Podiatrist (Foot and Ankle Specialist) Questions Diabetic Foot

My mother is diabetic and has thick nail growth in her feet. How can we cut them while avoiding injury?

My mother is 74 years old and is heavily diabetic. She has long toenails which is causing a lot of discomfort and the fear of breaking. How can we trim them without any injury as they are very thick and hard to cut?

15 Answers

I strongly advise taking your mother for diabetic foot evaluation to Podiatrist. Podiatrist will be able to trim her thick nails without causing any injury or infection.

Many cases of ingrown toenails may be prevented by:
Proper trimming. Cut toenails in a fairly straight line, and do not cut them too short. You should be able to get your fingernail under the sides and end of the nail.
Well-fitting shoes and socks. Do not wear shoes that are short or tight in the toe area. Avoid shoes that are loose because they too cause pressure on the toes, especially when running or walking briskly.

Home Treatment
Do not cut a notch in the nail. Contrary to what some people believe, this does not reduce the tendency for the nail to curve downward.
Do not repeatedly trim nail borders. Repeated trimming does not change the way the nail grows and can make the condition worse.
Do not place cotton under the nail. Not only does this not relieve the pain, it provides a place for harmful bacteria to grow, resulting in infection.
Over-the-counter medications are ineffective. Topical medications may mask the pain, but they do not correct the underlying problem.
Visit a podiatrist. We are highly trained in the trimming of thickened nails often caused by fungus (ringworm). It’s important to have your feet checked by a professional, but so important for a diabetic since we are able to check for other issues diabetics are faced with (cracking of the skin, which leads to infection, fungus, which can spread, numbness and burning, etc.). Checking circulation is a must since good blood circulation = good healing potential. Check for any bony prominences, which could lead to ulceration.
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Cutting a diabetic patient’s toenails can be very dangerous. Risk factors such as poor circulation, decreased sensation, and high risk of infection make cutting diabetic nails a job that should be done by a medical professional. I would advise you to have your mom see a podiatrist for treatment. This is a service covered by most insurances every 2-3 months.

Dr. Barbara Norvell
In this case, I would definitely recommend you not cut them but defer and see a podiatrist for a diabetic foot evaluation, traditional nail clipping technique may result in a serious injury or complication.
Unfortunately this is a common problem I see with my diabetic patients who develop onychomycosis or thick, hard and yellow nails. Because of the high risk of diabetic patients developing infections from simple cuts in the skin, I recommend you seek a podiatrist like myself to manage her diabetic foot care. Medicare will cover diabetic foot care. Please call the office if you would like to set an appointment for your mother. I wish you and your mother the best, thank you for your question.
You should not try to cut them yourself. As a diabetic it would benefit her to have regular foot exams by a licensed podiatrist, where they can perform nail care safely. You risk causing her pain and possible infection.
My suggestion is to have a podiatrist trimmed the nails so that there is less likely of injury to the skin and reduce chances of developing infection.
Hello and thank you for the question.

In general, if a diabetic has very thick and difficult to trim toe nails, then it is recommended they see a podiatrist for nail care. Often, the over-the-counter nail trimmers are unable to adequately trim thickened toe nails. If not properly cut, this can lead to painful ingrown nails and possibly infections. There is also the chance of causing a cut into the skin of your mother which could lead it slow healing, infection and (in worst case scenarios) amputations. It is important to be very careful in trimming a diabetic patient's nails, and a Podiatrist would be the most qualified to do this with minimal risk. In addition to the trimming of your mother's nails, the Podiatrist will also be able to do a thorough foot exam to assess general issues and health.
She should have a diabetic exam before any home treatment.
I don’t trim toenails other than my own, however, you should have your mother see a podiatrist. If she has Medicare, given her diabetic status, this is a covered service every 61 days. In addition, they will also provide guidance and can typically troubleshoot for your mother to prevent ulcerations as well.
You should not be cutting her nails- she should be seen by a Podiatric Physician
Individuals suffering from diabetes can be at risk for complications involving the lower extremities and particularly the feet. As a disease, diabetes can produce injury to the peripheral nerves and circulation. This may leave the patient with impaired sensation and poor blood flow. Secondary findings can include dermatologic changes such as nail thickening, dryness of skin, and risk for infection. We often do not encourage palliative hygienic self care for maintenance of nails, trimming of calluses/corns in these individuals as local injury can lead to significant problems. Health care providers, particularly the specialty of podiatry, are highly knowledgeable in the management of the diabetic foot. Screening by a podiatrist can establish a risk stratification by assessing circulation, nerve function, structural deformity and skin integrity. A patient with diabetes demonstrating compromise in any of these areas would be best cared for on a periodic basis by a foot specialist. The value of these services has been recognized by insurance payers to include Medicare and is a covered benefit when criteria is met.
Grinding the nail down carefully without breaking the nail. This will alleviate the risk factors of the nail.
Depends on the nail and the nail bed. Could be mycotoxins nail, which must be debriefed and could be mycotic nail which can be treated by lamisil or topical antifungal like lamisil. Take a sample and send it to the lab and will be treated.
I advise you strongly to see a podiatrist. Podiatrists are trained to care for diabetics with many comorbidities, including painful fungus nails.