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