Meanwhile on Dr. Oz.....Nail salons are a dirty business!!!!

This is a topic we beat to death, but for good reason, even the most sensible and smart ladies I know(including doctors, lawyers, college professors and my super smart stay at home mom friends) many people who still continue to take the risk of manicures and pedicures even though they know there is a chance they could walk out with an infection.  So this makes me think they really don't realize the risks, and how great the risks are.

Since I am a foot doctor, I am going to stick to the pedicure side of the coin. I can tell you anecdotes over the last 13 years of patients that have come into the office after a  pedicure with an infection that is bacterial or fungal.  I see at least 20 plus patients a week that present to the office with a fungal infection that is a direct result of a pedicure.  I try to make the patient feel better knowing that at least they didn't get a bacterial infection that could have led to limb loss, but somehow this is not comforting to those who just want a pretty nail!  Our need to be beautiful sometimes precedes good common sense and judgement.   The picture to the right is of a fungal nail infection that was a direct result of a pedicure. This is what you put yourself at risk for if you are not asking the right questions at you nail salon. But this is not the worst case scenario of how bad your pedicure can affect your limb.  There are accounts that have been published where nail salon clients walk out unknowingly infected with a bacteria that eventually would lead to amputation or death! (Death By Pedicure, by Dr. Robert Spalding  Chattanooga Fu Fu Factory; 1st edition (August 19, 2006))

Getting a pedicure is sometimes considered a relaxing treat that helps us beautify ourselves at a fraction of the cost of what we spend on our hair.  But the reality is that most of us feel uneasy once we sit in that chair and contemplate the water in the tub below our feet. In a recent episode of Dr. Oz (who by the way gives my patients many terrible ideas for treating their problems, but in this case I agreed with him)he had a certified medical nail tech explain many of the dangers you can encounter in your standard nail salon. People choose the cheap nail salon for a pedicure but may be picking up a problem that could cost them thousands plus dollars to treat and may never get rid of it!

Below is a link to the Dr. Oz episode from this past February, where Dr. Oz and the certified medical nail technician go over the importance of sterilizing instruments that are used for a pedicures. They go over what you should be looking for in your pedicure salon. I recommend watching this clip when you are done with this blog. (warning you have to sit through a 15 second commercial you can't skip but after that it gets good)

http://www.doctoroz.com/article/what-you-need-know-about-your-nail-salon

From Michele McGowan on clipix.com (via doctoroz.com)

A certified medical nail technician is what you will find often times in a podiatrist's office that offers pedicure services.  A certified medical nail technician is licensed via their state that has completed the Advanced Nail Technician Certificate that is above and beyond what their state requires.Cosmetic pedicures are performed by the certified medical nail technician in a podiatry practice.

It always seems like a shameless plug when I mention that we have a technician that performs pedicures in our podiatry office. But the reality is, the only reason we have this service is because we are in the business of keeping feet healthy! So we developed spa services in our office that are for those who care about their feet as much as they care about their hair.  It is sad to to think that some people spend over $150 every 8 weeks for highlights and style for hair but then turn around and cheap out on their feet, which they need to walk on! It is totally true that the cheapest pedicure you can get in our office is an express $50 and our most expensive pedicure is our Therapeutic Spa Pedicure for $65.  But when you have a pedicure in our spa it is not an inflated cost of a pedicure(which you have to watch out for an inflated cost of a pedicure that is not taking your safety into account). What you get is the following The Safe Pedicure Experience:

1.  A sanitation protocol that is above and beyond our surrounding market.  All instruments are autoclaved. No dirty instruments are ever used on a client. Our nail technician uses universal precautions using disposable gloves for each client and she understands that the gloves are to protect not only her but also you!

2.  All buffers and files in our spa are disposable. The use of disposable liners for the tub and a magnetic jet that can be removed and sanitized between each patient goes above and beyond the industry standard.

3. Nail polish is not used from client to client.  In our spa, you pick your color and it goes home with you after the pedicure. Our nail polishes are specially formulated and are 3-free.  They do not contain harmful chemicals that can contribute to unnecessary damage to the nail.  There are many great colors to choose from!

4. My favorite part is that it is private.  It is just you, in an environment that is safe and luxurious.  Our spa is pretty and relaxing.  You can choose to close your eye and rest and you are not hearing a million conversations at once, or you can watch TV or chitty chat with our awesome nail tech Brooke! Brooke has over 10 years experience and is professional who knows what needs more advanced care.

Brooke understands that our spa is different then others and takes great pride in being part of something special.

