Dr. Mark Hinkes
Trimming our toenails is something that our moms usually did for us as children. As soon as we were able to care for ourselves trimming our own nails became a regular part of our personal grooming habits. Nails that are clean, smooth, shiny and not affected by mold yeast or fungus, are easily trimmed using an appropriate clean instrument in proper lighting. But unfortunately, for many people the thickness, color changes, consistency and configuration of the nails may make nail trimming difficult and can lead to other foot health problems. So trimming deformed toenails can be a challenge but is essential for maintaining good foot health.
What Makes the Nails Become Thick and Discolored?
Thick, discolored, flaky, or brittle toenails are the changes in the nails associated with mold yeast or fungal infections and this problem is called Onychomycosis. It can make the nails difficult and in some cases nearly impossible to trim, even with a decent nail clipper. Diseased toenails are often associated with a fungal infection of the skin called tinea pedis or athletes foot. Thick discolored nails can also become secondarily infected with bacteria that usually turns the nail black in color.
What are the Health Risks Associated with Diseased Toenails?
Lacking an appropriate instrument to trim the nails, some people just give up and stop cutting their nails altogether. Failure to trim the nails may result in other foot pathology including ingrown toenails, ulcers, pain and functional disability. Long and deformed toe nails usually won't fit into shoes easily, and if a person could get their shoes on with nails in that condition they may find walking to be very difficult. For people with diabetes or peripheral vascular disease long toenails can become a trigger causing mechanical trauma and resulting in lacerating the adjacent digit. This trauma can start a chain of events that can lead to an ulcer and infection that could lead to amputation. I have seen patients with toenails so long that they curved around the tip of the digit and punctured the skin on the bottom of the toe. While most physicians don't pay much attention to issues of toenails, it is important to mange the nails correctly to prevent other foot pathology.
Use the Right Instrument to Trim Your Nails
The issue of trimming the nail can be compounded by the use of inappropriate instruments. Thick nails usually cannot be trimmed with drug store bought nail clippers. In lieu of having an appropriate instrument to cut the nails, many people use what they have in their bathrooms: scissors or razor blades. These tools are not meant to trim nails and their use often leads to ingrown toenail, laceration of the digit, infection or in some unfortunate cases a portion of the tip of the toe is accidentally cut off. I have seen this happen with my neuropathic diabetic patients who come to the office with bloody infected toes due to improper nail trimming.
The Poor Triad
Another set of problems excluding the issue of instruments that are usually associated with senior citizens trimming their own toenails is poor lighting, poor vision and poor eye-motor coordination. I like to tell these folks we are going to confiscate their "bathroom surgeons license" and recommend they have professional nail care that can be provided by Foot Care Nurses or Podiatrists.
Who Ya Gonna Call?
Proper care/trimming of the toenails and keeping them free of mold yeast or fungal infections is an important component of foot health. Diseased toenails that present a challenge for self care can be treated medically with either topical or oral medications and can be trimmed by a Podiatrist. So if you have this problem visit your foot care specialist or Podiatrist for a consultation. People who have no nail deformities or risk factors like diabetes or PVD but are unable to self care and need the nails to be trimmed often use the services of a foot care nurse or chiropodist.
Sarah Lockbaum RPN, CDE, IIWCC
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