I go to my podiatrist every 6 weeks to get my toenails cut. Lately, both of my big toenails have become painfully ingrown. The doctor said she could remove the toenail in the office in 30 minutes, but my A1c is 7.7, and she wants to be safe and wait because of the risk of infection.
How many of you with T2 have gotten an infection from a big toenail removal, and how many of you have not?
I am leaning towards waiting, as is my doctor, but it is so painful when it becomes ingrown as it is growing out; I am done with the pain. I have to get shots (anesthesia) to get my big toenails cut. I really appreciate any help you can provide. Thank you all in advance.
If it were me with an A1c of 7.7%, I would wait until I could drop my A1c to under 6.5%. There are no guarantees here, just tipping the odds of infection and slow healing in my favor. In fact, I would adopt, at least temporarily, a strict lifestyle of eating and exercise to drastically improve my glycemia.
At a minimum, if you can, I would start on a CGM if you’re not already using. This item is a great teacher and would provide you motivation to alter some lifestyle factors.
An A1c of 7.7% is an average glucose of 174 mg/dL. I’ve not had big toenails removed but I’ve experienced many procedures to treat ingrown big toenails. I’ve lived with T1D for 42 years. The risk of infection and the possibility of that infection leading to amputation is daunting. My lifetime of visiting podiatrists for various procedures have forced me to listen to many of their gruesome cautionary tales.
I’ve lived with an A1c as high as the low 8% range and had many respiratory infections. I also had GI infections that led to a stubborn C-diff infection that took months to resolve. Some C-diff infections never heal!
Sorry to bring up the dark side of your situation but I think you should approach this situation carefully, which you seem to already understand. I wish you the best in bringing this circumstance to a healthy conclusion. Maybe this will alter some of your habits that could enable better BGs. I know it’s hard but you can do it!
I performed an AI search using the following setup.
This situation pertains to a t2d with an a1c of 7.7%. Podiatrist considers patient desire to remove big toenail in order to relieve chronic pain but views the current a1c as risky. Is podiatrist caution warranted? Be truthful, direct and challenge any assumptions.
It came back with this:
AI Overview
Yes, the podiatrist’s caution is fully warranted. An A1c of 7.7% in a patient with Type 2 diabetes (T2D) significantly increases the risk of complications from toenail removal, even though it is considered a minor procedure.
Key Risks and Medical Context
Increased Infection Risk: Numerous studies have found a significantly higher rate of postoperative surgical site infections (SSI) in diabetic patients with A1c levels greater than 7%. Uncontrolled blood sugar impairs immune function and the body’s ability to fight off bacteria, making infection a primary concern.
Impaired Wound Healing: Elevated glucose levels interfere with the normal wound healing process, which can lead to the surgical site re-opening (dehiscence), delayed recovery time, and potentially severe complications.
Risk of Serious Outcomes: In diabetic patients, seemingly minor foot issues and subsequent infections can escalate rapidly, in some extreme cases leading to hospitalization and even amputation, particularly if the patient also has neuropathy or peripheral vascular disease.
A1c Thresholds: While some guidelines suggest a cutoff of 8% for many general surgeries, a stricter goal of 7% or lower is often preferred for foot and ankle procedures due to the unique vulnerability of the diabetic foot. An A1c of 7.7% falls into a range where the risk of complications is demonstrably higher than for a patient with better glycemic control.
Challenging Assumptions
“Minor” Procedure Assumption: The assumption that a toenail removal is a universally minor, low-risk procedure is incorrect for a T2D patient with suboptimal glycemic control. Diabetes fundamentally changes the risk profile for any procedure involving the extremities.
Patient Desire vs. Medical Safety: The patient’s desire for immediate pain relief is valid, but the podiatrist’s primary responsibility is patient safety. Proceeding against medical guidelines could put the patient at significant, avoidable risk.
The podiatrist is making a responsible decision by prioritizing the patient’s long-term health and safety over immediate convenience. The best course of action is likely to postpone the elective procedure until the patient’s A1c is lowered to a safer level (ideally below 7%) through improved diabetes management.
I am sorry you find yourself in this painful position. I’ve lived with toenail pain for short-term episodes and can’t imagine being forced to live with it for any indeterminate time length. My thoughts are with you!
Terry, I SO appreciate you and the time you took to secure all of this valuable information. Your feedback and suggestions are also vital to me. I agree with you. My mom, T2, was diabetic, and after getting infections in her toes, she ultimately lost her leg; so I am pretty concerned about having a toenail removed. Thank you again, so, so, so much. Grateful!
Amy, they can permanently remove just a sliver of the toenail, allowing it to straighten itself out. They remove a sliver, usually on the inner edge closest to the next toe, and then they cauterize the root, so it doesn’t grow back.
I had that done many, many years ago, and it lasted for many, many years until I got a bad podiatrist who cut my toenails wrong, causing them to ingrow again. I probably should find another podiatrist who can do that because four of my toenails are curving so much that even my pedicurist is having trouble cutting them safely.
