By Eulalee Thompson, Staff Reporter 
Poorly treated corns and calluses can set in train a downhill battle to save a digit or a limb.
SOMETIMES, EVEN with the best intentions, pedicurists make a bad situation worse. They cross the line between making toe nails more beautiful and actually performing foot surgery. This is a concern for those involved with the care of persons with diabetes, a particularly vulnerable group.
"A lot of the pedicurists out there are doing... nail surgery without any proper or formal training... with disastrous effects. This is not, conjecture; this is empirical evidence things that we have seen and continue to see," said Owen Bernard, surgical chiropodist and executive director of the Diabetes Association of Jamaica.
The pedicurist is in pursuit of the-glossy-magazine-type beauty ideal but when the client sitting before her is a diabetic with a thick, crusty nail condition or corns and calluses, this is where the "disastrous effects" can set in. A sick foot in the care of unskilled hands can set in train a series of events ending up with the person with diabetes losing his leg amputation.
"The pedicurists... have a different role to play beauty, aesthetics whatever. They are not medically trained and they should not deal with these conditions; these are medical conditions that require somebody with the skills, knowledge and the proper tools to do the job," Mr. Bernard stressed.
Some of the more common foot conditions which require the attention of a trained surgical chiropodist include:
the involuted nails (the curving in of the nail) -- Mr. Bernard explained that nails can become bent under the influence of heat, moisture or pressure and especially, if they are not properly trimmed and cared for, the pressure of the shoes or boots can force the toenails into various shapes.
corns (helomas) Mr. Bernard said that these can be very painful and if not properly treated, can result in a septic or inflammatory condition.
onchogryphosis (thick, crusty nails) Mr. Bernard said that a thickened nail is difficult and if allowed to grow can become moulded by the shoe. He said that trauma may be the initiating facto and the nail is also grossly deformed which develops into a rams horn shape.
Other common foot conditions include calluses and apical helomas as a result of hammer toe trauma.
"These nail conditions, left unchecked, have been causing a lot of trauma to soft tissue and remember diabetics... have no sensation in the feet; some of them can't even bend down and they don't find out that there is something wrong until it is too late," said Mr. Bernard.
It is because footcare is such an integral part of the management of patients with diabetes, that the Diabetes Association of Jamaica has started the training of foot care assistants. Community-based individuals are trained and given the tools to handle the more common problems of the feet.
"They are registered with the Diabetes Association of Jamaica, they are monitored and there are strict guidelines they must wear identifications...They are not foot specialists and they should not use that term; they are foot care assistants, trained to deal with basic foot problems," Mr. Bernard stressed.
