Nail Care for People with Diabetes

P.Bamila
SeenaRajsekar
Dept. of Podiatry

People with diabetes must care for their nails. Nails protect fingers and toes from injury and trauma. Diabetics have decreased sensation and poor circulation to their lower limbs due to long duration of uncontrolled diabetes hence it is easy for them to suffer from infections which can lead to drastic measures including amputation. So it is critical that nails are kept in good condition. The condition of nails can be a great indicator of health problems. Healthy fingernails and toenails will be smooth, slightly curved and somewhat pink. If nails are not healthy looking, this may indicate some type of underlying disease.

Some of the most common nail complaints seen include Fungal nails,ingrown nails,thickened (Ram’s horn) nails, crumbly nails and abscessed/infected nails.
Onychomycosis-Fungal nails


People with diabetes  are prone to developing a fungal infection known as onychomycosis. This fungal infection accounts for approximately 50% of all nail infections. The nails become thickand  brittle that can develop sharp points and hurt  the surrounding skin. Unnoticed small cuts on the fingers and toes can breedbacteria that leads to fungal infections. To keep the nails from developing fungal infection, it is important that all diabetics learn proper nail care. If fungal infections go untreated, they can lead to foot ulcers and gangrene. Many diabetics have lost part of a foot or even a whole foot from diabetic foot ulcers. Diabetics will also find that nail care of the lower extremities will also help to improve their health and well-being because they often suffer from peripheral vascular compromise.

Ingrown toenails

Ingrowing toe nails ,also called Onychocryptosis,occurs when small nail spike or tear on the side of the nail pierces the skin leading to pain and infection. This normally occurs along the sides of the nails from improper nail cutting techniques or trauma.

What causes ingrown toenails?
The sideways growing portion of nail acts like a foreign body and pokes into or pinches off a small piece of skin at the outer edge of the toe. This may cause a break in the skin, causing inflammation and possibly infection. The inflammation often causes more thickening of the nail skin fold, further exacerbating the problem. The protruding piece of nail keeps pushing into the skin, causing further injury and pain.

How to prevent ingrown toenails from recurring
Wear wider-toe shoes and avoid trauma and repeated injury to toenails. Protect toes during sports and avoid curving or cutting toenails too short at the edges.

Hypertrophied  fungal Nail

The nails are exceptionally hypertrophied from fungal infection in this patient who has not had podiatric care.  Due to the increased pressure transmitted to underlying tissues, these nails can damage the nail bed which may then become secondarily infected and ulcerate.

Curved Nails

Involuted nails have a higher curvature of the nail than usual. In some cases the curvature of the nail is so severe that the tip of the nail curves around in a circle leading to pinching of the skin causing pain, discomfort, and infection.
Involuted nails are often painful and can develop into ingrown nails. The tendency for involuted nails often runs in families. Ill-fitting shoes and incorrect nail cutting, particularly cutting down the sides of the nails can aggravate involuted nails.
Onychophosis

Onychophosis is a growth of the horny epithelium in the nail. This often causes a build up of "dead skin" under and around the nail.
Nail Fungus

This infection is contagious and will often travel from the skin to the nail especial after a trauma has occurred to the nail bed. It can result in discoloration, thickening, chalkiness or crumbling of the nails. Fungal infections in the nails can take on a number of appearances and should be assessed by a podiatrist. It is also important to note, however, that nail scrapings are not always accurate way to diagnose onychomycosis.
Thickened Nails

Onychogryphosis (ram's horn nails) is a general thickening of the nail/nails. It can often occur as a result of injury to the matrix such as dropping a brick on a toe, long term neglect (especially elongated nails), or a number of repetitive  knocks such as those that occur with continuous use of poor fitting shoe wear. In addition to increased thickness and curvature of then nail, it may also become discolored with a brown tinge and may grow more quickly of one side than the other. When nails get too thick to cut, you may need regular nail care from a podiatrist to reduce the thickness of the nails and to help trim them back as required.   
   
Lifting of the Nail
Onycholysis is the painless separation of the nail from the nailbed. Onycholysis can occur in response to illness, prolonged water exposure, skin diseases such as psoriasis, irritation from chemicals or the result of injury or repetitive trauma and irritation such as from tight shoes or high heels.

Treatment Options for nail conditions:
Nail pathology in diabetes can be a serious ailment, but some simple and effective treatments are available.
o    Doing pedicure regularly
o    Visiting the podiatry department for nail care
o    Topical/ oral antifungals application as per the podiatric surgeon’s prescription should be followed.
o    In extreme cases of onychomycosis, surgical intervention has to be administered to prevent recurrence.
o    Keeping sugar under control.

Good Hygiene Is the Best Preventive Measure:
•    The best way to keep nails free from fungus is to have good hygiene.
•    Keep the fingernails and toenails clean and make sure to dry the feet thoroughly before putting on socks and shoes.
•    A person with diabetes should only wear comfortable fitting leather shoes that are not too tight.
•    Diabetics should only wear cotton socks that will absorb moisture from the skin of the feet.
•    Don’t cut toenail very deeply. Always  file the nails with the nail file
•    Keep good blood sugar control.
•    Visit the podiatristregularly.