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The Basics of Toenail Debridement

As our seniors increase in numbers, foot and toenail care will become a vital part of healthcare. When this care is done properly and given regularly, it is capable of preventing infections and even ulcerations.
The tools to help you get started are simple: Clippers, curette and Dremel. Clippers are available in single-action and double-action.

Toenail Cutting

Double-action clippers provide a more ergonomic grip over single-action clippers. This mechanical advantage is important when dealing with thick mycotic toenails. The depth of the clipper blade is less important since you will only be using the distal 2-3 millimeters of it when cutting nails. Curettes come in a variety of lengths and tip sizes. For foot care, a double-ended 2.5 millimeter curette is ideal. Bigger curettes are not recommended since they will not comfortably slide underneath the nail. Remember that nail care should never be painful. If your patient is in pain, you have been too aggressive, whether with a nail clipper, a Dremel or a curette.

In a professional setting, we will always use a round beveled cut on our patients. This type of cut will ensure that patients can go longer in between visits and will prevent ingrown toenails, a common cause for pain and infection. The proper rounding of the nail is absolutely imperative and must be completed with a clipper and a curette in conjunction. Use the clipper to cut the seen portion of the nail into a rounded shape, then use the curette to expose any unseen nail "spikes" that can easily grow inward as the nail gets longer.

When clipping extremely curved nails, also known as omega or pincher nails, take care to change the angle of intent often in order to adjust to the curvature of the nail.

Dystrophic Toenails

Not all nails will require a Dremel sander, however, it is common that you'll see dystrophic nails in this line of work. Dystrophic nails can be thinned through manual sanding, however, the quickest and most effective way to sand very thick toenails is with an electric sanding device. Thick nails should be sanded to avoid ulcerations due to shoe pressure, and can be sanded as thin as you desire. While the skin under the nail may be initially more sensitive under sanding, there is no harm in exposing it completely if necessary.
Because onychomycosis is not a curable condition, your ongoing treatment to cut and thin the nail in order to reduce discomfort or even injury is extremely valuable.

*If you are concerned about fungal infections in the lungs from dystrophic nails, understand that toenail onychomycosis is not transferrable through sanding particles. If you have concerns about inhaling fine particles in general, we recommend that you were a mask while sanding.

Dr. Julia Overstreet has practiced podiatry for over 25 years and aims to help nurses like yourself feel more confident in the care they provide. To expand your nail care knowledge through hands-on experience, check out one of our foot care training workshops.