Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Why Proper Toenail Care Matters
Toenail care is one of the most overlooked aspects of foot health, yet improper nail care is among the leading causes of preventable foot problems seen by podiatrists—including ingrown toenails, fungal nail infections, nail trauma, and skin breakdown. For most healthy individuals, proper toenail care is a straightforward routine that prevents these common problems. For patients with diabetes, peripheral vascular disease, or immunocompromise, careful toenail maintenance is a critical part of preventing serious complications including foot ulcers and infection.
How to Cut Toenails Correctly
The most important rule: cut toenails straight across, not rounded at the corners. Rounding the corners encourages the nail edge to grow into the surrounding skin—the primary cause of ingrown toenails. Cut the nail to the end of the toe, leaving a small amount of white nail visible beyond the nail fold. Do not cut the nail too short (below the end of the nail groove), as this exposes tender skin and increases ingrown nail risk.
Use proper nail clippers designed for toenails—they are wider and stronger than fingernail clippers. For thick nails (common in nail fungus), nail files or a podiatric nail drill may be needed to manage nail thickness before cutting. Cut nails after bathing when they are softer and easier to cut cleanly. If you cannot reach your toenails comfortably or safely, professional nail care from a podiatrist is the appropriate solution—particularly for patients with limited flexibility, vision problems, or health conditions affecting healing.
How Often Should You Cut Toenails?
Toenails grow approximately 1.5mm per month—slower than fingernails and slower in older adults. For most people, trimming every 6–8 weeks is appropriate. Nails that are allowed to grow too long are susceptible to trauma (being caught on socks, stubbed, or broken) and are more likely to develop ingrown edges. Athletes—particularly runners—should keep toenails trimmed shorter to prevent black toenails (subungual hematomas) from nail-to-shoe repetitive trauma. If a toenail is thickened, discolored, or difficult to cut, have it evaluated by a podiatrist before continuing home maintenance.
Preventing Ingrown Toenails
Ingrown toenails (onychocryptosis) result from the nail edge piercing or pressing into the adjacent nail fold skin. Prevention: cut nails straight across (never curved), do not cut below the nail fold, wear shoes with adequate toe box width that do not compress the toes, and avoid tearing or picking at nail edges. Tight-fitting shoes and athletic footwear that compress the forefoot are common contributing factors. If an ingrown nail is developing, early intervention (soaking, lifting the edge, proper trimming) prevents progression to infection. Recurrent or painful ingrown nails warrant a podiatrist visit—a simple in-office procedure (partial nail avulsion) permanently resolves most ingrown nail problems.
Recognizing and Preventing Toenail Fungus
Fungal toenail infection (onychomycosis) affects approximately 10% of the general population—rising to 20% in adults over 60 and 50% in adults over 70. Early signs include nail discoloration (yellow, brown, or white), thickening, and brittleness. Prevention: keep feet dry (change socks daily, dry between toes), wear moisture-wicking socks, avoid walking barefoot in locker rooms and pool areas, use antifungal spray in shoes, and do not share nail clippers or footwear. If a nail develops signs of fungal infection, early treatment with topical antifungals is more effective than waiting—once established, nail fungus is difficult to treat and can spread to other nails and to the skin.
Frequently Asked Questions
Should diabetics cut their own toenails?
Many diabetics with good circulation, adequate sensation, and normal vision can safely trim their own toenails using proper technique—straight across, not too short, with proper clippers. However, diabetics with peripheral neuropathy (reduced sensation), poor circulation, limited vision, or difficulty reaching their feet should have toenails trimmed by a podiatrist. The risk for diabetics is that even minor nail care errors (cutting too short, nicking the skin) can lead to wounds that heal slowly and potentially progress to serious infection. Medicare and most insurance plans cover routine nail care by a podiatrist for diabetics with documented neuropathy or vascular disease—this is not considered cosmetic treatment in this context. When in doubt, professional nail care is the safer choice for any diabetic patient.
What causes thick toenails and how do I treat them?
Thick toenails most commonly result from fungal nail infection (onychomycosis), which changes the nail matrix and produces abnormal, thickened, brittle, and discolored nails. Other causes include nail trauma (repeated microtrauma from shoe pressure or sports), psoriasis affecting the nails, aging (nails naturally thicken with age), and peripheral vascular disease. Fungal nail infections are treated with topical antifungals (ciclopirox, efinaconazole) for mild cases or oral terbinafine for more extensive disease. Thickened nails from other causes are managed by regular reduction—filing or grinding—to keep them at a comfortable thickness. A podiatrist can confirm the cause (including KOH preparation or nail culture for fungus) and advise on appropriate treatment.
Is it safe to get a pedicure at a nail salon?
Pedicures at nail salons carry some risk of fungal and bacterial infection, particularly from shared foot baths and instruments that may not be adequately sterilized between clients. Risks can be reduced by choosing salons that use disposable liners in foot baths, sterilize metal instruments in an autoclave, use single-use files and buffers, and are visibly clean. Avoid shaving or waxing legs immediately before a pedicure (micro-cuts increase infection risk), and inform the salon if you have any open wounds, skin conditions, or nail problems. Diabetic patients and those with compromised immunity or circulation should consult with a podiatrist before receiving salon pedicures—medical pedicures performed in a podiatric office are a safer alternative that addresses both cosmetic and health aspects of nail care.
Medical References & Sources
- American Podiatric Medical Association — Nail Care
- American Academy of Dermatology — Nail Care Tips
- PubMed Research — Toenail Fungus Prevalence and Treatment
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He provides professional toenail care, ingrown nail treatment, and onychomycosis management for patients of all ages including diabetic patients requiring medical nail care.
Dr. Tom’s Recommended Products for Toenail Problems
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Toenail Problems? We Treat Them All
From fungal nails to ingrown toenails to thickened nails, our podiatrists provide professional toenail care and treatment for all nail conditions.
Sources
- Westerberg DP, Voyack MJ. “Onychomycosis: current trends in diagnosis and treatment.” Am Fam Physician. 2013;88(11):762-770.
- Haneke E. “Nail surgery.” Clin Dermatol. 2013;31(5):516-525.
- Rich P. “Nail disorders: diagnosis and treatment of infectious, inflammatory, and neoplastic nail conditions.” Med Clin North Am. 2023;107(4):703-717.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
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