Nail Clinic: Peripheral Neuropathy


Peripheral neuropathy affects an estimated 30 million Americans. Here’s what you need to know when servicing a client with the condition.

Humans have more than 7,000 nerve endings in each foot and 17,000 touch receptors and free nerve endings in each palm, so your clients’ feet and hands certainly feel the sensations of life—walking, running, gripping, touching, clipping, rubbing and more. With so much neural stimulation on these extremities, it’s no wonder clients visit nail salons for foot rubs and hand massages. However, clients with peripheral neuropathy (PN) can experience varying levels of numbness and pain—especially in their hands and feet—which can impact the services you provide them. The good news is that you can still service clients who have PN— with some modifications.

What is Peripheral Neuropathy?

Your body’s nervous system contains two major players: the central nervous system, made up of the brain and spinal chord, and the peripheral nervous system, which is composed of nerves. Think of nerves as communication wires between the two systems: Nerves carry information to and from the brain, such as telling the muscles to move or informing skin to sense temperature. “When the nerves aren’t working right, we call that peripheral neuropathy (‘neuro’ means nerve and ‘-opathy’ means not working right),” says Elaine C. Jones, MD, fellow of the American Academy
of Neurology (FAAN) and board-certified neurologist in Hilton Head, South Carolina. “When this happens, people can experience changes in sensation and weakness or trouble moving muscles.”

PN can affect one or several nerves, and can target one or multiple locations in the body. However, two areas of special concern for nail technicians, the hands and feet, tend to succumb to PN. “Typically, people with PN will develop numbness or tingling, occurring first in the feet and progressing to the hands,” Dr. Jones says, adding that the medical community refers to this as “stocking and glove” distribution. In addition to numbness and pins and needles, clients with PN can experience sharp shooting pains, temperature shifts (burning or extreme cold) that aren’t influenced by climate and balance issues due to numbness.

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Diagnosing PN

With more than 100 types of PN identified that present different symptoms, it’s often hard to pinpoint its cause—if at all (known as idiopathic peripheral neuropathy). Underlying medical conditions can be the root: Diabetes tends to be a common trigger, while infections (HIV and Lyme), vitamin deficiencies and autoimmune disorders (celiac disease, lupus and rheumatoid arthritis) have also been identified as risk factors for PN.

Chemotherapy, certain medicines, toxins (lead, arsenic and mercury), repetitive motion injuries (carpel tunnel syndrome) and alcohol abuse additionally precipitate PN. “PN is diagnosed based on the description of the symptoms—numbness, tingling, weakness—in the distribution
of a nerve,” Dr. Jones explains. “Once a PN is suspected, based on the history and exam, the patient should see a neurologist.” The neurologist will conduct blood work and possibly an electromyography (EMG) test, which measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle in order to help detect neuromuscular abnormalities. “An EMG can show when damage is occurring and the pattern of nerves/muscles involved, which tells the neurologist the cause of the problem (i.e. a pinched nerve, like sciatica, versus peripheral neuropathy),” says Dr. Jones.

The Treatment’s in the Cause

“If a cause is found for the neuropathy, such as diabetes or a vitamin deficiency, then treating these underlying problems can help,” Dr. Jones reasons. Those experiencing compression of the nerve, like with carpal tunnel, can benefit from splints, exercises or, in some cases, surgery. According to Dr. Jones, pain management for PN should eschew traditional pain medicines, such as narcotics, in favor of safer, more effective neuropathic pain medication. If clients suffer from weakness or balance issues associated with neuropathy, treatment may include physical therapy or occupational therapy.

Because so many medical conditions can be the root cause of the PN damage, practicing prevention for those triggers is recommended. “As with most conditions, healthy lifestyles are the best prevention,” says Dr. Jones. “Eating healthy diets low in fat and higher in vegetables can prevent diseases associated with neuropathy, such as diabetes.”

Set Up for Comfort

Though your salon likely considers client comfort, PN sufferers warrant extra care. “Always support the legs underneath from the knees down during a pedicure,” says Janet McCormick, MS, educator, author and co-owner of Nailcare Academy. Elevated pedicure chairs that require stepping up should be avoided for these clients, says Denise Baich, Certified Advanced Nail Technician, Certified Medical Nail Technician, Certified Safe Nail Professional and owner of The Pedicure Plus in St. Louis. “I recommend that the foot support area be approximately 3 feet across, allowing for plenty of room to accommodate flexing and repositioning of their feet as needed,” she adds. Keeping warm towels and blankets on hand for cold feet helps as well.

For manicures, “soft wrist support, such as a rolled towel, can be helpful for clients with carpel tunnel,” says McCormick. Additionally, she recommends offering support to clients with PN as they sit and when they stand as their balance is often compromised.

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Open Dialogue

PN requires a constant flow of communication between the tech and client—which begins with a client health intake sheet. McCormick stresses that offering client health intake sheets should be mandatory in salons, as they can help techs identify whether the client suffers from a medical condition that causes PN. From there, perform an evaluation, advises Baich. “If certain scenarios are present (such as wounds, fungus or extremely cold feet), refer the client to a physician, as these conditions are beyond the scope of a nail tech,” she says. “If as service is appropriate, proceed with temperature, pressure and implements being important considerations in the care for the client.” During your assessment, McCormick recommends asking the client if she’s in pain. “If some degree of pain is mentioned, consider only changing her polish and shortening the nails. If she insists on the service, mention to her that you may cease the service if it seems too painful,” she says.

Take Care

Modifications are a must for clients with PN. Steer clear of cutting cuticles, intense pushing of the eponychium or using steel implements. Filing and clipping should be done with immense care—especially for those who experience numbness, as they won’t feel a knick that could lead to serious infection. “I suggest clipping in small segments, pulling gently at the pad of the toe or finger to move the skin away from the free edge and side walls while trimming,” says Baich, who adds that it’s best to refrain from trimming the nails too short to avoid any potential ingrown scenarios that a PN sufferer might not detect. Use a crystal file rather than files with abrasive grits, as the smooth sides will cut down on any micro-tears that could result from abrasion.

During the service, be vigilant. “Repeatedly be aware of any pain responses, such as pulling back or taking a sudden breath, and back off immediately,” says McCormick. Be sure to intermittently ask if your pressure is tolerable, if she’s in pain and if the temperature is OK.

By all means, don’t skip the massage! Massages can actually be beneficial for clients with PN, but be gentle and use nonabrasive scrubs. “Remember not to overuse scrubs—even gentle ones—as the individuals dealing with neuropathy are often diabetic, which lends to extreme dryness that doesn’t respond well to aggressive exfoliation,” warns Baich.

For clients with PN, nail techs can actually serve as a line of defense against health setbacks. Says Dr. Jones, “Regular care and maintenance of the hands and feet may help prevent problems from missed injuries, ingrown nails, etc.”

–by Karie L. Frost


[Image: iStock Photo]

This story first appeared in the December issue of Nailpro magazine. To receive the magazine, click here to subscribe.

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