What are the causes of onychodystrophy in diabetic patients. How does onychodystrophy impact diabetic foot health. What are the challenges in managing toenail deformities in diabetes. How can onychodystrophy lead to foot ulceration in diabetics. What is the connection between peripheral circulation and nail health in diabetes.

Understanding Onychodystrophy: A Common Diabetic Foot Complication

Onychodystrophy, a term encompassing various nail deformities, is a frequent occurrence in individuals with diabetes, particularly those with compromised peripheral circulation or neuropathy. This condition can manifest as thickened, discolored, or structurally altered nails, often causing concern and discomfort for patients.

In the case presented, a 54-year-old woman with type 2 diabetes exhibited a striking example of onychodystrophy. Her big toe nail had become laminated, thickened, and dark yellow, presenting an unusual structure that prompted medical attention. This case highlights the importance of recognizing and addressing nail abnormalities in diabetic patients to prevent potential complications.

Key Characteristics of Diabetic Onychodystrophy

• Thickening of the nail plate
• Discoloration (often yellow or brown)
• Structural changes (e.g., lamination)
• Brittleness or fragility
• Separation of the nail from the nail bed (onycholysis)

Etiology of Onychodystrophy: Beyond Diabetes

While diabetes is a significant contributor to onychodystrophy, it’s crucial to understand that various other factors can lead to nail deformities. Are there other conditions associated with onychodystrophy? Indeed, the etiology of onychodystrophy is multifaceted and can be linked to several factors:

1. Genetic syndromes
2. Fungal and non-fungal infections
3. Non-infectious inflammatory dermatological diseases
4. Benign and malignant neoplasms
5. Systemic drug use

In the case of diabetic patients, poor peripheral circulation and peripheral neuropathy are the primary culprits behind onychodystrophy. These conditions compromise the nail’s health by reducing blood flow and sensation in the extremities, leading to structural changes and increased vulnerability to injury.

The Impact of Onychodystrophy on Diabetic Foot Health

Onychodystrophy in diabetic patients is not merely a cosmetic concern. It can have severe implications for foot health and may serve as a precursor to more serious complications. How does onychodystrophy affect diabetic foot health?

The deformed nails can become a source of several issues:

• Increased risk of bacterial growth due to debris accumulation beneath thickened nails
• Potential sites for ulceration when exposed to pressure from ill-fitting shoes
• Difficulty in proper foot care and hygiene
• Increased risk of ingrown toenails

These factors collectively contribute to an elevated risk of foot ulceration, a serious concern for diabetic patients given their compromised healing abilities and increased susceptibility to infections.

The Challenging Nature of Onychodystrophy Management

Managing onychodystrophy in diabetic patients presents unique challenges. Once the nail deformity occurs, reversing or significantly improving the condition can be difficult. Why is treating onychodystrophy in diabetics particularly challenging?

Several factors contribute to the complexity of treatment:

1. Reduced blood flow to the extremities, slowing healing processes
2. Potential presence of neuropathy, increasing the risk of unnoticed injuries
3. Compromised immune function, making infections more likely and harder to treat
4. The chronic nature of diabetes, requiring ongoing management and vigilance

Given these challenges, a multidisciplinary approach involving podiatrists, endocrinologists, and dermatologists is often necessary for effective management.

Preventive Measures and Management Strategies

While managing existing onychodystrophy is challenging, prevention and early intervention are key. What steps can diabetic patients take to prevent or manage nail deformities?

• Regular foot inspections to detect early signs of nail changes
• Proper nail care, including gentle trimming and filing
• Wearing well-fitting shoes to avoid pressure on nails
• Maintaining good glycemic control to support overall foot health
• Seeking professional care for any nail abnormalities or injuries

For existing onychodystrophy, management may include:

1. Professional nail trimming and debridement
2. Topical or oral antifungal treatments if fungal infection is present
3. Use of emollients to soften thickened nails
4. In severe cases, partial or complete nail avulsion may be considered

The Role of Patient Education in Onychodystrophy Prevention

Education plays a crucial role in preventing and managing onychodystrophy in diabetic patients. How can patient education contribute to better nail health in diabetics?

Effective patient education should focus on:

• Understanding the link between diabetes and nail health
• Recognizing early signs of nail abnormalities
• Proper techniques for nail and foot care
• The importance of regular podiatric check-ups
• Awareness of the potential complications of neglected nail health

By empowering patients with knowledge and skills, healthcare providers can significantly reduce the incidence and severity of onychodystrophy and its related complications.

Advanced Treatments and Future Directions

As research in diabetic foot care advances, new treatments for onychodystrophy are emerging. What innovative approaches are being explored for managing nail deformities in diabetic patients?

Some promising areas of research and development include:

1. Laser therapy for fungal nail infections associated with onychodystrophy
2. Bioengineered nail substitutes for severe cases
3. Advanced topical formulations for nail restoration
4. Gene therapy targeting specific nail growth factors

These emerging treatments offer hope for more effective management of diabetic onychodystrophy in the future, potentially reducing the risk of associated complications and improving patients’ quality of life.

