Management of Ingrown Toenails in Diabetic Patients

Assessment and Risk Stratification

The International Working Group on the Diabetic Foot (IWGDF) recommends evaluating the patient's diabetic foot risk category to determine the appropriate treatment approach and follow-up frequency 1
Assess for signs of infection, such as erythema, pain, swelling, and purulence, which would require more urgent intervention 3, 4
Check for peripheral neuropathy, peripheral arterial disease, and foot deformities, which may complicate treatment and healing 5

For uninfected ingrown toenails, professional nail care by a trained healthcare professional is recommended, including proper trimming of the ingrown portion of the nail, removal of excess callus, and careful debridement of the nail border 1, 2
Conservative approaches, such as nail bracing techniques, orthotic interventions, and properly fitting footwear, can provide immediate symptom relief without surgery 2, 6, 7
For infected ingrown toenails, obtain appropriate cultures before starting antibiotic therapy, and consider broader spectrum coverage and longer duration of treatment for moderate infections 3, 4, 8
Surgical intervention, such as partial or complete nail avulsion, may be necessary for recurrent or severe cases that don't respond to conservative treatment 2, 6

Educate patients on proper nail trimming technique, such as trimming straight across and not too short, to prevent ingrown toenails 7, 5
Advise against barefoot walking or wearing inappropriate footwear, and instruct patients to inspect their feet daily and seek prompt medical attention if problems develop 6, 7
Recommend appropriate footwear that accommodates the shape of the feet and fits properly 1, 6

Schedule regular follow-up visits based on risk category, such as every 1-3 months for high-risk patients and every 3-6 months for moderate-risk patients 1
Provide integrated foot care, including professional foot care, adequate footwear, and structured education about self-care 1

Never delay treatment of ingrown toenails in diabetic patients, as they can rapidly progress to serious infections 2
Avoid self-treatment by patients, especially those with neuropathy, and be vigilant for fungal infections that often coexist with ingrown nails in diabetic patients 7, 2
Consider vascular status before any surgical intervention, as poor circulation may impair healing and increase infection risk 3