Community Update

Dear Clients

I found a great article written for nail technicians; subject
Diabetes. I made all facialists and nail technicians study this article. I
think it will be good for you to read, as well.  If you frequent spas that do not follow
certain sanitation rules, hopefully this article will make you aware of some of
the hidden dangers.

Diabetic clients have
specific needs and concerns when it comes to nail services, especially
pedicures.  Below are some of the
symptoms of diabetes and what you need to know to take the proper precautions
to help your diabetic client enjoy a safe and relaxing service.

POOR CIRCULATION/PERIPHERAL NEUROPATHY:  Poor
circulation is one of the major complications of diabetes.  “High blood sugar levels improperly nourish
the nerves in the lower leg arteries, which results in peripheral neuropathy, a
type of nerve damage that leads to decreased sensation, especially in the
feet,” says Godfrey F. Mix, DPM.  Before
performing a pedicure on a diabetic client, evaluate her circulation by making
sure you can feel the pulse in her feet. 
They should be warm and have good coloration (not bluish or deep
reddish).  Other indications of poor
circulation are the absence of hair growth on the extremity and thin, fragile
skin, with lack of underlying fatty tissue. 
Next, check for normal feeling by lightly rubbing your fingertip on the
bottom of her foot, doing the same on the palm of her hand, and then asking her
if she feels a difference in sensation between the two.  If so, or if there are indications of
extremely poor circulation as outlined above, you should refer her for medical
evaluation before performing a service. 
If she passes your evaluation, perform the pedicure with extreme
care.  Use only tepid water to soak or
simply clean the feet, no hotter than 90 degrees.  Some experts contend that soaking the feet
may dry them further.

BLOOD CLOTS:  According to the American Heart Association, diabetes
increases the risk of plaque buildup in the arteries, which can cause dangerous
blood clots.  Use an extremely gentle
massage technique, lightly rubbing the client’s feet and calves to keep the
blood moving.  Apply gentle, even
pressure on the foot, heel, and calf. 
Because of the possibility of blood clots, Melodie Hand of Tickled Pink
Salon and Spa in Clayton, N.C., has a policy of no deep massage of the
feet and legs during a diabetic’s client’s pedicure.  “Massage runs the risk of throwing
(dislodging) blood clots that may be present – either known or unknown –
causing further complications for the client,” says Hand.  “In addition, due to the possible thinning of
the skin, over-manipulation can also cause skin tears.”

THINNING OF THE SKIN: 
One third of all diabetics
will suffer some skin-related condition in their lifetime, according to Dr.
Mix.  Poor circulation and lack of
sensation cause many skin problems. 
Small blood capillaries in the skin are easily injured by fluctuations
in blood sugar levels, and glands in the skin slow or even cease production of
natural lubricants.  This results in dry,
cracked, thin, fragile, and itchy skin that is easily injured, which can lead
to severe consequences for a diabetic. 
In addition to evaluating a client’s circulation before performing a
pedicure, you should also check the skin on her feet and calves to make sure
there is no broken skin, open cuts, ulcers, wounds, or infections.  Never perform a pedicure if there are open
cuts or infection.  Apply lotion to the
top and bottom of the feet only; do not apply between the toes.  Moisture between the toes can become trapped,
which can lead to infections.

SUSCEPTIBILITY TO INFECTION:  Because
diabetes reduces the white blood cells’ ability to destroy bacteria, the
diabetic cannot fight infections well. 
“Any minor skin irritation or injury has the potential of becoming a severe,
life threatening condition,” says Dr. Mix. 
Use a disinfectant on the client’s feet before the service.  Never cut the client’s cuticles or push them
back, the cuticle should remain intact, as it acts as a natural barrier that
keeps bacteria from getting under the nail fold.  File the toenails to shape them, and if you
must trim them, do so carefully. 
Straight across is best.  To
reduce the risk of ingrown toenails, cuts, or infections, leave a small free
edge.  Refer the client to a podiatrist
if the corners need to be removed or if you see potential for ingrown
nails.  When filing the nails, use extreme
care, as any abrasion of the skin can cause an opening for infection.  (For the same reason, a foot file and
sloughing creams should be used very carefully, if at all.)  Never use Credo blades, even if they are
allowed in your state.  Consider
providing personal implement kits for your diabetic clients.  And last, but most important, practice
impeccable sanitation procedures in your salon.

DIABETIC’S RX:  Here’s a summary of the basic steps to use in a
diabetic pedicure:

·                
Gather your
client’s history and keep a record of it. 
If she says her blood sugar averages higher than 150 or if she is
insulin-dependent, refer her to a podiatrist for foot care.

·                
Do a physical
evaluation of the client. Check the skin, the circulation, and the sensation of
the lower extremity.

·                
If it’s safe to
proceed, wash the client’s feet gently with an antibacterial soap and water no
hotter than 90 degrees, and then pat dry.

·                
Shape the nails
straight across with a file.  Work
gently, being especially careful not to abrade the skin.

·                
Soften cuticles
by applying a mild cuticle treatment, but do not trim or push back the
cuticles.

·                
Use a foot file
to gently smooth calluses, but only if necessary; thinning skin can lead to
susceptibility to infection.

·                
Apply moisturizer
to the top and bottom of the feet, but do not apply between the toes.

·                
Massage each foot
thoroughly using gentle pressure.  Apply
polish.

Nails
Magazine   March 2014