From the Guidelines
The treatment for an ingrown toenail in a diabetic patient requires prompt medical attention due to increased infection risk, and professional treatment by a podiatrist or physician is essential, which may include partial or complete nail removal under local anesthesia, with phenol application to prevent regrowth in severe cases, as recommended by the International Working Group on the Diabetic Foot (IWGDF) guidelines 1. Initial management includes warm water soaks 3-4 times daily for 15-20 minutes, keeping the area clean and dry, wearing open-toed shoes or sandals to reduce pressure, and using over-the-counter pain relievers like acetaminophen if needed. However, diabetic patients should not attempt self-treatment with sharp instruments or home remedies. Following treatment, proper foot care is crucial, including:
- Daily inspection
- Wearing properly fitting shoes
- Regular nail trimming straight across
- Maintaining good blood glucose control to promote healing Diabetic patients should have regular podiatric check-ups every 3-6 months to prevent recurrence and complications, as suggested by the IWGDF guidelines 1. Additionally, the IWGDF guidelines recommend providing appropriate treatment for any pre-ulcerative lesion or excess callus on the foot, for ingrown toe nails, and for fungal infections on the foot, to help prevent a foot ulcer in a person with diabetes who is at risk of foot ulceration (IWGDF risk 1–3) 1. It is also important to consider the patient's overall risk of foot ulceration and provide integrated foot care, which includes professional foot treatment, adequate footwear, and education, as recommended by the IWGDF guidelines 1. The patient should be educated on proper foot self-care, including daily foot inspection, proper footwear, and regular nail trimming, to prevent future complications, as suggested by the IWGDF guidelines 1.
From the Research
Treatment for Ingrown Toenail in Diabetic Patients
- The treatment for an ingrown toenail in a diabetic patient can be challenging due to the risk of infection and complications 2.
- A study published in 2008 found that the application of a nail brace can be a safe, simple, and inexpensive treatment option for diabetic patients with ingrown toenails, providing immediate relief of symptoms and reducing the risk of recurrence 2.
- However, it is essential to note that diabetic foot infections, including those caused by ingrown toenails, require careful management to prevent complications such as amputation 3, 4, 5.
- Antibiotic therapy may be necessary to treat infections, but it should be used judiciously and only when clinically evident infection is present 4, 6.
- The selection of antibiotic therapy should be based on the severity of the infection, the likely etiologic agent, and the patient's medical history, including any previous antibiotic use 3, 6.
Management of Diabetic Foot Infections
- Diabetic foot infections require a multidisciplinary approach, including wound debridement, pressure off-loading, glycemic control, and surgical interventions as needed 3, 4, 5.
- Proper wound care, including cleansing, debridement, and local wound care, is crucial for healing and preventing complications 3, 5.
- Imaging studies, such as MRI, may be necessary to diagnose and manage deep tissue infections, including osteomyelitis 3, 5.
- The duration of antibiotic therapy should be based on the severity of the infection and the clinical response to treatment, ranging from a few weeks to several months 3, 5.