Diabetes & Ingrown Toenails: What You Must Know

There’s a lot that comes to mind when we think of diabetes, and for most people, the risks to their feet and ingrown toenails are not one of them. Yet as podiatrists that specialise in treating ingrown nails, seeing a diabetic with ingrown nails, particularly if they’ve had more than one in the past, rings some big alarm bells for us. Here’s why.

Background: The True Impact Of Diabetes

Diabetes is a whole-body disease that interferes with the way the body removes the sugar from our bloodstream after we eat, leaving high concentrations of sugar in the bloodstream. This becomes dangerous as it produces toxins that negatively affect all body organs and systems, including our vision, heart, kidneys – and the circulatory system and the nerves in your feet and legs, all the way down to the toes Specifically, diabetes impairs a person’s ability to fight infection, supply enough oxygen and nutrients to their cells, efficiently heal wounds, and feel what is happening to and around their feet. This occurs because two key processes are disrupted: Regular, healthy sensation (feeling) Our nerves are responsible for our ability to feel, detecting everything from a feather being moved across our toes, to standing on an uncomfortable pebble in our shoe. As diabetes can damage the nerves, our ability to feel can fade, become mixed up, and may eventually be lost altogether. This is called peripheral neuropathy When we can’t properly feel what is happening around our feet, this makes us vulnerable to sustaining damage, even something as simple as a scrape or a blister from our shoes, and not knowing it has occurred. This means that we can’t take the right measures to look after the wound and protect our feet, leaving them vulnerable to further damage, infection, the wound turning into an ulcer, and more. Circulation When diabetes damages the blood vessels and impairs your circulation, your tissues aren’t able to receive the blood flow they need to thrive and carry out their essential cellular processes most efficiently. This means that when you sustain a wound, it will take longer for the body to heal, leaving it open and vulnerable to picking up an infection. If an infection takes hold, it is more difficult for your body to fight, exposing you to a range of potential problems.  Together, impairments in both sensation and circulation are some of the key reasons why 34% of people with diabetes are expected to develop a foot ulcer in their lifetime, approximately half of which become infected, and 15% of which then require an amputation. 

What Does This Mean For Your Ingrown Nails?

It means that if you have diabetes:
  • You’re at risk of not being able to detect when an ingrown nail starts, as well as when it becomes severe, because your ability to feel pain is disrupted.
  • Without pain telling you to care for your toe, you may also miss an infection, which may then spread.
  • Aside from being absolutely not recommended for those with diabetes, attempted home treatments for ingrown nails are far less successful because we can often tell when the entire nail spicule is removed from deep within the skin from the feeling of relief and notable pain reduction – something that can be disrupted in diabetes, meaning you may think you successfully removed the ingrown spicule but only part was removed, and part was left behind. This can be very dangerous.
  • You may have difficulty healing and closing the wound left from your ingrown nail because of the effects of poor circulation and reduced blood flow to the toes.
  • Together with the above, attempted home treatment can worsen the problem because it deepens or widens the wound, making it even more difficult to heal. Additionally, any time you have an open wound, it is susceptible to infection.
  • You may continue to struggle with complications from repeated ingrown toenails if you don’t apply effective and ideally permanent treatment to stop the ingrown nail for good.

Having Diabetes Means You Must Take Extra Care With Ingrown Nails

The bottom line is that having diabetes means that you must take extra care of your feet and ingrown toenails to reduce your risk of significant complications like infections or worse. This is where our podiatry team works extensively with people with diabetes to give them the confidence that their feet are safe and progressing well, as well as provide permanent treatment solutions for troublesome, recurring ingrown nails that can solve the problem for good. Diabetes New Zealand has a formal recommendation for having your feet and ingrown nails cared for by a podiatrist to best support your foot health. You can book an appointment with us online here.

Care Tips For Diabetic Feet

To help you best support your foot health at home, here are a few tips from our podiatrists:
  • Wash and dry your feet thoroughly every day, including drying well between the toes to prevent moisture from becoming trapped
  • Check your feet daily by holding them up against a mirror if needed, and check the top, bottom and sides of the feet, including between the toes. Look for marks, spots, cuts, swelling or redness that is not normal. 
  • If you notice anything out of the normal with your feet, book in with a podiatrist or a GP promptly
  • Ensure you have good, supportive shoes that minimise your risk of damage to the feet
  • Check your socks – ideally, these should be cotton with no elastic in the tops, as they will absorb sweat and reduce pressure at the top of the sock line. There are also seamless diabetic socks available
  • Book your diabetic foot assessment every year
  • If you have difficulty trimming your toenails, or if you get corns or calluses, consider having podiatry nail and skin care every 6-12 weeks, during which your podiatrist will also be able to check for any warning signs related to your diabetes

Diabetes, Your Feet and Perform Podiatry

If you or any of your family members have diabetes, you’ll likely know that it’s very important to look after your feet. What many people may not be so familiar with, is the exact reason why it’s so important and how diabetes affects the feet. Here are the two main ways diabetes poses a significant risk to your feet and why you need to look after them! Diabetes affects your ability to feel Because of the way that diabetes damages the nerves, your sensation progressively worsens over time. There are many changes to sensation that can occur with diabetes. The more common changes can include:
  • Numbness
  • Tingling
  • Pins and needles
While these are the less dangerous of the changes, they still hinder your overall ability to feet and you may find that you can no longer feel very light things brushing over the skin of your feet. Your nerves may also start sending mixed messages. They may interpret hot as cold, sharp and dull, and vice versa. This is more dangerous, and can lead to burns or breaks in the skin. Any breaks (openings) in the skin leave it vulnerable to infection, and should be avoided at all measures. Perhaps the worst change is losing the ability to feel altogether. This doesn’t occur as a numbness, but as an unnoticeable absence in sensation where there is no numbness or odd sensation but just nothing. If you don’t feel that anything is wrong or off, then the body just perceives that everything is normal, when it very much isn’t. Losing the ability to feel means you won’t detect when you’ve stood on something sharp that has broken the skin. It can then remain lodged in the foot and remain vulnerable to infection, which is likely when walking around on the ground. Changes in your circulation Diabetes also causes damage to the vessels and impairs the blood flow to the feet. The feet are already the area furthest away from the heart, so anything that impairs the blood flow makes can have a significant impact on the feet. Your feet may often be cold, appear pale, the skin may become dry and the nails, brittle. Importantly, a poorer blood supply to the feet also means a means a longer healing time for any cuts and breaks in the skin. This, when paired with an increased likelihood for cuts and wounds from the effects on sensation, is a very dangerous combination. It poses a great risk of infection and secondary infection as open wounds take longer than normal to close. Infections are harder to fight, and persist for longer. This places the feet at a great risk for ulceration, and at its worst, amputation. Diabetes is currently the leading cause of lower limb amputation, other than traumatic injuries. If you’re concerned about your feet and diabetes, the best thing you can do is come in and see our expert team here at Perform Podiatry. Because the effect of diabetes on your feet progressively worsen, we conduct a comprehensive diabetes assessment to tell you the exact risks to your feet based on your circulation and sensation findings. We’ll teach you how to best care for your feet, avoid injury, and everything you should be looking out for. We also liaise with your GP with your permission, to keep them updated on your feet, so you get the best care. Give us a call on 09 523 2333