5.  We also offer other services like the KeryFlex Nail restoration for deformed nails.  KeryFlex a is cosmetic treatment that can give you beautiful nails for up to 8 weeks. This procedure cost $150  and this is not a treatment for nail fungus, but for those who struggle with thick nails and just want to wear sandals for the summer this is an awesome treatment.

If you would like to learn more about our safe pedicure experience visit our website at http://centeranklefootcare.com/id102.html

Also, if you have not listened to our podcast "Is your Pedicure Killing You?" I included the link for you below, it is informational and entertaining.

Remember to take care of your feet, you are only given two so treat them right!

Michele McGowan, DPM
Center for Ankle and Foot Care
Clermont, FL
Summerfield, FL
centeranklefootcare.com

Don't wait to treat your nail fungus!

It's that time of year again, when we are all hiding our toes in shoes during these cold winter months.
Even in Central Florida this weekend we hit below 40 degrees! But we all know that as we thaw out from the winter cold we will be excited to go back to our sandals and flip flops.  Not everyone will be as excited as the next guys.  There are many of you out there suffering with unsightly nail fungus that want to wear the sandals and flip flops, but will cover those tootsies up instead!

We would like to give you reasons why not to wait one more second to treat your nail fungus!  The number one reason to not ignore your nail fungus even one more second is because it takes FOREVER to get rid of your nail fungus!   Even with the latest technology to help improve the appearance of the nails, like the PinPointe Laser we have in our offices, nail fungus is slow to progress after treatment for a couple of years.  So the sooner you get started with your treatment the better chance you have to healthier prettier toe nails.

Over the last several years, our personal approach to treating nail fungus with the PinPointe laser has changed. Currently, we offer patients many choices to help improve the appearance of their nails.  I tell every patient that they will be treating their nail fungus for a long time, they need to have a realistic expectation of the time it takes to win the war on nail fungus.  I also tell every patient that they need to have a home course of care established as well.  And we spend a lot of time talking about avoiding reinfection by avoiding places like pedicures and other high risk places like showers in a gym.

We also speak with the patient about the other big place they get reinfected, which is their shoes! Believe it or not, this is one of the biggest culprits of reinfection for many people.  Fungus is not like bacteria, fungus does not require a live host to thrive.  Translation is, fungus will slough off in your shoes with your dead skin cells and can live for quite some time, you put your shoe back on and BAM you get reinfected!  I tell patients to give their shoes the "sniff test" if your shoes smell like corn chips, it's time to throw them out.  But for the shoes that do not stink I recommend a shoe  sterilizer.  In many studies, the UV light shoe has been proven to kill the fungus and molds that are common causes of nail fungus.  Below I have attached a couple different ones I found on AMAZON.com. Well worth the investment for healthy feet.


Besides sterilizing your shoes, the after care for the laser requires you to use a topical medication.  Some people choose a prescription medication and others want a cheaper but effective alternative. We discuss both with our patients.  When prescription is not an option due to price we often recommend the products below that are a small fraction of the cost of the prescription medication and if used on a regular routine can work very well to protect your investment of the laser. (Topicals will not cure the fungus but can prevent re-infection and prevent your current fungus from getting worse.)




If you are interested in the laser it is best to come in and see Dr. McGowan or Dr. Henne for a consultation.  At our website http://centeranklefootcare.com/id17.html you can go to our Laser Center page to read on and learn more about nail fungus and the laser as a treatment option.

Does my nail polish matter? And Pedicures are Safe, Right???

Why 3 Free Nail Polish?

Simply put, beauty should not come with a price tag of harmful chemicals. The beauty industry has a great divide that has developed over the last several years. The consumer now has access to information right at their fingertips to help them make an informed decision on their purchasing choices.  Nail polishes that are 3 Free do not have Formaldehyde, Toluene or Dibutyl Phthalate(DBP). These chemicals at one time were used to help with the consistency and longevity of a nail polish, but they also have potential draw backs linked to in utero development issues, cognitive function decrease, skin allergies and dermatitis.

Many popular nail polish companies still have some of these chemicals in their polish.  So this leaves the consumer in the very familiar buyer beware situation.

Now that more advances have been made in the development in nail polish, you don't have to have

exposure to these harmful chemicals but still enjoy a nice coat of polish! In our medical spa in our podiatry office our nail technician only uses 3 free nail polish that we have developed and bottled, or she uses Dr.'s Remedy nail polish for a small upcharge.

