Nail and Skin Care

As we age, our feet naturally undergo changes. Skin can become thinner and drier, nails may thicken or change shape, and circulation or sensation might decrease. These age-related changes can make feet more susceptible to common problems like thickened nails, fungal infections, dry or cracked skin, corns, and calluses. Paying attention to foot health is crucial for older adults in Singapore to maintain comfort, mobility, independence, and prevent potentially serious complications. Regular professional podiatric care plays a vital role in managing these conditions effectively.

It’s helpful to be aware of common age-related changes and potential problems:

Nail Changes:

• Thickening (Onychauxis): Nails become thicker and harder to cut.
• Brittleness: Nails may split or break easily.
• Discoloration: Yellowish, brownish, or opaque appearance, which can sometimes indicate fungal infection (onychomycosis).
• Ridges or Deformities: Nails may develop lines, become curved (pincer nails), or distorted.
• Ingrown Toenails: The nail edge grows into the surrounding skin.
• Slow Growth: Nail growth rate often decreases with age.

Skin Changes:

Dryness (Xerosis): Skin loses moisture and elasticity, becoming dry, flaky, or itchy.

• Cracked Heels (Fissures): Deep cracks can form in dry skin, especially around the heels, potentially opening pathways for infection.
• Calluses and Corns: Thickened patches of hard skin develop over areas of repeated pressure or friction.
• Thinning Skin: Skin may become more fragile and prone to tearing or bruising.
• Reduced Sensation: Decreased ability to feel light touch, pressure, pain, or temperature changes (related to neuropathy or circulation issues).
• Cold Feet / Discoloration: Changes in skin colour or temperature may indicate circulatory problems.

Several factors contribute to nail and skin issues in older adults:

• Natural Ageing Process: Reduced collagen and elastin production leads to thinner, less elastic skin. Decreased natural oil production causes dryness. Nail growth slows, and structure can change.
• Reduced Circulation (Peripheral Artery Disease – PAD): Blood flow to the feet often decreases with age or due to underlying conditions, impairing nutrient delivery and waste removal, affecting skin and nail health, and slowing healing.
• Reduced Sensation (Peripheral Neuropathy): Nerve function can decline due to age or conditions like diabetes, making it harder to detect injuries, pressure, or irritation.
• Systemic Health Conditions: Chronic diseases like diabetes, arthritis (osteoarthritis, rheumatoid arthritis), kidney disease, thyroid problems, and vascular disease significantly impact foot health.
• Medication Side Effects: Some medications can cause skin dryness or other foot-related side effects.
• Years of Wear and Tear: Cumulative stress and minor injuries over a lifetime take their toll.
• Decreased Mobility/Flexibility: Difficulty bending down or reaching feet can make self-care (washing, drying, inspecting, nail cutting) challenging.
• Impaired Vision: Difficulty seeing feet clearly can lead to unnoticed problems or unsafe nail trimming.

Inadequate Footwear: Wearing ill-fitting or unsupportive shoes for many years contributes to corns, calluses, and nail problems.

• Infections: Fungal infections (nails, skin) or bacterial infections entering through cracked skin, ingrown nails, or cuts from improper nail care. Infections can be more serious in those with poor circulation or diabetes.
• Pain and Discomfort: Corns, calluses, thick or ingrown nails can cause significant pain, limiting mobility and activity.
• Ulceration: Particularly in individuals with diabetes or poor circulation, pressure from calluses or minor injuries can lead to skin breakdown and non-healing ulcers.
• Reduced Mobility and Independence: Foot pain is a major contributor to reduced mobility and loss of independence in older adults.
• Increased Fall Risk: Painful feet, unstable footwear choices due to foot problems, or altered gait can increase the risk of falls.

A podiatrist at Fine Podiatry Clinic provides a thorough assessment:

• Detailed Medical History: Reviewing overall health, chronic conditions (especially diabetes, arthritis, vascular disease), medications, allergies, previous foot problems, and current symptoms.
• Foot Examination: Carefully inspecting skin condition (dryness, cracks, calluses, corns, signs of infection), nail health (thickness, colour, shape, signs of fungus or ingrowth), and foot structure.
• Vascular Assessment: Checking foot pulses, skin temperature, colour, and potentially performing non-invasive tests (like Doppler) to assess blood flow.
• Neurological Assessment: Testing sensation to identify any loss of protective sensation (neuropathy).
• Footwear Assessment: Evaluating current shoes for fit, support, and appropriateness.
• Nail/Skin Samples (If Needed): Taking clippings or scrapings if fungal infection is suspected for laboratory confirmation.

Professional podiatric care is essential for safely managing geriatric nail and skin conditions, especially when self-care becomes difficult or underlying health issues are present.

Management focuses on comfort, prevention of complications, and maintaining mobility using Non-Surgical Treatments:

• Professional Nail Care: Safe and comfortable trimming, filing, and reduction (thinning) of thick, brittle, or deformed toenails using specialized, sterile instruments. Management of ingrown toenails
• Skin Care Management: Application of appropriate emollients/moisturizers. Advice on managing dry, cracked skin.
• Callus and Corn Debridement: Painless removal of problematic hard skin by the podiatrist to relieve pressure and prevent underlying issues. Self-treatment with blades or harsh chemicals is strongly discouraged.
• Fungal Infection Management: Professional advice and management options for fungal nail or skin infections, tailored to the individual’s health status.
• Footwear Advice & Modifications: Recommendations for appropriate, supportive, well-fitting shoes. Advice on accommodative footwear if deformities are present.
• Padding and Offloading: Use of protective padding for sore spots or pressure areas.
• Custom Orthotics: May be considered to improve foot support, cushioning, and pressure distribution if needed.

Note: Our priority is providing safe, gentle, and effective care to keep older adults comfortable and mobile.

Maintaining good foot habits is key:

• Daily Inspection: Check feet daily (or have someone assist) for cuts, blisters, redness, swelling, or changes in nails/skin. Use a mirror if needed.
• Gentle Hygiene: Wash feet daily with mild soap and lukewarm water. Dry thoroughly, especially between toes.
• Moisturise: Apply a recommended emollient daily to prevent dryness, avoiding areas between toes.
• Proper Footwear: Wear well-fitting, supportive shoes with non-slip soles both indoors and outdoors. Ensure adequate room for toes. Avoid tight hosiery.
• Safe Nail Care: If vision is poor, hands are unsteady, nails are very thick, or if you have diabetes or poor circulation, it is safest to have nails cut professionally by a podiatrist. If cutting own nails, trim straight across, not too short, and file sharp edges gently.
• Keep Feet Warm & Dry: Wear appropriate socks (cotton or wool blends are often good choices). Avoid prolonged exposure to cold or dampness.
• Regular Podiatrist Visits: Schedule routine check-ups for professional foot care and early detection of potential problems.