My Blog
By Dr. Steven Miller
February 07, 2021
Category: Education

Fish pedicure photoThere are reports of infection following fish pedicure. However, careful attention to details is important when trying to assessing risk for the general population.

Take the story of Victoria Curthoys. The toes of her right foot were amputated in Australia over the course of five years after she went for a fish pedicure in Thailand. One detail that was omitted in some accounts was found in her Instragram account.  She was “born with no feeling in my foot” and may not be aware of subtle injury from any cause.

A report from ABC News reported a “bacterial outbreak among 6,000 Garra rufa fish imported from Indonesia to British salons and pedicure spas”. However, an important point was omitted. Most of the fish were dead. 

Another complication reported was toenails falling off, but could not be proven that it was due to the fish pedicure. 

In contrast to most people who go for fish pedicures sporadically to exfoliate skin, ichthyotherapy (the formal name of fish pedicures) requires more frequent use for alleviation of psoriasis.

The CDC (Centers for Disease Control and Prevention) states that each state has the authority to ban fish pedicures. Possible reasons include:
  •  The fish pedicure tubs cannot be sufficiently cleaned between customers when the fish are present.
  •  The fish themselves cannot be disinfected or sanitized between customers. 
  •  Chinese Chinchin, another species of fish that is often mislabeled as Garra rufa, grows teeth and can draw blood, increasing the risk of infection.
  •  Garra rufa could pose a threat to native plant and animal life if released into the wild.
  •  The fish must be starved to eat skin, which might be considered animal cruelty.

Fish pedicures are illegal in licensed salons in Nevada. However, the website for SeaQuest Las Vegas promotes their “relaxing spa..while Doctor Fish gently exfoliates your feet.” The word “pedicure” in not mentioned. PETA has requested an investigation.

Caveat emptor.

By Dr. Steven Miller
January 03, 2021
Category: Education

Foot bathCleaning procedure for whirlpool pedicure foot spas, self-contained foot basins, sinks and pedicure bowls are in the Illinois Administrative Code (Title 68, Section 1175.115c). It states that after each use:

  •  Drain all water from the foot spa, pedicure basin or bowl;

  •  Clean the interior surfaces and walls of the foot spas or basin with soap or detergent to remove all visible debris; rinse with clean, clear water;

  •  Disinfect by spraying the interior surface of the foot basin or bowl with either an EPA-registered disinfectant (demonstrated bactericidal, fungicidal, and virucidal activity used according to manufacturer's instructions) or 10% bleach solution; and

  •  Wipe dry.

Additional cleaning steps are required at the end of every day. Once a week, bleach solution (or the equivalent) must sit in the spa or pedicure basin overnight (at least 6-10 hours).  The log for the last 90 days shall be readily accessible and available upon client request.  

The introduction of this regulation states that these procedures were developed by the International Nail Technicians Association. The International Nail Technicians Association and America's Beauty Show® (formerly the Chicago Midwest Beauty Show) are owned by Cosmetologists Chicago® (Chicago Cosmetologists Association, Inc). Document explaining their recommendations can be found here.

California (which had an outbreak), Mississippi, and many other states have similar laws. Texas has videos on recommended cleaning procedure. Washington has a sample log for salons. Virginia recommends not shaving or waxing legs within 24 hours beforehand since nicks, cuts, and abrasions increase the risk of infection.

EPA-registered disinfectants should have an EPA registration number on the label and state that the product is for hospital or medical use.

By Dr. Steven Miller
December 13, 2020
Category: Orthotics

Arch support orthoticAs the new NBA season excitement builds, star players with plantar fasciitis may be watching tip-off courtside. Most individuals with heel pain from plantar fasciitis benefit from these five treatments:

  • Rest and apply ice to the painful heel

  • Stretch and strengthening exercises

  • Shoes with a stiff supportive sole, even indoors

  • Arch supports (see below)

  • Anti-inflammatory medication, either orally or by injection

Supporting the arch to alleviate tension of the plantar fascia is most commonly achieved with a molded insert in the shoe, either a custom-made foot orthotic or the less expensive mass-produced version. Each unique combination of materials and shape will feel and function differently.

Elastic bands and compression socks and sleeves have also been tried, with less reliable results. Additional treatments like a night splint and surgery are added if needed.

If you have a painful heel or arch, please call our office at (847) 675-3400 or click here to schedule an appointment.

By Dr. Steven Miller
August 30, 2020
Category: Orthotics

Letter about orthotics Previously, I explained what a foot orthotic (arch support) is and who may benefit. Two of the most common indications are heel pain and flat feet.

This letter was written by one of our patients:

Dr. Miller –
Thank you so much for this excellent service you are providing! The orthotics you crafted have been life-changing, allowing me to continue to run and be active. You are easily the best podiatrist I have worked with. Thank you.

By Dr. Steven Miller
June 30, 2020
Category: Injury

Dislocated toe fractureBroken toes are common and can be very painful. They typically result from a traumatic event such as falling, stubbing the toe, or dropping something on the toe. One may feel a “pop” or “crack” when the bone breaks. Common symptoms include pain, throbbing, bruising, swelling, and redness.

If you suspect that you have a broken toe, you should make an appointment immediately. For most people, a combination of taping and protective footwear is sufficient. 

X-rays help determine if broken bones need to be reset. The attached images demonstrate closed reduction in our office without surgery (the x-rays were taken 15 minutes apart). 

If a deformity cannot be corrected easily, surgery may be needed. Broken bones that are not properly positioned, immobilized, and protected may advance into a painful nonunion.

If you sustained a toe injury, please call (847) 675-3400 right away to schedule an assessment.

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