The Dr.'s Remedy nail polish is very nice and has the great features of being free of the bad chemicals and has the added benefit of being enriched with Tea Tree Oil and Wheat Protein.  This is the polish I always recommend for the patient that is experiencing the white dots and drying of the nail.  I explain to patients that those white dots can be the start of damage to the nail from polish and can lead to nail fungus down the line.  If they insist on painting their nails, I tell them the Dr.'s Remedy polish is the best option,  Plus, this is really nice polish.  It is safe for kids, patients under going chemotherapy, pregnant women and people who care about the health of their nails in general. We sell this polish in our office or it is available through our Amazon Store:


Pedicures are Safe, Right? 

Our little intimate spa is very different from the run of the mill strip mall joint.  We take your safety and luxury very seriously.  Every thing in our Natural Nail Spa is single use and all of our instruments are autoclaved(sterilized), even the nail polish goes home with you. Currently, there are only two states that require instruments to be autoclaved or sterilized in the nail spa industry: Texas and Iowa.  Since these are a long commute from Florida and maybe the state you live in, I wanted to give you some advice from one girl(who happens to be a foot doctor) to another girl!

If you do not live in Texas or Iowa, you need to really re-evaluate the place you are getting your bi-monthly pedicure.  Yes it feels great to close your eyes and get pampered having someone take care of your feet.  You can live your life saying what all people say before bad things happen, "That won't happen to me".  Or you can pull your head out and really look at the environment around you.

I wanted to give you 5 Truths(whether you want to hear them or not!) about the "treat" of pedicures:

1. Fancy does not = Clean: When looking for a place to get you nails done, do not be fooled by a nice imported tile floor from Italy, this will most likely mean they are skimping somewhere else to pay for the floor expense.  Ask where their autoclave is!

2. Just because they keep your instruments in a box and say "it's yours", does not mean they do not use it on someone else! Yep, you can not trust this 100%.  There are countless stories I have heard right out of the mouths of patients who have witnessed this first hand.  Also, I have several patients who have got nail fungus from places who claimed to have never used their instruments on someone else.  TAKE YOUR STUFF HOME EACH TIME.  Also, ask them where the autoclave is!

3. In the water you are soaking your feet in, there is most likely tiny pieces of other people's dead skin! This is really one of the grossest truths I know.  Unless they are using a pipeless tubeless spa pedicure chair and cleaning it appropriately, you are most likely putting your feet into a pool of tons of DNA samples.  Don't put your feet in the water!

4. Liners for the tub do not protect you from the DNA samples discussed above: Just because they put a liner in the tub, does not protect you from the a whole lot of anything.  Once the tub is full the water in the liner is contiguous, or touching, the water on the other side of the liner.  That being said, we use liners in our pipeless tubeless spa chairs in our spa, but I think this may be out of peer pressure:)

5. Most nail salons use the cheapest nail polish, multiple times: When researching nail polish for our spa, I found several cheap alternatives, but they involved putting the client at risk.  The cheap alternatives were shipped from China and were not three free and most likely the cancer rate in the factory where it is bottle is at 99% or higher.  Many salons take advantage of such cheap offers because they are only charging $25 for the service so they can not spend more than 10 cents on the bottle.  Now remember, when you go to the salon you pick your color and then it goes back on that wall to be reused.  I have several patients that go for pedicures and they have fungal nails.  They are not turned away from these fancy salons, even if they do not have an autoclave to kill the fungus on the instruments they just used! Again, ask to see their autoclave!

Check out our link here http://www.nailsnaturalspa.com/id21.html for our best suggestions available on Amazon for an awesome at home pedicure!

Yes, I do take time out of my day to beat up the pedicure industry.  This has a lot to do with all of the damage I have seen to peoples feet from pedicures.  If you have ever had to cut someones toe off after a terrible aggressive bacterial infection that someone got from a pedicure, you too may be a little more intense on the subject matter.  Below is a repeat broadcast of "2 Pods and a Microphone: Is Your Pedicure Killing You?"

The War on Nail Fungus...the many battles you must fight to kill nail fungus!!!

New treatment modalities for different medical conditions come and go. When we first heard about the PinPointe Laser for toenail fungus we were certainly skeptical about it being a miracle cure for fungus.This laser has been available on the market since 2007 and when we first heard of this laser, we thought here goes another trend that will cost the patient a lot of money and won't work. I thought this device would leave as quick as it came. This did not happen, in fact, we started to have patients that we refer to as "Snowbirds" living here in Florida only part time, that had this procedure done up North with great success. Yes they had to wait 9 months or longer to see the return on their investment, but happy when they saw their result. This prompted us to investigate the PinPointe Laser in more depth. At the time, the PinPointe Laser was the only laser built from the ground up to kill nail fungus and was cleared by the FDA based on peer reviewed studies. When introducing a modality into your office for patients, you take a certain leap of faith that what you know from research and speaking to other physicians success stories will translate into success for your patients. 2012 the Center for Ankle and Foot Care introduced to PinPointe Laser for nail fungus into our practice.

