Toenail Troubles

Why some caregivers should leave nail trimming to podiatrists

When my mother was in hospice, home health aides and nurses weren’t allowed to trim her toenails because of the risk of infection or injury. They also advised against my trying; her toenails were too thick, anyway.

If you land in a similar situation, here’s why — and how — to get care.

Toenails and aging

Toenail problems are common in older adults. With age, nails grow more slowly, which can affect their recovery from injury or infection, particularly in people with circulation issues such as diabetes or vascular disease.

Older adults often have chronic conditions, especially blood flow problems, that contribute to toenail issues, says Jessica Knight, DPM, a podiatrist with Endeavor Health in Elmhurst, Illinois.

“Typically, toenails get very thick,” Knight says. Contributing factors include dehydration, trauma (often from tight shoes), and fungal infections, she says. But toenails can also have the opposite problem: becoming thin and brittle, leading to cracks or splits.

Risks with trimming

The Illinois Department of Public Health bars home health aides and certified nursing assistants from trimming nails in patients with diabetes or other conditions involving circulatory issues or loss of sensation. My mother had congestive heart failure, so her heart didn’t pump blood well, especially to her lower extremities.

“Generally speaking, home care nurses or home health aides do not trim patient toenails,” says Roy Tago, regional director of operations for Loyola Medicine Home Care in Oak Brook, Illinois. “Any small issue after cutting the nails could cause a major issue.”

Infection is the biggest concern when cutting toenails the wrong way, Knight says. “It can cause them to grow curved, digging into the skin.” Ingrown toenails can lead to skin infections.

Inadequate blood flow not only contributes to nail changes, but it also makes treating infections and healing wounds more difficult, according to Knight. Because older adults also have less fat on their feet, infections can worsen quickly. “If they get a skin infection, it doesn’t have to go far before it gets to the bone,” she says. “That’s when you hear about amputations.”

How podiatrists help

For toenail trimming, home care agencies often refer patients to podiatrists (foot care specialists), “That podiatrist will continue to follow up with the patient even after we discontinue our services,” Tago says.

My mom saw one who makes house calls.

Podiatrists use special tools to trim, smooth, and remove thickened or ingrown toenails. In cases of severe pain or damage, removal may require surgery under local anesthesia.

Routine foot care with a podiatrist can also catch toenail and foot issues early, before they turn serious. “Typically, Medicare will pay for you to see a podiatrist every six weeks if you have certain qualifying factors, which are blood flow issues and diabetes,” Knight says.

Toenail care tips

Whether caring for someone’s toenails or your own, follow these tips:

• Stay hydrated. “Dehydration is a big [factor] that leads to nails not being healthy,” Knight says.
• Dry feet well after bathing. Damp feet can increase infection risk.
• Wear shoes that fit. Recheck foot size and width. Feet tend to grow and spread with age. Circulation issues also cause swelling.
• Moisturize feet and toenails daily. Use petroleum jelly or a thick urea-based moisturizer, which helps soften skin and nails, Knight says.
• Check feet thoroughly. Many older adults have nerve damage, Tago says. “They can’t feel that there are problems with their feet.” Look for open wounds or signs of infection. Healthy feet should feel warm to the touch, with skin and toenails a normal color and thickness, Knight says.

If you notice any problems, contact a podiatrist. Toenail issues can affect someone’s quality of life and cause serious issues if left untreated.