Nail care with diabetes: cut safely, check daily, care properly

With diabetes, nail care is not a cosmetic matter but injury prevention. Two things make the difference compared with healthy feet: nerve damage (polyneuropathy) takes away the sensation of pain, so a cut in the skin goes unnoticed – and poorer circulation makes small wounds heal slowly. This is how a nail cut too short can turn into an ulcer. This guide shows how to care for your nails and feet safely at home, which instruments are made for this and when podiatry should take over.

You will find models with a secure grip and a controlled cut in our category Nail nippers for diabetics.

First the question: care for them yourself or see a podiatrist?

Whether you may cut your nails yourself does not depend on diabetes as such, but on the condition of your feet. Discuss this with your doctor. As a guide:

• Caring for them yourself is acceptable if you feel touch and temperature normally in your feet, no circulatory disorder has been found, the skin is intact and you can see and reach your toes well.
• Podiatry should take over nail care in cases of polyneuropathy, a diagnosed circulatory disorder (peripheral arterial disease, PAD), thickened or ingrown nails, calluses, and always if there has ever been a wound on the foot.

In cases of diabetic foot syndrome, podiatric treatment is covered by statutory health insurance: the doctor issues a prescription for therapeutic treatment, and the health insurer covers the costs except for the co-payment. This is not a luxury but the safest way – and it does not rule out filing and checking your nails yourself between appointments.

The daily check – more important than any instrument

If you cannot feel pain, you have to look. Once a day, ideally in the evening:

• Look at the soles, heels, spaces between the toes and nail edges – with a mirror with a telescopic handle if you cannot see the sole directly.
• Look out for redness, pressure marks, blisters, cracks between the toes, discolouration of the nail and anything that was not there yesterday.
• Before putting on your shoes, feel inside with your hand for small stones, creases and loose seams.

Every wound, even a small one, is a reason to see a doctor – not in two weeks, but within the next few days.

Cutting nails: the rules

1. After washing, not after a long bath. A short lukewarm foot bath of three to five minutes softens the nail. No longer – softened skin tears more easily. Check the water temperature with your elbow or a thermometer (maximum 37 °C), not with your foot.
2. Cut straight. The nail edge runs straight, the corners stay in place and may protrude slightly beyond the tip of the toe. Rounded corners are the most common cause of ingrown nails.
3. Not too short. The nail should end flush with the tip of the toe. If you feel an edge with your finger, it is right; if you feel skin, you have taken off too much.
4. In small steps. Three to four short cuts instead of one long one. This keeps the blade flat on the nail so that it does not get into the nail fold.
5. File the edges. File in one direction with a glass or sapphire file until no sharp corner rubs against the neighbouring toe any more.
6. Check afterwards. Look at the nail edges and skin. This way you will still see a tiny bleed that you cannot feel.

Which instruments are suitable with diabetes

These instruments differ from normal ones in one respect: they have rounded tips. Pointed nail scissors can stab into the nail fold when you position them without you noticing. A rounded blade grips only the nail.

• Safety nail nippers – nail nippers with rounded tips and rounded edges. For fingernails and toenails, even slightly thicker nails, because nippers transmit more force than scissors.
• Mini end cutter with rounded tips – a short, curved blade for thick, hard toenails. The small design is easy to control.
• Nail scissors with a blunt tip – familiar handling for thin fingernails, but without the tip that can cause injury.
• Filing instead of cutting – if you are unsure, shorten your nails every one to two weeks using only a file. This is slower, but free of injury.

Which model suits which nail is compared in detail in the guide Which nail clippers for diabetics.

What you should not use on your feet

• No callus planes and no blades. A plane removes skin without you feeling how deep it goes. With diabetes, calluses are only filed – carefully, layer by layer, never down to the pink skin – or removed by a podiatrist.
• No corn plasters and no corrosive tinctures. They dissolve not only the callus but also the healthy skin underneath.
• No pointed scissors, needles or corner lifters at the nail fold. With diabetes, an ingrown nail is not treated yourself.
• No hot-water bottle and no heating pad on your feet. Without a sense of temperature, burns occur that you do not notice.

Skin and the spaces between the toes

• Wash your feet daily, lukewarm, briefly. Dry thoroughly between the toes – moisture there is the most common entry point for fungus and cracks.
• Top of the foot, sole and heel: apply a cream containing urea (5 to 10 percent) against dry, cracked skin. Do not apply cream between the toes.
• Smooth calluses in small steps with a rasp or file, always on a dry foot. As soon as it gets warm or the skin shows pink: stop.
• Socks without pressing seams, fresh every day. Shoes that leave a thumb's width of space at the front and do not leave any pressure marks.

Frequently asked questions

As a diabetic, may I cut my toenails myself?

If you have normal sensation in your feet, no circulatory disorder and can see your toes well: yes, with rounded instruments and the rule “straight and not too short”. In cases of polyneuropathy, PAD, or thick or ingrown nails, podiatry takes over – on prescription.

Does health insurance pay for foot care?

With diagnosed diabetic foot syndrome, yes: podiatric treatment is prescribed on a prescription for therapeutic treatment, and you only pay the statutory co-payment. Purely cosmetic foot care is not covered.

Which nail clippers are right for diabetics?

Ones with rounded tips. For normal nails the safety nail nippers, for thick toenails an end cutter with rounded tips. You can find the comparison of the models in Which nail clippers for diabetics.

What should I do about an ingrown nail?

Do not treat it yourself. A foot bath for relief is fine, but lifting, packing and cutting belong in the hands of a podiatrist if you have diabetes – and if there is redness or swelling, see a doctor promptly.

How do I recognise that something is wrong?

By anything that is new: redness, a blister, discolouration, a crack, a spot that is warmer than the rest of the foot. Because pain is missing as a warning signal, the daily check with the mirror replaces sensation.

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