A Podiatrist's Pedicure?

Dec. 27 -- Christine Witte likes getting pedicures, but she has reason to be particular about where she gets them.

"I actually had foot fungus in the past, and it was probably [from] going to an unsanitary place to get a pedicure," Witte said.

When she learned through her work contacts that she could get a pedicure overseen by a podiatrist in an office where specific sanitary practices are promised, she decided to give it a try.

The Foot & Hand Spa where she went is inside the podiatry office of Dr. Mitchell Waskin. Waskin, whose practice normally runs to treating ailments such as diabetes-related foot problems, sprains, hammertoes, or running-related plantar fasciitis, has started offering what he refers to as medical pedicures.

In a room set apart from the podiatry practice, clients can get a manicure or pedicure by licensed nail technicians like JoElla Hardee, who work under Waskin's supervision.

Medically supervised pedicures are not new, and some have questioned whether they are just a marketing gimmick. Waskin counters that there is reason for consumers to take notice of salon sanitation and that some customers in particular should be concerned.

"It applies to just about everyone," but especially to those with medical conditions, "especially people that are immunocompromised, such as people with diabetes, people with chemotherapy," Waskin said. "It really applies to anyone who is just in need of going to a facility to get a manicure or pedicure and [feeling] confident they are not going to potentially get an infection from it."

Nail technicians, who have to be licensed in Virginia, typically work out of hair salons, day spas or salons that primarily do nails. Oversight of nail technicians falls under the Virginia Department of Professional and Occupational Regulation, and the rules are lumped with those that apply to cosmetologists and barbers.

With podiatrists offering pedicures, it's not the first time medical specialists have stretched beyond their traditional boundaries. Some dermatology practices, for instance, offer facials and other aesthetic treatments. Some dentists offer teeth whitening, a cosmetic procedure. Adding such services can be lucrative -- there are no insurance reimbursement hassles because such services usually are not covered and patients pay. Waskin said safety was a reason he started the Foot & Hand Spa, which is on the campus of CJW Medical Center (Johnston-Willis). Services include basic pedicures for $30 and pedicures especially for people with diabetes and arthritis for $65. "One of the big errors that's made is in the whirlpool chairs," Waskin said. Some places might squirt a disinfectant on the surface and wipe the whirlpool baths down between clients. "Most of the bacteria and fungus and viruses are not on the outside surface," Waskin said. "It's actually inside the motor area, in the little tubes that are inside the equipment. The only way of cleaning that is to use a proper antiseptic and running it through the motor and the inside drainage system." There are no hard statistics on infections from manicures and pedicures, but there are case studies in medical journals of people developing infections after pedicures. In one of the most reported cases, the California Department of Health in 2000 investigated an outbreak of a bacterial infection among more than 100 clients of a salon. Some, according to a report, suffered "prolonged boils on the lower legs that left scars when healed."
Disciplinary cases at the Virginia Board of Cosmetology and Barbers show some lapses in procedures. Clients have filed complaints about heel cuts during pedicures, developing blemishes on the legs or toenail fungus after pedicures, among other things. Salons owners have been disciplined for letting unlicensed workers do manicures and pedicures. Waskin said some of the newer footbath technology doesn't have the nooks and crannies where pathogens can accumulate. Other infection-control methods include single use of tools and use of hospital-grade disinfecting solutions. Tennessee podiatrist Robert Spalding has been critical of the nail-care industry but wants to work with salons that follow certain sanitation procedures. He runs a Web site, http://justfortoenails.com. He also has done presentations on financial benefits of podiatrists offering nail services.
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