Be sure the results of your pedicure are pretty, not painful

It's sandal season, which means that nail salons are busy clipping, buffing and polishing toes galore. Tending those colorful toes, though, poses some health risks that should be considered, doctors say.

"One is fungus, then viruses and bacterial infections," says Gene Mirkin, a podiatrist at Foot & Ankle Specialists of the Mid-Atlantic in Kensington, Md. "If the place you go to isn't vigilant about how they treat the instruments between clients" - more on this below - "there's a greater possibility" of picking up something that could make summer toenails more painful than splashy.

And even the most skilled pedicurist will occasionally slip and cut the skin, says Washington podiatrist Howard Osterman, who sees a few patients every week with toe infections that developed after salon pedicures. (That's fewer than he saw 15 or 20 years ago; he thinks pedicurists are better trained and salons more conscientious about hygiene these days.)

The risk, according to Osterman, "really lies with the pedicurist wanting to do such a good job that they become too aggressive cleaning the cuticle, for example. They get their little scissors out and (push back and then) trim the cuticle, and that just opens the body up to infection."

Podiatrists consider tampering with the cuticle, which helps anchor the nail to the skin, a major mistake; pushing back the cuticle or clipping it, both of which are common during pedicures, can let bacteria in.

Gina Saffo, a podiatrist in Greenbelt, Md., says that another common mistake made in pedicures is cutting nails too aggressively on the sides. This can lead to painful ingrown toenails that break the skin, sometimes requiring surgical treatment.

To avoid this problem, Saffo says, it's important for pedicurists to cut the nails either straight across or with a slight curve - but not down into the corners of the nail.

Andrew Carver, a Washington podiatrist whose specialties include laser treatment of nail fungus infections, says that while people can acquire fungus at a salon, the average healthy person is not likely to walk out with diseased toenails and toes. In most cases of toenail fungus, he says, "there's an immune-system defect" that explains it.

"Just make sure you aren't being treated with used pumice" - this porous rock used for exfoliating skin can harbor bacteria - "and don't be afraid to ask questions" about sterilization procedures for all equipment.

The gold standard is to clean metal tools in an autoclave, a machine that sterilizes instruments using high-pressure, high-temperature steam. Cleaning tools in liquid disinfectant can kill most germs and viruses if they soak for at least 10 minutes, but that won't guarantee sterility, the doctors says.

Of course, Saffo says, "the only way to know (that instruments are clean enough) is if you actually see them coming out of a sterilizer."

She suggests buying and bringing to the salon your own pedicure kit: "If they're good-quality instruments, you can actually run them through the dishwasher at home at high temperature or soak them in ethyl alcohol."

Bringing in your personal tools is acceptable in most salons, though AcquaNails in Maryland, for example, prefers to use its own sterilized tools on the off chance that a customer hasn't done a good job sterilizing her own equipment, explains General Manager John NGO.

Pedicurists use disposable emery boards, and metal tools are put into a sterilizer pouch and autoclaved. The pouch is opened in front of the customer.

Ngo has installed glass bowls for foot-soaking in his salons because, he says, fiberglass or plastic bowls are porous and can harbor bacteria more easily than glass ones. His employees clean the bowls with "hospital grade cleaner" that wipes out bacteria and viruses.

He adds, "We can basically guarantee that if a customer doesn't come in with any previous infections, they won't walk out with something."

Mirkin says he cautions his patients about the whirlpool foot baths used in many pedicures because they are connected to piping that is difficult to sterilize. As a result, he says, they can be "cesspools for bacteria, fungus and yeast." If possible, opt for simple glass or metal bowls, which also are offered in some salons.

Many podiatrists say certain higher-risk people should probably avoid salon pedicures altogether, even at businesses that are conscientious about sterilization and look squeaky-clean.

These people include anyone with immune problems or poor circulation, such as people undergoing chemotherapy or with heart trouble or diabetes. Diabetics don't heal as well as others, Saffo says, and often don't realize they've been cut because the disease can cause numbness. So "a small nick for them could become a huge problem."

People older than 65 are also more susceptible to infection, since the immune system declines with age.

Foot care for those most at risk should be handled in a podiatrist's office, leaving the simple applying of nail polish to the salon, notes Osterman, who has many patients who come in to have their nails cut and calluses shaved. Any procedure smacking of even minor surgery is not salon-appropriate.

"We're not going to put polish on them," Osterman says, but "they can go to the salon to just have their nails painted."

Ngo says that his workers are trained to recognize signs of diabetes and other illnesses and that, after confirming any illnesses or medical issues with the customer, they might agree to perform a simple polish, with no cutting.

On occasion, though, his employees have turned away customers with severe diabetes. Some get upset, he adds, but "we say, 'It's for your benefit.' We're not doctors, we're just basically beauticians, and we can only take it so far."