1.1 Describe the effects of common medical conditions on the feet and toenails

This guide will help you answer 1.1 Describe the effects of common medical conditions on the feet and toenails.

Many health and social care workers support people who have medical conditions that directly affect their feet and toenails. Left unmanaged, these problems can cause pain, reduced movement, and higher risk of more serious issues. People with certain medical conditions are more likely to develop infections, changes in skin and nail health, and foot deformities. If you are supporting someone with foot concerns, understanding how different conditions affect feet and toenails will help you deliver better care.

In this guide, we will look at the effects of diabetes, poor circulation, fungal infections, arthritis, and neurological conditions.

Diabetes

Diabetes is a condition where the body struggles to control blood sugar levels. Over time, high sugar levels damage small blood vessels and nerves, especially in the feet.

People with diabetes have an increased risk of foot and toenail problems, such as:

• Loss of sensation (neuropathy): People might not feel pain, heat or injuries. Small wounds or blisters can go unnoticed and worsen.
• Poor blood supply (peripheral arterial disease): Feet may be slow to heal, and skin can appear shiny, hairless, or thin.
• Increased risk of infection: High blood sugar provides a good environment for bacteria and fungi. Even small cuts or splits in skin can get infected quickly.
• Foot ulcers: Persistent wounds or sores often form on the bottom of the feet or heels. These can become deep and may not heal well.
• Changes in the shape of the foot: Nerve and circulation problems can weaken muscles. This might lead to “claw toes” or a high arch.
• Dry, cracked skin: Sweat glands may not work as they should, causing dryness and leading to splits or fissures.
• Fungal nail infections: Nails may thicken, become discoloured, and crumble.
• Ingrown toenails: Misshapen nails or pressure injuries might lead to nails growing into the skin.
• Amputation risk: In severe cases, serious infection or gangrene can mean part of the foot or toe must be removed.

Symptoms and What to Look For

• Numbness or tingling
• Changes in skin colour (red, blue, or pale)
• Swelling
• Cuts, sores, or blisters that do not heal
• Unusual odour or discharge from an ulcer
• Blackened skin (sign of dead tissue or gangrene)

Supportive Actions

• Daily checking of the feet
• Gentle cleaning and moisturising
• Reporting any new injuries or changes to a healthcare professional
• Careful nail trimming

Poor Circulation

Poor circulation, or peripheral arterial disease (PAD), happens when blood does not flow well to the feet. Blockages, usually from fat deposits in the arteries, reduce oxygen and nutrients sent to tissues.

This can lead to:

• Cold feet and toes
• Blue or purple skin colour
• Hair loss on feet and toes
• Thin or shiny skin
• Sores that heal slowly or not at all
• Nail changes – thickening, slow growth, or brittle nails
• Pain when walking (claudication)

Lack of blood supply means feet are more prone to injury and infection. Even small wounds can become serious.

Long-Term Effects

• Increased risk of ulcers, particularly on heels, ankles, or toes
• Dead tissue (gangrene) if blood supply is completely blocked
• Loss of toes or other parts, sometimes needing surgery

Supportive Actions

• Checking feet every day
• Keeping feet clean and warm
• Avoiding tight shoes or socks
• Not using hot water bottles (if sensation is reduced)

Fungal Infections

Fungal infections are common, especially in people with diabetes, weakened immune systems, or poor foot hygiene. One well-known infection is athlete’s foot (tinea pedis). Toenails can develop fungal nail infection (onychomycosis).

Athlete’s Foot

• Red, itchy, scaly rash
• Cracks or splits between toes
• Flaking or peeling skin
• Sometimes blisters or ulcers

Fungal Nail Infections

• Discoloured nails (yellow, brown, or white)
• Thickened or distorted nails
• Nails become brittle, crumble, or lift from the nail bed
• Sometimes foul smell

Both conditions can spread to other areas or people. Scratching can cause bacteria to enter and lead to other infections.

Why Infections Occur

• Warm, moist environments (sweaty shoes, not drying feet)
• Cuts or breaks in the skin
• Weak immunity

Supportive Actions

• Keeping feet clean and dry, especially between the toes
• Not sharing nail scissors or footwear
• Wearing sandals in communal showers
• Using treatment prescribed by a healthcare professional

Arthritis

Arthritis is inflammation of the joints. Two common types affecting feet are osteoarthritis and rheumatoid arthritis. Both can cause pain, deformity, and changes to the way feet function.

Osteoarthritis

• Wears down the cartilage at the ends of bones
• Causes stiffness, pain, and swelling
• Big toe and ankle are often affected
• May lead to bones rubbing against each other

Rheumatoid Arthritis

• Immune system attacks the lining of the joints
• Causes joint pain, swelling, and long-term deformity
• Toes can be forced out of normal position (“hammer toe” or “claw toe”)
• Bunions, corns, and calluses often develop
• Nails might become thickened or ridged if blood supply is reduced

Effects on Toenails

• Nails may become thick, yellow, or brittle
• If toes are misaligned, increased pressure may cause in-growing nails
• Swelling may make nail cutting painful or difficult

Supportive Actions

• Using footwear with enough room for swollen joints
• Regular podiatry visits
• Using joint supports if advised
• Gentle washing and drying

Neurological Conditions

Some conditions affect the nerves that supply the feet and toes. Nerve damage is called neuropathy. Common causes are diabetes, strokes, multiple sclerosis, and spinal injuries.

