![]() ![]() ![]() 23 Elderly diabetic patients' nails may grow even slower and require a longer duration to treat. 13Toenails grow at one-third to one-half the rate of fingernails and thus need to be treated longer. The treatment of onychomycosis in diabetic patients is the same as in patients without diabetes. These may also provide a route for the entry of bacteria. 3, 4, 14, 15Extension of the fungal infection to surrounding skin causes tinea pedis,which may lead to fissures in the plantar and interdigital skin. ![]() When combined with peripheral neuropathy, blisters and erosions may progress to cellulitis or osteomyelitis of the underlying bone. 3, 4, 9, 14, 15Thickened nails can cause erosions of the nail bed and hyponychium because of pressure, just as tight shoes can cause friction blisters in these patients. Injury to adjacent skin from mycotic nails may occur without patients' awareness and can lead to secondary infections, both fungal and bacterial, including paronychia and cellulitis. Thickened,dystrophic nails can be very painful and make walking difficult. 13Because onychomycosis in diabetic patients can lead to many complications,most insurance companies cover treatment in documented cases. Thus, effective treatment in these patients is of paramount importance. 4, 10- 22The outcome from not treating onychomycosis in diabetic patients can be worse than in those without diabetes. Onychomycosis in people with diabetes is more than a cosmetic nuisance it increases the risk for other foot disorders and limb amputation. ![]()
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