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Posts for category: Education

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 Skokie Foot & Ankle Specialists, Ltd.
November 15, 2018
Category: Education

Doctor holding cigarettePhysicians are to be the authority on promoting and restoring health.

This trust was exploited decades ago when actors appeared in magazines dressed as doctors to promote smoking. This marketing ploy stopped when the health hazards became more widely known.

There are many laws prohibiting deceptive practices. In one instance, the United States Federal Trade Commission required pomegranate products not be advertised to treat or prevent heart disease and prostate cancer without at least one randomized, well-controlled human clinical trial. 

So what about television personalities like Dr. Oz who promote undocumented therapies? One of the loopholes is that Dr. Oz doesn't have a financial stake in the remedies he endorses.

In podiatry, many over-the-counter products give the perception to eradicate toenail fungus but have never been proven to work. Some bone implants have long-term complications. Caveat emptor.

To find out if a treatment is effective and safe, contact Dr. Steven Miller by calling (847) 675-3400.

By Dr. Steven Miller
November 09, 2014
Category: Education
Tags: winter   cold   toes   Raynaud  

Raynaud toesAs the temperature drops and winter approaches, just the phrase "polar vortex" can make a person shiver. However, those with Raynaud's phenomenon have to be especially careful.

Named after French physician Maurice Raynaud (1834–1881), this condition is believed to be the result of vasospasms that decrease blood supply to the extremities in response to cold or emotional stress.

Toes and fingers change color (pale or blue) during a spasm and can be painful.  Nails may also develop longitudinal ridges.  Often the underlying cause is not known.

The following tips may help individuals with Raynaud's phenomenon stay comfortable during the upcoming winter:
  ◦  wear leggings and use activated heat packs (handwarmers)
  ◦  keep moving when in cold temperatures
  ◦  recognize and adapt to stressful situations
  ◦  avoid smoking and vasoconstrictive medication (including some blood pressure medication and over-the-counter cold remedies)

If you need additional guidance, schedule an appointment at Skokie Foot & Ankle Specialists by calling (847) 675-3400 or by clicking

April 02, 2014
Category: Education

A fish pedicure involves patrons dipping their feet in a tub of water filled with small fish called Garra rufa. Garra rufa eat the dead skin, leaving newer skin exposed. 

The Centers for Disease Control and Prevention is not aware of any published reports on illnesses resulting from fish pedicures. However fish pedicures are not permitted in some states, including Illinois. Reasons for banning fish pedicures include: 

  • The fish pedicure tubs cannot be sufficiently cleaned between customers.
  • Live fish cannot be disinfected or sanitized.
  • Chinchin, another species of fish that is often mislabeled as Garra rufa, grows teeth and can draw blood, increasing the risk of infection.