– Yolanda, Florida It seems that you and your doctor have taken the surgeon’s approach to toenail infection! Before we get to cutting or removing the nails, let me point out a few general facts. Individuals who suffer from diabetes are susceptible to toenail fungal infections and their complications. It is very important to treat the infection and achieve good glucose control. (This is not just a cosmetic problem for individuals who have diabetes.) Treatment depends on the stage of the infection and other factors. If there is only a white patch on the nail, an antifungal lacquer application will cure the infection. If there is nail thickening, brittleness, separation and inflammation, an oral (pill) antifungal agent can be effective as a single therapy or in combination with an antifungal lacquer. The usual discoloration of the toenail is a yellowish brown hue. If there are other organisms causing the change in the toenail, the discoloration may take on a dark green to black appearance. Black toenail can also be caused by trauma, autoimmune disorders, and melanoma. So it is important to arrive at the right diagnosis before treatment. This can be done by a biopsy and culture of the toenail. Removing the toenail completely is not recommended for individuals who have diabetes, since the risk of complications due to poor wound healing and infection is high. I would highly recommend that you go to your doctor or a podiatrist to manage the trimming and, if necessary, the removal of the nail. Reasons for removal include the following reasons: if leaving the toenail will cause further complication, if trimming does not achieve the desired result, and/or if you are not eligible for antifungal agents. Since you have recurring athlete’s foot, you might also consider the following guidelines:
Keep your feet dry but not excessively dry. Use lotion to prevent excessive dryness, but do not use it between your toes.Be vigilant about careful drying after bathing or physical activity, or when you are in a warm humid environment. To help keep feet dry, you may use either regular or antifungal talc. Wear socks made of “breathing” fabric, which keep moisture off the skin.Make sure you examine your feet daily for minor skin breaks, rashes, and nail changes.Keep your shoes in a cool dry place.Because any trauma to the toes increases the chance of fungal infection, wear well-fitting shoes and seamless soft socks. Keep your toenails trimmed straight across and not too short.Do not walk barefoot.Clean your tub with bleach and use shower shoes when in a public gym or swimming pool.
Q2. I have type 2 diabetes. I have fungus on two of my toes. I was told by the doctor that he could remove my toenails permanently. I don’t know if this would be the best solution. What do you think? — Annette, Illinois Generally, removing the nail is a last resort to deal with fungal infection, which is a very common problem among people with diabetes. If nail infection is not treated promptly, it can lead to permanent damage and nail loss, but there are effective ways of treating this condition. Medicines taken by mouth, such as terbinafine (Lamisil), cure fungal infections the majority of the time. Medicines applied directly to the nail as lacquer (such as amorolfine and ciclopiroxalamine), either in combination with the oral medicines, are also effective. Both the antifungal pills and the lacquer, if combined with each other and/or with removal of the thickened part of the nail, can cure the infection. However, many of the medicines have side effects and interact with other medications, so they might not be an appropriate option for some people. Because of this — and the destructive effects of fungal infections on the nail — removing a part of the nail plate may be indicated. Nonetheless, complete surgical removal of the nail plate is not usually recommended, especially if circulation is compromised as it might be among individuals with diabetes. My advice is to consult a podiatrist or dermatologist for a more specific treatment recommendation that better suits you. Q3. I have diabetes. Is it safe to get a pedicure? The short answer is yes, you can get a pedicure. However, you have to be careful not to expose yourself to potential infection, skin breaks, and other foot damage. Before you go to a nail salon, it’s best to see your doctor first. He or she will examine your feet for any signs of poor circulation, reduced sensation, skin damage, foot or nail infection, or bone and joint changes. Based on this exam, your doctor will advise you on whether or not you should have a pedicure. If there is any immediate concern, you may also be told to see a podiatrist — a foot doctor. Podiatrists can trim nails, remove calluses, and treat warts safely. They can also correct any deformity that might lead to further damage and advise about daily foot care. If there is no significant abnormality in your feet, then you can safely get a pedicure. You will, however, need to ask for some special treatment because of your diabetes. In general, unless you are visiting a specialized salon that is familiar with diabetic foot care, avoid getting your nails trimmed or your cuticles removed. Also, do not allow any sharp objects to be used on your feet. If you are getting a pedicure for the first time, talk with the salon personnel regarding their disinfection procedures. Examine the place, and observe how they sterilize and care for their tools. Alternatively, you can bring your own tub and supplies (a soft pumice stone, nail polish) to the salon. In general, to keep your feet healthy and prevent complications, it’s important that you stay well hydrated and prevent your skin from becoming dry. Avoid products that might cause your skin to peel or products that contain steroids. Examine your feet daily for any skin breaks and seek care from your doctor or podiatrist promptly if you observe any problems. Learn more in the Everyday Health Type 2 Diabetes Center.