The Importance of a Holistic Approach to Diabetic Foot Care

While focusing on nail health is crucial, it’s essential to view onychodystrophy as part of a broader spectrum of diabetic foot care. How does nail health fit into the overall picture of diabetic foot management?

A comprehensive approach to diabetic foot care should include:

• Regular vascular assessments to monitor circulation
• Neurological exams to detect early signs of neuropathy
• Structural foot assessments to identify biomechanical issues
• Skin health evaluations to prevent ulcerations
• Nail and callus care to prevent pressure points

By addressing all aspects of foot health, including nail care, healthcare providers can significantly reduce the risk of serious complications such as ulceration, infection, and amputation in diabetic patients.

Onychodystrophy in diabetic patients represents a significant challenge in foot care management. Its potential to lead to serious complications underscores the importance of early detection, proper management, and ongoing vigilance. By understanding the causes, implications, and management strategies for onychodystrophy, both healthcare providers and patients can work together to maintain optimal foot health and prevent debilitating complications. As research continues to advance, the hope is that more effective treatments will emerge, further improving outcomes for diabetic patients struggling with nail deformities.

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..: Toenail onychodystrophy of the diabetic foot

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• BMJ Case Rep
• PMC4544786

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BMJ Case Rep. 2012; 2012: bcr2012007314.

Published online 2012 Oct 19. doi: 10.1136/bcr-2012-007314

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,¹,² and ³

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A 54-year-old diabetic female patient with type 2 diabetes of 7 years’ duration presented with pain in her big toe. She had previously sustained foot ulceration several times and hence worried for recurrence. On examination she had a laminated, thickened, dark yellow toe nail of an extremely rare structure ().

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Laminated, thickened, dark yellow toe nail.

Onychodystrophy, which is a widely used term referring to nail deformities, has historically been linked with several genetic syndromes.¹ Additionally, it may be associated with fungal and nonfungal infections, various non-infectious inflammatory dermatological diseases, benign and malign neoplasms and systemic drug use.² None of these conditions was present in our patient. Onychodystrophy is also common among diabetic patients with poor peripheral circulation and/or peripheral neuropathy. It may have severe implications in the diabetic foot and may be the initial cause for several wounds.³ Excessive thickening and deformities of the nails may result in an accumulation of debris beneath the nail which may predispose to bacterial growth. Additionally improper shoes may press on the nails and may become the site of ulceration following repeated microtrauma. Once onychodystrophy occurs, it is rather challenging to manage these deformities. Hence, the care of toe nails in the diabetic foot is as important as any other aspects involved in ulceration. Close follow-up and timely interventions may prevent the occurrence of such deformities.

Learning points

• Toe deformities may be the initial cause for several diabetic foot wounds.

• Toe care is as important as the care of the rest of the foot in diabetic patients.

Competing interests: None.

Patient consent: Obtained.

1. Feinmesser M, Zelig S.
Congenital deafness associated with onychodystrophy. Arch Otolaryngol
1961;74:507–8. [PubMed] [Google Scholar]

2. Oppel T, Korting HC.
Onychodystrophy and its management. Ger Med Sci
2003;1:Doc02. [PMC free article] [PubMed] [Google Scholar]

3. Millikan LE, Powell DW, Drake LA.
Quality of life for patients with onychomycosis. Int J Dermatol
1999;38(Suppl 2):13–16. [PubMed] [Google Scholar]

Articles from BMJ Case Reports are provided here courtesy of BMJ Publishing Group

The color of the toenail has changed – what is it, how to treat it?

You should be alert for discoloration of toenails, which can occur for a number of reasons. What is the norm, and what is a pathology that needs immediate help from a podiatrist, we will understand further.

Causes of discoloration of toenails

Healthy toenails have a regular shape, smooth surface, pale pink color with a slight natural sheen. You should be alerted by the change in their color, the appearance of stripes and inclusions. This could point to:

• improper nail care;
• fungal infection;
• mechanical injury, including due to wearing tight and uncomfortable shoes;
• infection;
• deficiency of vitamins and minerals in the body;
• skin pathologies – eczema, psoriasis, dermatitis;
• diseases of the internal organs.

A qualified podiatrist, who should be contacted immediately if the condition of the toenails changes, may suspect a particular pathology based on their color and immediately prescribe a series of examinations and tests to confirm or refute the alleged diagnosis. Toenails can change color to yellow, green, white, bluish and even black, read on for what it says.

Change to yellow: causes and consequences

Yellowing of the toenail plate is a common pathology observed in older people. The yellow color of the nail is provoked by external and internal factors, from completely harmless ones, such as the use of low-quality decorative varnishes or long-term use of certain medications, to dangerous ones, for example, circulatory disorders in the feet, liver and gallbladder diseases. But the most common cause of yellowing of the nail plates on the legs is their fungal infection, in which:

• color intensity can be from a faint pale yellow to a rich brown;
• there is a thickening of the nails, their friability, peeling from the bed.

If you do not take action in time, the fungus can affect all nails. This disease is infectious, which means that you will become potentially dangerous for your loved ones. Fungal infections of the nails must be treated. The right decision would be to contact a qualified podologist at the New Generation Podology Center in St. Petersburg. Comprehensive treatment of nail fungus with the use of drug and photodynamic RAST therapy gives a good result.

