According to the American Diabetes Association, it is estimated that at least twenty percent of people with diabetes suffer from foot conditions, and some can be associated with everyday issues like ingrown toenails or onychomycosis, a cutaneous infection. However, can they cut their nails in order to prevent these health concerns?
Diabetics with neuropathy are generally warned not to cut their nails on their own due to the nerve damage that reduces their sensation. This can lead to a life-threatening injury if not treated by specialists. However, diabetes patients with both type 1 and 2 are encouraged to take special care of their toenails, especially if cutting them.
In this article, I will provide information on the changes on the toenail when diabetes develops, what causes these changes, how ingrown toenails emerge, and why it is necessary to be careful of the nail’s health. I will also provide proper trimming tips for you.
How Can Diabetes Affect Your Toenails?
People with diabetes are more prone to toenail and foot problems since this health condition damages their nerves, and produces lower or poor blood circulation.
This can sometimes lead to loss of sensations in your feet and unbalanced sweat and lubrication of the skin in this area. Poor circulation can also lead to wounds and infection.
What are the factors involved with this progression?
- Poor blood circulation
- Loss of sensations and pain related to neuropathy
- Susceptibility to acquiring fungal and cutaneous infections as a result of high blood sugars
It is extremely important to remain aware of how diabetes can affect your toenails and foot health.
Problems that can affect your foot health:
- Diabetic Neuropathy: As stated earlier, this condition is prevalent in diabetes mellitus. Based on a study done by doctors Elina Zakin, Rory Abram, and David Simpson, the neuropathic manifestations are often presented in a “distal symmetric polyneuropathy,” which in other words means diminished sensations and making people with diabetes prone to foot injuries. As a result, this may also cause dexterity issues, most commonly on the hands and feet.
- Peripheral Arterial Disease (PAD): This health condition is common in large vessel complications of diabetes patients and involves tissue loss and foot ulceration. In addition to this, there are other factors like infection, and it directly affects the blood flow.
Common Toenail and Foot Problems with Diabetes
Discoloration and nail changes can present in the diabetic foot. The following are some to watch out for: :
- Ingrown toenail: Medically known as “onychocryptosis,” is a nail that grows within the subcutaneous tissue of the nails. If the patient has peripheral neuropathy, they may not experience any pain resulting in this condition progressing without them noticing. There are various surgical techniques and procedures required for later stages.
- Onychomycosis: A fungal infection that can appear on the toenails, producing some discoloration and thickening of the nail plate. This is one of the most common nail infections worldwide. It is also estimated that it is 50% of all nail-related problems and 30% of cutaneous infections. This condition is predominant in diabetic patients, increasing their risk of acquiring foot disorders and potential limb amputation.
- Paronychia: Considered a superficial infection that occurs on the nail plate and is due to poor nail trimming. It can cause redness and swelling, along with palpitations on the skin. This is more common in pediatric and teenage patients that have type 1 diabetes mellitus.
Why Do You Need To Be Careful When Cutting Nails?
According to the American Diabetes Association, it is estimated that one in five people with diabetes seeks medical care for foot health conditions, which makes it one of the crucial things to look out for. It is a determinant factor on how advanced diabetes is, and how it can affect the patients by causing more severe complications.
According to the Centers for Disease Control and Prevention (CDC), it has been estimated that around twenty-six million Americans suffer from this health condition.
The podiatrist of Somers Orthopaedic Surgery and Sports Medicine Group, Dr. Alan Berman, maintains that diabetic neuropathy causes high blood glucose levels and initially starts with pain.
However, as it progresses, the loss of sensations and numbness in the area is more evident, allowing for any cut to be infected or turn into an ulcer. This is why caution is utilized during the trimming technique.
Protect your feet, perform daily foot checks, and inform your provider if you notice any irregularities. You will want to address any issues as soon as possible to help prevent any serious issues related to diabetes.
How Should People with Diabetes Take Care of Their Feet?
- Wash feet: Use lukewarm water daily and pat them dry between the tows. It is recommended to use moisturizing cream on the top and bottom of your foot and not in between the toes. See my in depth article on foot creams for diabetics.
- Cutting technique: Cut your toenails right after bathing when they will be softer and easier to cut. It is encouraged to make minor cuts of the toenails and cut straight across. After that, you can smoothen the edges with a file. However, if the patient has thick or yellow toenails, it is recommended to visit a specialist like a podiatrist, especially if they suffer from neuropathy.
- Choosing footwear: for diabetics, it is necessary always to wear shoes and dry socks to prevent accumulating moisture. The shoes should be of a robust material on the outside and softer on the inside for comfort.
- Daily foot examination: watch out for redness, ingrown nails, calluses, sores, cuts, or any other problems, irregularities that can be potentially life-threatening since it increases the risk of infection.
- Notify your provider: notify your specialist to detect any changes on your feet and to test for any nerve damage or blood circulation problems in your legs.
Meticulous and thorough foot care is the best way to assess any potential foot complications that can be caused by diabetes. A balanced diet, regular activity, and monitoring your blood glucose levels are the best ways to prevent other health concerns.
See an article, Diabetes Foot Care Education, written by a friend and colleague of mine, Dr. Mark Hinkes, DPM. Dr.Hinkes is a board certified podiatrist in Tennessee. He is an expert consultant for diabetic foot health, and he is passionate about amputation prevention. See his article on
Proper Nail Cutting for People with Diabetes
We have explored the causes of toenails health conditions, how diabetes changes your nails, and the importance of taking care of them. I will now focus on tips and proper ways of cutting nails for diabetes patients. However, it is always encouraged to visit a podiatrist or specialist.
Step by step guide on trimming your toenails properly:
- Have proper nail tools: diabetic patients need to have proper tools like a nail file and nail clippers for your use only. Larger nail clippers are great for longer nails, and it will be easier to use this instead of fingernail clippers. Also, make sure to disinfect them with rubbing alcohol before and after using them.
- Wash your feet: it is best to soak the nails for ten minutes to soften and make it easier to cut them.
- Cut straight across and in small sections: use the clippers straight across the nail and avoid, at all cost, cutting them in a curved shape. Also, do not attempt to cut the nail in one shot but rather make a few smaller cuts.
- Nail length: Try not to cut them too short since it may provoke ingrown nails to emerge and leave them susceptible to infections.
- Filing: You can file down your nails to smooth out the edges after clipping them. Again, the technique is critical here. You should gently move the nail file towards one direction until it is smooth instead of rocking back and forth.
- Do not remove cuticles: this can cause bleeding and an increased risk of catching an infection, but you can push them away with a cuticle stick if you want to achieve a neat look.
In summary, people with diabetes can cut their toenails if they do not have neuropathy. This condition can cause loss of sensations and pain, making them susceptible to cutting themselves without noticing. Cuts near the toenails are open wounds and are prone to fungal infections.
It is important to keep your scheduled appointments for foot checks with your provider or diabetes wound care nurse. Some people prefer to get pedicures.
Even if you are trimming your own nails, be sure to have a professional look them over at times in case you are not seeing a problem area. Diabetic neuropathy can sneak up on you.
A specialist or podiatrist can trim them, using the correct technique. In addition, daily foot checks are crucial to be aware of any irregularities that may be signs of a life-threatening condition.