What are the recommendations for toenail care in diabetes?

Toenail Care Recommendations for Diabetic Patients

For people with diabetes, proper toenail care is essential to prevent complications such as foot ulcers and infections, which can significantly increase morbidity and mortality. 1

Risk Assessment and Screening

• All individuals with diabetes should receive an annual comprehensive foot examination to identify risk factors for ulceration, including assessment of protective sensation, foot structure, vascular status, and skin integrity 1
• More frequent examinations are recommended for those with higher risk: every 6-12 months for IWGDF risk 1, every 3-6 months for risk 2, and every 1-3 months for risk 3 1
• Patients with a history of ulceration, amputation, or loss of protective sensation should have their feet inspected at every healthcare visit 1

Proper Toenail Care Techniques

• Cut toenails straight across to prevent ingrown toenails, which are more common in diabetic patients and can lead to serious infections 1
• Avoid cutting nails too short or rounding the corners, which increases risk of ingrown toenails 1, 2
• Daily foot washing with careful drying, particularly between the toes, is strongly recommended 1
• Use emollients to moisturize dry skin, but avoid applying between toes 1

Managing Common Toenail Problems

• Provide appropriate treatment for ingrown toenails, thickened nails, and fungal infections promptly to prevent complications 1
• Nail braces may be a safe, simple, and effective treatment option for diabetic patients with ingrown toenails, avoiding surgical intervention 3
• Fungal infections (onychomycosis) are common in diabetic patients and require proper diagnosis and treatment 4, 5
• Risk factors for onychomycosis in diabetic patients include poor glycemic control, retinopathy, neuropathy, and obesity 4

Patient Education and Self-Care

• Educate patients to examine their feet daily, including toenails, and to contact a healthcare professional promptly if they notice any problems 1
• Instruct patients never to walk barefoot, in socks only, or in thin-soled slippers, whether indoors or outdoors 1
• Advise against using chemical agents or over-the-counter remedies to remove calluses or treat ingrown toenails 1
• Daily foot washing is associated with reduced risk of onychomycosis in diabetic patients 5

Special Considerations

• Patients with visual impairment, physical limitations, or cognitive problems may need assistance from family members for proper foot and nail care 1
• For patients with significant deformities or history of ulceration, consider referral to a foot care specialist 1
• Obesity, previous trauma, poor circulation, and improper nail trimming are significant risk factors for ingrown toenails in diabetic patients 2
• Good glycemic control may help prevent increasing nail thickness in onychomycosis 5

Integrated Approach

• Provide integrated foot care for moderate to high-risk patients (IWGDF risk 2-3), including professional foot treatment, appropriate footwear, and structured education 1
• For patients with a history of foot ulcers or significant deformities, consider specialized therapeutic footwear 1
• Early intervention for minor nail and skin problems can prevent more serious complications 1
• Multidisciplinary care is recommended for high-risk patients, including those with prior ulcers or amputations 1