Manicure, pedicure and nail services
Domain 8 tests nail anatomy, recognition of nail disorders, safe manicure and pedicure technique, and the judgement to refuse or refer. The exam often shows a description of a nail abnormality and asks whether you would treat.
Nail anatomy and growth
- The nail unit includes the plate, bed, matrix, lunula, cuticle/eponychium, hyponychium, lateral folds and free edge.
- The matrix produces the plate; damage here causes lasting deformity.
- Fingernails grow about 3 mm per month; toenails about 1 mm per month.
Disorders and referral
- Beau's lines, koilonychia, leukonychia, onycholysis, onychorrhexis, pitting, clubbing and splinter haemorrhages.
- Paronychia is inflammation or infection of the nail fold; onychomycosis is a fungal infection causing thickening, discolouration and debris.
- Refer fungal or bacterial infection, warts, undiagnosed discolouration, severe paronychia and recent surgery.
Procedure and hygiene
- Consult, wash hands, file in one direction, perform cuticle work without cutting live tissue, buff, massage and polish.
- Pedicure includes soaking, careful callus work without blades, nail care and massage.
- Autoclave metal tools; use single-use files and buffers; disinfect foot baths and work surfaces; never share credo blades.
Contraindications
- Local infection, open cuts, warts, severe paronychia and recent nail surgery.
- Diabetes: proceed only with caution; refer if circulation or sensation is impaired.
- Psoriasis and severe eczema may require medical advice.
Worked example
A client's big toenail is thickened, yellow-brown and lifting, with debris beneath the free edge. The therapist suspects fungal infection, does not treat, and refers to the GP or podiatrist. She disinfects the foot bath, discards the file and records the referral. The reasoning is that treating an active fungal infection risks spread and does not address the cause.
Traps that cost marks
- Cutting live cuticle tissue.
- Sawing the file back and forth.
- Using credo blades on callus.
- Treating a suspected fungal infection.
- Ignoring diabetes-related circulation or sensation problems.
- Reusing files or failing to disinfect foot baths.