Effects

• Numbness, tingling, or burning in feet and toes
• Weakness or loss of movement
• Loss of sensation (can’t feel injuries, heat or cold)
• Poor balance or muscle wasting

Effects on Toenails

• Nails may become thick or overgrown if the person cannot reach their feet or does not notice problems
• Increased risk of untreated injuries near or under nails
• Fungal infections may go unnoticed as feeling is reduced

Supportive Actions

• Checking feet each day for signs of injury
• Helping with washing, drying, and nail cutting if the person struggles
• Using footwear that fits well and supports the foot

Gout

Gout is a type of arthritis caused by uric acid crystals collecting in joints.

• Most often affects the big toe
• Toe becomes red, hot, swollen, and very tender
• Repeated attacks can damage the joint and lead to lumps around the toe (tophi)
• Area around nail can become swollen, sometimes making nails grow abnormally or ingrow

Supportive Actions

• Gentle care during a flare-up as the affected toe is highly sensitive
• Wearing open or soft shoes
• Medical treatment as prescribed

Psoriasis

Psoriasis is a skin condition that can affect the feet and nails.

• Skin may appear red, scaly, and cracked
• Nails develop pits (small dents), become thick, crumbly, or lift from the nail bed (onycholysis)
• Increased risk of fungal nail infections

Supportive Actions

• Use of prescribed topical treatments
• Keeping nails short and clean
• Reporting new or worsening changes

Corns, Calluses, and Foot Deformities

Chronic medical conditions can change the shape of the foot and the way people walk.

• Bony changes may cause toes to point upwards (hammer toes) or sideways (bunions)
• Skin thickens where pressure is high, leading to calluses (hard areas) or corns (pointed, painful areas)
• Thick skin can crack, especially on the heel

Changes in pressure and shape can make nail problems worse, for example:

• Difficulties cutting nails
• Ingrown nails
• Pressure ulcers under thick nails
• Increased risk of infection

Supportive Actions

• Gentle filing of calluses if trained
• Referring to a podiatrist for advice
• Supporting safe footwear choices

Peripheral Neuropathy

Peripheral neuropathy refers to damage to the nerves outside the brain and spinal cord.

• Loss of feeling in the feet
• Pins and needles or numbness
• People may not notice cuts, blisters, or burns

This leads to greater risk of:

• Untreated injuries
• Ulcers from unnoticed pressure
• Infection

Toenails can develop fungal infections, overgrowth, or be damaged without the person realising.

Supportive Actions

• Careful checking for new marks or injuries
• Help with nail care
• Advising professional removal of calluses or corns

Poor Foot Hygiene and Mobility Problems

Many elderly people or those with long-term illness find it harder to reach and wash their feet. Weakness or stiff joints make nail cutting or drying between the toes difficult.

• Increased risk of fungal and bacterial infections
• Thick, yellow, or brittle nails
• Dirt or debris under the nails
• Athlete’s foot between toes

Care staff may need to help with:

• Gentle washing and proper drying
• Checking for signs of infection
• Filing nails or referring to a podiatrist for safe trimming

Pressure Ulcers

Pressure ulcers are wounds caused by constant pressure cutting off blood supply to one area. People who are less mobile, or use wheelchairs, are at higher risk.

• Heels and balls of the feet are common sites
• Early signs include red or purple skin
• Open sores, deep wounds or blisters may develop
• Infection can spread under the skin or nails

Supportive Actions

• Checking daily for red marks or sore spots
• Repositioning people who cannot move by themselves
• Using cushioned footwear or padded supports

Practical Support and Reporting

Health and social care workers must look for changes in the appearance, colour, shape, or condition of feet and toenails. Always record and report:

• Sores or ulcers
• Sudden changes to temperature or colour
• Nails that become thick, black, or come away from the nail bed
• New pain, redness, or swelling
• Any signs of infection (pus, odour, increased heat)
• Loss of sensation or reduced mobility

Early reporting helps prevent small issues from becoming serious. Regular foot care is part of daily support for people with these medical conditions.

Final Thoughts

Many people are embarrassed about foot issues or find it hard to talk about them. You can make a big difference by being observant, gentle, and reassuring. Keeping feet healthy supports comfort, confidence, and mobility.

Remember, always follow your organisation’s procedures and refer concerns to a health professional when needed. Never attempt to treat severe infections, ulcers, or thick nail problems unless you have the correct training. Podiatrists and foot health practitioners are the right people to manage complex problems. Your main role is to notice, record, support, and raise the alarm if anything changes or looks worrying.