Toenail Fungus and Diabetes: Why Foot Care Is Especially Important
Although it is estimated that around 8% of the general population may be affected by toenail fungal infections, this figure rises to as much as 30% among people with diabetes. Elevated blood glucose levels can alter immune system function and reduce the body’s resistance to fungal infections. For this reason, proper foot and nail care becomes a particularly important part of maintaining overall health for individuals with type 2 diabetes.
It is important to emphasize that toenail fungus itself is not a sign of diabetes. However, people with diabetes are significantly more susceptible to fungal nail infections, which means they need to pay greater attention to prevention and early detection.
Nail fungus, also known as onychomycosis, is a common foot infection that usually begins as a white or yellowish spot under the tip of the nail. The most common cause of the infection is a group of fungi called dermatophytes, although yeasts and molds can also be responsible.
If left untreated, a fungal infection gradually penetrates deeper into the nail structure and can lead to:
changes in nail color,
brittle, crumbling nails,
breakdown of the nail edges,
spread of the infection to other nails.
If the fungus affects the skin between the toes or the surface of the foot, the condition is known as athlete’s foot (tinea pedis). It is important to note that having had athlete’s foot increases the risk of developing a fungal nail infection later on. However, direct transmission from another person occurs relatively rarely.
Even after successful treatment, nail fungus can recur, which is why daily foot care should become a consistent habit—especially for people with diabetes. A weakened immune system and reduced blood circulation create favorable conditions for infections to develop.
Older adults are also at higher risk because they may have had longer exposure to fungi over their lifetime and because their toenails grow more slowly. Additional factors that increase risk include:
excessive foot sweating,
blisters and micro-injuries,
foot ulcers,
walking barefoot around pools, public showers, or locker rooms.
For people with diabetes, it is especially important to pay attention to reduced circulation in the feet. Untreated toenail onychomycosis can become painful and may even destroy the nail. Since individuals with diabetes already have a higher risk of cellulitis (a bacterial skin infection), even minor nail or skin injuries can lead to serious complications, including nerve damage.
Proper foot care is a vital part of healthcare for every person living with diabetes.
People with diabetes are more likely to experience secondary bacterial infections, foot ulcers, cellulitis, gangrene, and, in severe cases, lower-limb amputation. If blood flow is reduced due to peripheral vascular disease, these conditions can worsen further.
If you have diabetes and notice possible signs of nail fungus, it is recommended to consult a doctor, podiatrist, or dermatologist as soon as possible. These specialists are familiar with the specific challenges faced by people with diabetes and can help develop an appropriate treatment and care plan.
Living with type 2 diabetes requires constant attention to specific medical needs, and foot infections can affect not only physical health but also emotional well-being. Nail fungus often impacts self-esteem, social life, personal relationships, and even productivity at work.
Visible nail changes, fear of transmitting the infection to family members or others, and a persistent feeling of being “unclean” can become significant sources of embarrassment and reduced self-confidence. Untreated fungal and bacterial infections can be harmful both physically and emotionally over time.
Various treatment methods are used for nail fungus, depending on the severity of the infection:
Topical treatments (creams, sprays) are usually suitable for mild to moderate infections.
Terbinafine preparations (Lamisil)—tablets or creams—are widely used in both children and adults. In more severe cases, oral treatment may last several months.
Tea tree oil is sometimes mentioned as a natural option, but its effectiveness is not sufficiently supported by scientific evidence.
Oral medications may not be suitable for some patients due to potential interactions with other drugs or underlying liver conditions, so treatment should always be discussed with a healthcare professional.
It is important to note that because healthy nails grow slowly, visible treatment results may only appear after 12–18 months.
Daily nail and foot care helps detect early signs of infection and prevent progression. Recommended measures include:
washing, thoroughly drying, and moisturizing the feet daily;
disinfecting hands after touching an affected nail;
trimming nails straight across and filing thickened areas;
disinfecting nail care tools after each use;
always wearing protective footwear in public areas;
regularly disinfecting shoes with antifungal powders or sprays (e.g., Cutasept F);
choosing breathable footwear and moisture-wicking socks.
If you currently have or have recently had a fungal nail infection, it is advisable to temporarily avoid nail polish, gel, or acrylic nails, as these can trap the infection and delay timely detection.
