a pedicure. However, there are certainly many women who go regularly without experiencing any problems. So, if you do choose to have a pedicure, here are some tips to consider, including clues as to whether your pedicurist operates safely and responsibly.

The Game’s Afoot

First of all, become your own investigator at the spa. Check the facility for licenses and recent inspection certificates. Insist on cleanliness. Are items that cannot be sterilized (such as emery boards, nail buffers and toe separators) disposed of after each use? Does the pedicurist use a bladed instrument to shave corns or calluses? (In most localities, this is not allowed by law!) Your podiatrist should advise you about the causes of these areas of hard skin and what should be done to prevent them or treat them properly.

What does the pedicurist use to bathe your feet? This should be a plain tub of water that is soaked with disinfectant at least 15 minutes between clients. Better yet, purchase disposable tub liners that separate you from the tub. Also, there should be no moving water. Any tub that has jets or bubbles cannot be adequately cleaned in the time between you and the customer who was in the tub 10 minutes ago. Bacteria can flourish in the plumbing and filter screen.

Don’t shave your legs before your appointment. Shaving opens hair follicles and may cause tiny nicks in your skin that are openings for bacteria to invade.

Buy your own instruments and bring them with you. Complete kits are available, some even in attractive carrying cases, which would be yours alone. This kit, in addition to the disposable tub liner, would effectively isolate you from harmful bacteria, viruses and fungi. Your podiatrist may have these available for sale on his/her Web site.

Finally, if you discover a problem such as a change in color or thickening of a toenail, or a strange spot that wasn’t there before, call your podiatrist for an appointment. It’s much easier to treat a condition early in its course rather than later.

Pedicure 03About the Author

Neil M. Scheffler is a podiatrist in private practice in Baltimore, Maryland. He is a fellow of the American College of Foot and Ankle Surgeons and is boardcertified in foot and ankle surgery. Dr. Scheffler is a past president, Health Care & Education, Mid-Atlantic Region, American Diabetes Association. He is the attending podiatrist for the Prosthetics Clinic, Sinai Hospital of Baltimore. Visit him at