Managing Toenail Fungus in Diabetic Patients: Expert Advice for RNs

Question
Hi Liza, I am an RN and I do a lot of nail care for elderly diabetics.  I see a lot of toenail fungus and would like some good advice as how to best care for their nails.  Some nails I have seen are thick, brown and curved around the end of their toe.  Dr.'s don't seem to be concerned with the problem.  What can I do to help?

Answer
Hi Vickie
I know what you mean about doctors not being too worried about these infections.
The pathogens that cause fungal infections are oportunists. They thrive in conditions that are dark, warm and moist, and guess where all those conditions occur.. yup, feet!
That is why u will hardly ever see these infections on hands. Hands are like the dessert and feet are like the rain forest!
Prevention is always better than cure.
Good foot care involves daily washing and careful drying of the feet, especially between the toes. I appreciate that elderly people find this difficult if not impossible, which is why their feet are so vulnerable to these kind of infections.
If the infection is there, the best thing for the feet is a thorough pedicure. if the client has diabetes, then it may be advisable to see a chiropodist first.
There are some beauty therapists like me out there that take an interest in problem feet, and are well trained and can safely treat clients with diabetes. It would be advisable to check out case histories and qualifications.
A decent pedicure will remove all hard,dry, cracked skin without the use of a credo blade. These blades are still used, but in most cases only make the skin grow back quicker as it thinks it is under attack.
The skin needs to be removed over a period of treatments so that it heals properly.
The toenails need to be cut as short as possible and all the dead skin removed from around the cuticle area and under the toenail.
This is not for the faint hearted, but the more dead tissue that is removed, the less that the fungal infection has to thrive on.
In some cases it helps to thin out the thickened toenail with a file as this makes them more comfortable in their shoes. care needs to be taken to not over thin the nail though.

I hope this is of some help, good luck
Liza