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Diabetes and Toenail Fungus

For a diabetic, toenail fungus is much more than a cosmetic problem. Diabetes complications from fungus infections in the toenails and fingernails can lead to amputations of the entire limbs. To understand how serious fungal toenails can be to a diabetic, you must first understand how diabetes affects the body.

Diabetes - Causes of Problems in Toes

Diabetes is a disease that causes the body to have high blood glucose levels. Those high glucose levels can destroy nerves (diabetic neuropathy) and cause poor circulation. The nerve damage can occur anywhere in the body, but it is most common in arms and legs, with the fingers and toes usually affected first. Diabetes symptoms in the toes may include numb toes, tingling toes, burning toes, sharp toe pain, cramps, and extreme sensitivity when touched.

If you suffer from peripheral neuropathy, small sores on your toes can go unnoticed, concealed by the numbness. In addition, poor circulation from diabetes means any toe ulcers and infections are harder to heal. Left untreated, small problems can escalate, eventually spreading the infection to the bones. Once an infection invades your bones, amputation of the toes or foot could be required to save your life.

Diagnosing Toenail Fungus

In order to properly treat the toenail fungus, it is important to get an accurate diagnosis. Failing to correctly diagnosis the condition can cause a delay in resolving the problem that can be more critical to a person with diabetes than a person whose system can better tolerate the delay.

In a typical toe fungus, discoloration of the toenail is usually a yellowish brown. But the result is not always yellow toenails. If other organisms cause the changes in the toenail, the discoloration may take on a dark green to black appearance. Black toenails can also be caused by trauma, autoimmune disorders, and melanoma. So, color of the toenails may be an indication of the problem, but yellow toenails or black toenails alone are not conclusive.

To diagnose toenail fungus, your medical professional will first examine the toenail for telltale signs of fungus. The next steps may include taking scrapings of the nail for a lab culture, examining toenail scrapings under a microscope, or doing a biopsy.

Treatments for a Diabetic Toenail Fungus

Because of poor blood circulation to the toes and feet in a diabetic, it is hard for a diabetic's body to fend off the microbes that cause toenail fungus infections. As a result, people who suffer from diabetes are a particularly susceptible to toenail fungal infections and their complications. It is very important to treat the infection promptly.

Proper treatment depends on the nature and extent of the fungal infection. If the nail is relatively clear, an antifungal lacquer application such as ciclopirox (Penlac) may cure the infection. If the fungal infection is more extensive and includes thick, brittle nails, an oral antifungal agent such as terbinafine can be effective, either as a single therapy or taken in conjunction with an antifungal lacquer.

In extreme cases, your doctor may suggest partial or full removal of the toenail, either by surgery or by a chemical process that causes the nail to fall off. Completely removing the toenail is usually not recommended for individuals with diabetes, since poor healing of the wound increases the risk of infection and other complications of diabetes. Removing the infected toenail should be a last resort when other treatments have failed.

Caring for Diabetic Toes

While everyone should take good care of their feet and toes, people with diabetes should use even greater care. If you suffer from diabetes, here are some tips for good foot care that can help keep your toes and toenails free from problems:

  • Wash your feet frequently. Clean feet are less likely to harbor the bacteria that can cause infections in your toes.
  • Dry your feet thoroughly and keep them dry, especially between the toes. If needed, you may also use a foot powder, either regular or antifungal.
  • Don't allow your feet to be excessively dry, however, as that can lead to cracks that provide an opening for fungus or infection-causing bacteria. If your feet are too dry, apply lotion to keep your skin supple.
  • Wear appropriate shoes and socks, and change them often. Since trauma of any kind is bad for your toes, protective shoes and seamless socks can keep your toes safe. But shoes and socks can also trap moisture that can cause bacteria and fungi to thrive. Socks which wick moisture from the skin can help reduce the problem.
  • Keep your toenails trimmed, straight across and not too short. If you have difficulty trimming your own nails, consider using a manicurist or podiatrist to trim your toenails.
  • Do not go barefoot in public places. Wear shower shoes in health clubs and swimming pools. Clean your tub with bleach.
  • Do not share toenail clippers, nail files or other personal care items. If you go to a manicurist, make sure that all instruments are sterilized between uses.
  • Examine your feet daily for minor skin breaks, rashes, and nail changes. Treat any minor problems quickly.

With proper care, even a person with diabetes can keep her toenails clear and problem-free.