Appearance of white spots

White spots on the nails are diagnosed in people of different ages. They indicate leukonychia – the so-called pathology, characterized by the ingress of air bubbles into the space between the nail plate and the nail bed, which normally fit snugly together. Leukonychia is provoked by:

• injury to the nail plate due to impact or other vertical load;
• improperly performed nail extension procedure;
• sloppy manicure;
• certain medications;
• low hemoglobin level in the blood;
• mineral deficiency.

For the treatment of leukonychia, a medical pedicure is indicated, which will quickly get your nails in order.

Green discoloration: causes and consequences

A change in the color of the toenail plate from pale pink to yellow-green, greenish-blue or greenish-brown may indicate a bacterial infection of the nails, for example, Pseudomonas aeruginosa, which requires immediate medical attention. The infection can penetrate into the space between the nail plate and the nail bed. To get rid of it, you will be prescribed professional treatment for non-fungal diseases of the nails and skin using drug and photodynamic PACT therapy. Less dangerous causes of the green color of the nail plate include already healing bruises that have formed after an injury, bruise or pinching of the nail.

Cyanosis of the nails

Cyanosis of the toenails of character for older people who suffer from a general decrease in immunity. It appears due to poor circulation in the feet, hypoxia, anemia, asthma, heart disease.

Dark Spots

The most common cause of dark spots on the nails, ranging from light brown to black, is bruising resulting from injury or bruising. In addition, they can appear on the background of taking certain medications, hormonal disorders and during pregnancy.

Brown spots of various shapes and sizes may indicate non-fungal nail disease. The exact cause of their appearance can be determined by the podiatrist after receiving the result of the analysis of the scraping from the nail plate.

Inhomogeneous white color of the nail plates: causes and consequences

Changing the color of toenails to milky white is not completely, but also partially also requires an immediate consultation with a podiatrist. Most often, the white color of the nail plates indicates their defeat by a fungal infection. If adequate treatment of the fungus is not started in time, the nails will gradually thicken and grow, and their destruction will begin later.

The color of toenails can tell a lot about the general condition of the body. Its change from a pale pink hue to an unusual color for the nail plates is a reason to immediately contact a specialist. You can sign up for a consultation at our New Generation Podology Center in St. Petersburg, where an experienced doctor will quickly figure out what’s wrong and prescribe an adequate treatment that promotes a speedy recovery.

Why do toenails deform

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Pedicure

05 July 2021

900 04 Not every girl or woman can be proud of the impeccable condition of her toenails. Note that men also have this problem, but for them it is not so acute – after all, the representatives of the stronger sex, as a rule, wear closed shoes. And what should women do – especially in summer, when you want to wear open shoes or sandals? At the same time, the deformation of the nails often prevents the implementation of a pedicure and coating them with varnish. So many people ask the same question: what’s the matter, why do toenails look so terrible?

• Deformation of the nails and its causes
• Take a closer look at the nails – you will find a disease!

Nail deformation and its causes

Needless to say, beautiful and well-groomed toe nails are a serious advantage of every woman. Unfortunately, perfect nails are not as common as we would like. Even in young people, nails can be observed that have lost their regular shape, coarsened, and changed color. We list the reasons why deformation occurs:

• age-related changes;
• serious illness;
• lack of nail prophylaxis;
• pedicure violations;
• increased load on the legs.

As a rule, toenails begin to deform with age, and nothing can be done about it. Over the years, the nails lose their original elasticity, begin to coarsen, thicken. You have to cut them off no longer with scissors, but with special pedicure nippers. Age-related changes cannot be canceled – it remains only to strengthen the care of the feet and often give them the correct shape.

By the way, curvature of the nails, their deformation is observed not only in mature people, but also in athletes, as well as those who are engaged in heavy physical work. This is due to increased load – both excess weight and physical exercise can lead to impaired blood circulation, gradual internal changes in the feet and the nails themselves.

A pedicure carried out at an amateurish level for years can also damage the nails. Incorrect cutting, rough cleaning of dirt from under the nails with sharp tools, damage to the cuticle – all this causes a gradual deformation. Nails begin to thicken, microtraumas (obtained after cleaning and trimming) grow unevenly. Therefore, despite the fact that doctors see the deformation of the nails as a symptom of certain diseases, the masters of beauty salons say that one of its main reasons is the wrong pedicure.

Take a closer look at the nails – you will find the disease!

The most unpleasant and disturbing cause of changes in toenails is, of course, a consequence or symptom of a disease. Most often, this is a fungal infection, as a result of which the nails not only thicken and become excessively rough, but also become brittle, change color. In addition, the following diseases can be observed:

1. Furrows (usually transverse) – the result of problems with blood circulation, reduced immunity.
2. Flat deformity – a possible indication of eczema or cirrhosis of the liver.
3. Dots and tiny indentations on the nail – worth checking for rheumatism or tuberculosis.
4. Spoon deformity (nails begin to sag inward) – problems with blood circulation or the presence of iron in the body.