Onycholysis refers to the lifting of the nail plate either up from the...
Serving the Military
Clients serving their country deal with tough shoes and rigorous training; learn how to properly approach their special needs.
We all admire the sacrifices soldiers in our armed forces make, but what we may not think about are the sacrifices they bear with their feet as they train. With the rigors of marching, running obstacle courses and completing endurance tests—not to mention spending hours in the same rigid boots while performing these tasks—it’s no wonder that many people in the military experience issues related to their feet. And after returning home from overseas deployment, their bodies reflect the harsh conditions they experienced: extreme desertlike conditions and prolonged lengths without performing simple tasks, such as changing their socks. When these clients come to you, they need more than a little pampering; they need special care. To help you better serve those in the military, we spoke to experts to find out what prevalent issues exist and what you can do to understand and help your clients.
Although some military clients may exhibit problems with dry skin or fingernails, most of their issues affect the areas below their knees. Brad Wenstrup, DPM, FACFAS, currently works at Wellington Orthopaedic & Sports Medicine in Cincinnati, but from 2005 to 2006 he worked as the Army Reserve chief of surgery at the prison hospital of Abu Ghraib in Iraq, where he saw a wealth of foot conditions among troops. The most common issues he treated were stress fractures, plantar fasciitis, blisters and ingrown toenails. For each of these, we give you information on how to carefully handle them and the clients who are affected.
Stress fractures, says Wenstrup, are “fairly common” among troops. Your more athletic clients also may have experienced them because of the pressure they exert on their bodies. “Carrying 40- to 70-pound packs on the back every day can put amazing stress and strain on feet,” he notes. Wenstrup explains these types of fractures commonly occur in the heel bone and metatarsals (the bones connecting the toes to the middle bones of the foot). “In fact, the fracture of the second metatarsal is often called a ‘march fracture,’ a term that stems from the military,” he says. Stress fractures aren’t broken bones; they are in fact a bending of the bone, so X-rays may not detect the problem. If a client complains of pain in her heel or foot or you notice swelling around those areas, direct her to a foot and ankle surgeon to have the problem diagnosed. The bone may break completely if she continues to ignore her condition.
Reed also notes that severe symptoms, such as skin cracking or redness, may require a trip to the dermatologist, so call your client’s attention to any skin issues that look out of the ordinary.
Plantar fasciitis is another condition that plagues the general public as well as military personnel. According to the American Academy of Orthopaedic Surgeons, this condition stems from excessive running or jumping, leading to inflammation of “the tissue band (fascia) that connects the heel bone to the base of the toes.” If a client complains of pain under her heel that seems to be at its worst when she takes her first steps out of bed in the morning, encourage her to see an orthopaedic surgeon for a diagnosis. Carol Frey, MD, director of orthopaedic foot and ankle at the West Coast Orthopaedic Sports Medicine Foundation in Manhattan Beach, California, relates that a client with this problem can often lessen the pain through simple steps, such as wearing shoe inserts or night splints, performing stretching exercises or taking anti-inflammatory medications. As a nail tech, you can help by applying a firm but gentle touch to the area; the American Academy of Family Physicians reports that “cross-friction massage above the plantar fascia” can help stretch the area and relieve pain.
Blisters, which are caused by friction, frequently occur in the military because skin on the feet rubs against tough shoes all day. Nail techs should never pop a blister on the job, but your client can take care of the problem herself. “First, she should gently cleanse the area with soap and water, then take a sterilized needle and gently pop the very top layer [of the blister], allowing the fluid to drain,” advises Jacqueline Sutera, DPM, who has private practices in New York and New Jersey. “Once the blister is flattened out, triple antibiotic ointment and a bandage should be applied, and both the ointment and bandage should be changed twice daily for the next four days.” However, several factors indicate your client must see a doctor: she has a blister filled with blood or pus (as opposed to clear fluid); swelling or redness is present; or she has diabetes or poor circulation. Sutera recommends avoiding massage, abrasives (such as scrubs or foot files) and prolonged soaking on the affected area. Because blisters can expose the body to infections, be sure to thoroughly disinfect your tools and equipment, such as pedicure tubs.
Ingrown toenails grow into skin at the sides of the nail, causing irritation that leads to pain, redness, swelling and/or warmth in the toe, according to the American College of Foot and Ankle Surgeons. If the nail breaks skin, infection may also occur. Ingrown toenails can be easily prevented with a few simple steps, including wearing well-fitted shoes and cutting nails properly. “Nails shouldn’t be cut too short, and they should be cut straight across so that they don’t interfere with the surrounding skin,” notes Wenstrup. “In the worst cases, they may require a local anesthetic and removal of the nail.” Do your part to prevent the problem by cutting nails correctly and pointing out any warning signs of infection to your clients. If you do see symptoms that indicate infection, refer the client to a physician before working on her nails.
Military personnel have to be fairly resilient to handle the toll that all of the physical requirements of training and serving take on the body. However, when it comes to servicing your clients, you should always be on the lookout for special considerations, regardless of whether or not they are enlisted. “A foot has the same essential needs no matter what, so I treat a military client’s situation the same as any other,” says Erika Terzani, former spa owner in Vista, California. “If the client is experiencing problems or is new to the military, I explain the differences in regular socks versus military-issued socks, how a well-fitted shoe should feel, what problematic symptoms she needs to look for, the basics of exfoliating and nail trimming and how to keep calluses tamed.” By keeping an open dialogue with all clients, you’ll be better equipped to cater to their specific needs.
Though common sense suggestions, such as those Terzani mentions, can be appreciated by any client, don’t ever attempt to treat or diagnose medical conditions. “A technician can give advice to clients in the military, but when in doubt, always end the visit by saying, ‘See your doctor,’” emphasizes Wenstrup. “However, since clients may be more apt to speak with a nail professional about their bodies and their concerns, maintaining a good working knowledge of these problems is helpful.” In other words, your client gives her best in the military, so she deserves the best in care from her trusted nail tech. And don’t forget to say thank you!
Tracy Morin is a freelance writer and editor based in Oxford, MS.