Why nails can thicken with age
It’s widely recognized that toenails often become thicker, harder and slower-growing as people get older. Years of pressure from shoes and minor knocks to the toes can play a part. But nails can also thicken for other reasons, including fungal infections and other conditions that need a clinician to assess them.
From the outside, these can look similar. A nail technician can’t tell which is which, and shouldn’t try. That’s the first and most important point in this article: thick nails can be groomed, but the cause is a question for nursing staff or the resident’s podiatrist.
Why thick nails get skipped
Thick nails are often the ones left alone the longest. Ordinary clippers can’t cut through them, and forcing a clipper risks splitting the nail or pinching the skin. Staff may not have the time or the right tools. Residents usually can’t reach their feet or see them clearly. So the nails get longer and thicker, and the job gets harder each month it waits.
Long, thick toenails can press against shoes and neighboring toes and catch on socks and bedding. That can make shoes uncomfortable to wear and walking less comfortable. Keeping them trimmed is mostly about comfort, and about making sure someone is looking at the resident’s feet regularly.
What a licensed nail technician can do
Within the limits of their license, a nail technician can provide routine grooming for thick nails:
- Trim nails to a comfortable length using tools suited to thick nails, rather than standard clippers.
- File and reduce thickness gradually, a little at a time, rather than trying to fix everything in one visit.
- Smooth sharp or jagged edges that catch on socks, stockings or bedding.
- Keep nails on a regular schedule so they don’t become overgrown again.
- Note visible changes, such as color, crumbling, lifting or redness around the nail, and pass them to nursing staff.
The key word is gradually. A conservative approach avoids cutting too close, avoids forcing a nail, and stops if the resident is uncomfortable. The resident should stay seated and supported throughout.
What a nail technician cannot do
Nail technicians are licensed to provide cosmetic nail services. They are not medical providers. A nail technician should not:
- Diagnose or treat fungal infections or any other nail condition.
- Treat ingrown toenails, especially ones that are painful, red or swollen.
- Cut into or treat wounds, broken skin or anything that is bleeding.
- Provide care that a resident’s care plan or your facility’s policy reserves for a podiatrist or physician.
- Give advice about medications, creams or treatments.
If a provider offers to do any of these, that’s a reason to look elsewhere.
When to involve nursing staff or a podiatrist
As general guidance, a nail technician should stop and refer to nursing staff or the resident’s podiatrist if they notice:
- Redness, swelling, warmth or drainage around a nail.
- Pain when the nail or toe is touched.
- Nails that are badly discolored, crumbling or lifting away from the nail bed.
- Broken skin, sores or anything that looks like a wound.
- Any concern at all for a resident with diabetes or poor circulation.
Many care plans call for a podiatrist to handle foot and nail care for residents with diabetes or circulation problems. Your facility’s policy and each resident’s care plan should decide who provides what. A good nail care provider will ask about this before the first visit, not after.
Working together
Nail technicians and podiatrists do different jobs. A podiatrist assesses and treats medical problems. A nail technician keeps nails trimmed, filed and clean on a regular schedule. For residents whose care plans allow it, the two can work well side by side: routine grooming between podiatry visits, and a quick referral when something changes. Clear communication through nursing staff is what makes that work.
How we would approach it
Skilled Nail Care provides care for thick and difficult nails as part of our on-site pedicures for seniors. Our approach is to reduce thick nails gradually with the right tools rather than forcing a cut, keep the resident seated and supported, and follow your facility’s policy and each resident’s care plan. We don’t diagnose or treat nail disease. Anything that looks like it needs attention would go to your nursing staff so the resident’s podiatrist can take a look.
This article is general information, not medical advice. Skilled Nail Care provides nail technicians, not medical providers.