We jumped into the laser for nail fungus feet first!(yes pun intended) We acquired our laser in February of 2012. Over the last 2 and 1/2 years we have developed protocols for the laser that work best for different case scenarios.  But before I ever discussed with patients the laser, I give them all of their treatment options.  I first discuss the topical approach, I do explain that topical success rate truly depends on if the fungus is under the nail or on top of the nail.  If the patient has a superficial fungus a topical can be effect.  If the fungus is under the nail, no dice! The thick nail and topical anti-fungal is a wildly unsuccessful combination.

If your nail is thick and fungal, an oral medication can be a treatment option.  Lamisil is the drug of choice.  We get what is called a liver function test, blood work to make sure your liver is free from disease.  If your liver function test is normal, you can take the Lamisil.  I make my Lamisil patients follow all of my laser patients after care.  They have to prevent reinfection with the same steps listed below.

The last option I discuss with patients is the PinPointe Laser treatment.  Some people can not take the medicine by mouth or just do not want to take the medicine by mouth.  They want the laser.

Many patients are interested in having the State of the Art PinPointe Laser Treatment for their discolored, thickened fungal toenails.  Before anyone jumps into having this procedure done, we sit down and explain to them why, what they do at home, is just as important as the Laser treatment itself. Yes the PinPointe Laser for toenail fungus is a great procedure, but patients have to be active in their roll to prevent any reinfection!

How the PinPointe Laser works is simple. This patented laser is specially designed to shine through your toenail and destroy the specific pathogens embedded in and under your nail causing the infection.  Unlike other lasers that are used for skin or pain treatments, the PinPointe™ laser is designed and used for only one purpose; to safely destroy molds and bacteria that cause fungus nail infections (Onychomycosis). If the nails is extremely thick it can take up 15 plus treatments and quite a bit of patience, as it truly takes 9 months to a couple years for a whole new nail to grow out.

Before the patient has the PinPointe Laser performed a thorough evaluation of the skin and nails is performed. If the patient has a bad case of athlete's foot, they will be given a prescription for a topical anti fungal for the skin. I would see them back after a couple of weeks before I would perform the laser treatment. I explain that success is dependent on the foot being in an environment that is free of fungus. If a patient has the PinPointe Laser procedure performed, what they do from that moment on can play a role in their success rate. Once we have performed this procedure, patients are given instructions on preventive care for the toes.

What to Avoid After Having the PinPointe Laser Treatment :

• Any shoes that you have worn before the Laser (especially shoes you have worn without socks)
• Nylons or panty hose
• Going barefoot in environments that could expose you to fungus again
• Pedicures in places that do not AUTOCLAVE instruments and take all precautions to protect you
• Wet moist environmental exposure to feet(ie. constantly having wet shoes) usually occupational hazard

Why it is Important to Avoid these things After The Laser:

• Any shoes that you have worn before the Laser was Performed are basically little incubators for the fungus, putting these shoes back on puts you at risk for reinfection!
• Nylons do not breath, again causing an environment that will be moist and possibly be a red flag for your toes!
• Taking precautions in environments that you are not familiar with is important, if Joe Schmo has fungus and you walk in his house barefoot, you are increasing your chance of reinfection!
• Do not get a Pedicure unless you know: that all instruments are autoclaved, they use liners between each client, that the pedicure chairs are pipeless and tubeless, that they do not reuse any files on anyone and that they do not reuse nail polish from client to client!
• If you are a landscaper, chef or someone whose feet are constantly getting wet at work, you need to change your shoes during the day and even consider spraying your feet with an anti fungal spray during the day while at work!

The laser is not in itself a miracle cure if the patient does not take an active roll in their own care.  The laser can dramatically improve the appearance of the nail and get rid of the fungus, but if you have a nail that has had previous trauma and the nail is deformed you still may wind up with a disfigured nail just fungal free.

   Biggest rate limiting step for patients perceived successful outcome is how slow the nail grows. We do advise those with extremely thick nails, that they will most likely need multiple treatments and recommend our comprehensive care plan of the unlimited zaps until their fungus is gone.  We want people to know if they are serious about getting rid of their nail fungus we have something that actually works and worth the investment for their future good foot health. 

What we charge:
1. If your nails are not thick we recommend the 5 zaps for $500
2. If your nails are thick you should consider the unlimited zaps until your fungus is gone for $1500. We will be with you every step of the way until the fungus is gone!

If you are interested in learning more about the PinPointe Laser Treat for Nail Fungus click the link below.