The most frequent foot safety problems related to pedicures include overly aggressive care and transmission of infection. While most pedicure providers are gentle and skilled, there are some that are unnecessarily aggressive. Nails can be trimmed too far back, which inevitably causes damage to the skin fold next to the nail. When this skin becomes inflamed from the injury, it can cause a previously silent ingrown toenail to become painful, and possibly infected. However, to be accurate, there is no trimming technique that creates an ingrown toenail, this begins at the nail root due to damage to the nail root cells, and has nothing to do with nail trimming. Callus trimming can likewise be too aggressive, leading to irritated skin, and possibly even bleeding and soreness. While most people can heal quickly from an overly aggressive skin shaving or buffing, diabetics are at particular risk for infection, which can lead to gangrene and amputation in the worst cases.
Infection can be transferred from one client to another if the instruments used during the pedicure are not properly disinfected. While many facilities practice in a clean and hygienic manner, not all are as careful. Serious disease, like hepatitis, HIV, and highly resistant bacteria, is possible to transmit from one client to another through unclean pedicure instruments, but this is very rare, especially HIV which requires exposure to fresh blood. It is far more likely that fungus is transmitted to nails and skin from the contaminated instruments. Nail fungus is difficult to treat, and requires a physician monitored treatment program to cure it. It can result in discolored, thick, crumbly nails, and will not resolve on its own,
These problems can be prevented by ensuring one goes to a pedicurist that is known to be skilled, not overly aggressive with nail trimming or callus reduction, and that treats their instruments as a surgeon would: by either chemically disinfecting them with surgical grade solutions or using steam sterilization after each use. Any facility that does not clean their instruments in one of these two techniques should be avoided. Diabetics in general should avoid pedicurists, as most diabetics have poor foot sensation and can’t feel if a pedicurist is being too aggressive. Once the injury occurs, a pedicurist is not trained with how to deal with diabetic foot complications, and cannot offer proper immediate care, necessitating a visit to a physician.
Injuries and infections caused by improper pedicures can be treated by physicians, particularly podiatrists. Since ingrown nails are chronic in nature, even if never experienced before the aggressive pedicure, they are often treated with a simple ten minute in-office procedure that removes the ingrown nail border and treats the nail root cells to permanently prevent regrowth of the nail into the side of the skin. Skin damage from overly aggressive callus trimming is treated like any other skin tear or cut, with antibiotic control and bandage until the skin is healthy again. Diabetics need special attention to ensure the skin heals properly and does not get infected. Fungus infections that do develop from pedicures (which is difficult to prove since these infections can also occur at home as fungus is everywhere) are treated with either topical anti-fungal medications if on the skin (Athlete’s foot infection), or oral medications if in the nails. Nail fungus is best treated with oral anti-fungal medication, and requires three months of use. Some specific topical anti-fungal lacquers may have some effectiveness against nail fungus, but not as much as the oral medications. The diseased portion of the nail also needs to be reduced to increase the likelihood of treatment success.
Prevention involves a careful choice in who to go to for pedicures, and recommendations by friends and online reviews probably carries good weight. If problems do develop, prompt treatment by a podiatrist may make a difference in whether or not the injury leads to chronic disease. Finally, those with diabetes, poor circulation, poor immune systems due to cancer, organ transplantation, long term steroid use, or viral disease, and those with thin skin or extremely thick nails who are at greater risk for injury due to improper foot care should avoid pedicurists and seek skin and nail care by a podiatrist.