When a surgical procedure left Karen Bakaj too sore to bend and touch her toes for several weeks last summer, she decided to treat herself to a pedicure. Days after her appointment at a local nail salon, however, the fourth toenail on her left foot turned cloudy and fell off. Horrified—and with several other toenails starting to look iffy—Karen saw a podiatrist, who diagnosed her with a fungal infection.
"I'm a person who wears flipflops in the gym shower and won't even walk barefoot in hotels," says Karen, 55, of Columbia, South Carolina. "I knew it must have been the pedicure."
It would take four months of daily treatment with a topical antifungal medication for the infection to clear up. Every year during sandal season, millions of women visit nail salons to pretty up their feet. Most don't experience complications, but a significant number do. "At least once a month I see a patient who has contracted an infection from a nail salon," says D'Anne Kleinsmith, M.D., a dermatologist in private practice in Bloomfield, Michigan. "I've even developed two fungal infections from pedicures myself."
Licensed nail salons are subject to inspections by state or city health departments. But the frequency of monitoring depends on the ratio of inspectors to nail salons in the area. And even then, the rate of compliance with health regulations can vary widely. Fungal infections like Karen's are the most common risk. Bacteria are another hazard—particularly MRSA, a rare but tough-to-treat strain of staph that can rapidly progress beyond skin.
Bottom line: "If you develop redness, pain, swelling, discomfort, or any unusual symptoms in your feet or lower legs after a pedicure, alert your doctor," says Johanna Youner, a podiatric surgeon in New York City.
Fortunately, experts say that if you follow a few basic pointers, safe pampering is possible.
"Stand-alone foot basins that aren't hooked to an outside water source offer the absolute safest pedicures," Dr. Youner says. Unlike attached footbaths, which recirculate water using whirlpool jets, freestanding basins have no inner workings in which germs and debris can hide. "All reported cases of MRSA from pedicures have been traced to bacteria in the footbath plumbing," Dr. Youner adds.
Plus, detached basins are easier to clean between clients, says Sara Gasparotto, a stylist and manicurist at Primrose Organics Salon in Los Angeles. "We bring them to a sink and scrub them under hot running water, then apply disinfectant," she says. "Any debris goes down the drain."
If your local salon does use whirlpool footbaths, make sure your nail tech builds in at least 15 minutes between clients. This is a clue that the salon takes sanitation seriously.
"Disinfecting a whirlpool footbath involves scrubbing the basin with hot soapy water, removing and cleaning the filter, spraying everything with a hospitalgrade disinfectant, and running disinfectant through the pipes—a 10-minute process," explains Linda Bond, executive director of the International Pedicure Association, an organization that educates salon personnel on pedicure safety. Techs also need several minutes to wash their hands and lay out a clean set of tools.
At a nail salon, nothing spreads germs more quickly than unclean tools. So if you can't see the tools being sterilized (either in an autoclave—a device that subjects them to germ-killing heat—or a special chemical bath), bring a set from home.
"I'm never insulted when a client comes in with her own supplies, because her comfort level is my top priority," Gasparotto says. Just note that even personal tools should be cleaned with rubbing alcohol or hot soapy water after every use. You might want to avoid the shared bottles of polish, too.
"It's not unusual for us to find fungi growing on polish brushes," says C. Ralph Daniel, M.D., a dermatology professor at the University of Alabama in Birmingham. Bringing your polish not only protects you from microbes, it gives you control over color and allows you to reduce your exposure to the potentially irritating trio of formaldehyde, toluene, and dibutyl phthalate. When shopping for polish, choose a brand labeled "3 free" or one that doesn't list these chemicals in the ingredients.
Sharp tools such as callus shavers and cuticle clippers make quick work of removing rough stuff from feet. The downside is that it takes just one slip of the hand to break your skin. This leaves you vulnerable to infection after you leave the salon.
So for the bottom of your feet, ask your pedicurist to use a foot buffer or pumice stone: They both remove calluses more gradually. And consider leaving your cuticles as is. "This skin forms seals around your nails that protect against harmful organisms," Dr. Kleinsmith says. If the cuticles on your toes are dry and scratchy, try rubbing in cuticle cream to soften them.
Cutting toenails too short or into a rounded shape ups the odds that they will become ingrown, says Dr. Johanna Youner. This is a nuisance unto itself, but ingrown nails also create a potential on-ramp into your skin for infectious bacteria.
For these reasons, ask your pedicurist to cut your toenails straight across, keeping them more or less flush with the tips of your toes.
And if you do develop an ingrown nail, head to a doctor, not back to the salon. "Treatment may require minor surgery," Dr. Youner says.
Because nicks and cuts in skin can provide an entryway for waterborne bacteria, it's smart to refrain from shaving or waxing your legs for 24 hours prior to your pedicure, says Linda Bond, executive director of the International Pedicure Association.
Also, dry skin tends to be vulnerable to infection (due to tiny surface cracks), so podiatrist Johanna Youner suggests applying a gentle moisturizer such as Cetaphil to feet and lower legs a few hours before you go. One final tip: Use a nailbrush to clean under your toenails at home. This allows you to skip the more aggressive—and therefore riskier—cleaning you'd likely get at the salon.