Many diseases and foot problems can be prevented through healthy personal hygiene and taking care of your feet. Healthy foot hygiene practices include not only washing your feet but also clipping your toenails and wearing well-fitting, protective footwear.
How to protect your feet:
- Wash your feet every day and dry them completely.
- Clip your toenails short and keep them clean.
- Change your socks at least once a day.
- Check your feet regularly for cuts, sores, swelling, dryness, and infected toenails and apply treatment as needed.
- When visiting a salon for foot care, choose a salon that is clean and licensed by your state’s cosmetology board. Make sure the salon sterilizes instruments after each use (such as nail clippers, scissors, and other tools).
Several foot-related conditions are directly related to hygiene:
Athlete’s foot, or tinea pedis, is an infection of the skin and feet that can be caused by a variety of fungi that thrive in warm, dark, and moist environments. Although tinea pedis can affect any part of the foot, the infection most often affects the space between the toes. Good hygiene practices, like keeping your feet and toes clean and dry and changing your shoes and socks regularly, help to prevent or control tinea pedis.
Diabetes can damage the nerves and affect blood flow in feet and legs. Poor foot hygiene can put you at an increased risk for infection.
Fungal nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Small cracks in your nail or the surrounding skin can allow these germs to enter your nail and cause an infection.
Hookworm is a parasitic worm (also called a helminth). Globally, it is one of the most common roundworms found in humans. Hookworm infection is most common in resource-limited settings with poor access to water, sanitation, and hygiene. The best way to avoid hookworm infection is not to walk barefoot in areas where hookworm is common and where the soil may be contaminated by human poop (feces).
During a fish pedicure, also known as a fish spa treatment, customers place their feet in a tub of water filled with small fish called Garra rufa [PDF – 12 pages]. Garra rufa are sometimes referred to as “doctor fish” because they eat away dead skin found on people’s feet, leaving newer skin exposed.
Garra rufa are native to the Middle East, where they have been used as a medical treatment for people with skin diseases, like psoriasis.
Several published case reports describe illnesses resulting from fish pedicures (see below).
Why have some states banned the use of fish pedicures?
Each state has the authority to ban fish pedicures, and some states have done that.
Reasons for the bans include the following:
- 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, and there is no effective way to disinfect the tubs. Because of the cost of the fish, salon owners are likely to use the same fish multiple times with different customers, which increases the risk of spreading infections.
- Chinese Chinchin, another species of fish that is often mislabeled as Garra rufa and used in fish pedicures, grows teeth and can draw blood, increasing the risk of infection.
- Fish pedicures do not meet the legal definition of a pedicure.
- Some state regulations specify that fish at a salon must be contained in an aquarium.
- The fish must be starved to get them to eat skin, which might be considered animal cruelty.
- According to the U.S. Fish and Wildlife Service [PDF – 12 pages], Garra rufa could pose a threat to native plant and animal life if released into the wild because the fish is not native to the United States.
Methicillin-resistant Staphylococcus aureus foot infection after fish pedicure. Sugimoto K, Frei R, Graber P. Infection. 2013 Oct;41(5):1013-5. doi: 10.1007/s15010-013-0437-8.
Fish pedicure-induced foot mycobacteriosis infection due to Mycobacterium marinum: a first case report. Vanhooteghem O, Theate I. Eur J Dermatol. 2017 Jun 1;27(3):299-300. doi: 10.1684/ejd.2017.2976.
Periungual Mycobacterium marinum infection following a fish manicure. Vanhooteghem O, Theate I, De Schaetzen V. Skin Appendage Disord. 2021 Aug;7(5):393-396. doi: 10.1159/000514853.
Staphylococcus aureus infection of the feet following fish pedicure. Veraldi S, Nazzaro G, Çuka E.Infection. 2014;42(5):925-926. doi:10.1007/s15010-014-0622-4
- Zoonotic disease pathogens in fish used for pedicure [letter]. Verner-Jeffreys DW, Baker-Austin C, Pond MJ, Rimmer GSE, Kerr R, Stone D, Griffin R, White P, Stinton N, Denham K, Leigh J, Jones N, Longshaw M, Feist SW. Emerg Infect Dis. 2012;18(6).
- Guidance on the management of the public health risks from fish pedicures. Health Protection Agency Fish Spa Working Group. London: Health Protection Agency; 2011.
- Recommended Cleaning and Disinfection Procedures for Foot Spa Basins in Salons. US EPA.
- Fish Pedicure: Review of Its Current Dermatology Applications. Shih T, Khan S, Shih S, Khachemoune A. Cureus. 2020;12(6):e8936. Published 2020 Jun 30. doi:10.7759/cureus.8936