Prevention and Care of Toenail Disorders Due to Chemotherapy

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Toenail disorders are fairly common during chemotherapy, especially with certain drugs. The most common problem is onycholysis, or damage to the tissue that keeps toenails and fingernails in place. Fortunately, solid research has found that this damage can be greatly reduced by using a natural plant balm.1 Learn about what you might expect, how to care for your toenails during treatment, and when you may need further treatment.
Common Toenail Problems During Chemotherapy

The most common toenail problem related to chemotherapy is onycholysis, damage to the tissue that keeps the toenails from falling off, and when this occurs, they commonly do. The process itself is usually painless, but when combined with other nail changes and a low white blood cell count, can lead to discomfort and risk of infection.

There are a number of other nail problems during chemotherapy that may occur as well, but onycholysis is one of the most distressing among women facing breast cancer.
Timing

Fingernail issues usually resolve around six months after completing chemotherapy, but toenails can take longer to recover.
Chemotherapy Drugs Most Likely to Cause Issues

Any chemotherapy drug may cause toenail problems, but these symptoms are more likely to occur with some drugs than others, including taxanes (such as Taxol), anthracyclines (such as Adriamycin), and 5-FU. both Taxol and Adriamycin are commonly used for breast cancer as well as several other cancers.
Prevention

While there had been little people could do to reduce nail problems during chemotherapy (other than practice good nail care), this is changing. A 2018 study looked at the use of natural polyphenolic-rich herbal oil (PolyBalm) which is applied to the nails during chemotherapy.1 In a double-blinded randomised trail they found that the balm "profoundly" reduced chemotherapy-related nail damage when compared with a control group.
Treatment

Even when practicing prevention, secondary problems such as fungal infections or secondary infections may occur. During chemotherapy this is of greater concern, as people may not be able to fight off an infection as easily.

If you develop redness, discharge or drainage around your nails, or a fever, see your doctor. She may prescribe topical (or sometimes oral) antibiotics or antifungal creams.
Toenail Care Tips

Toenails grow only half as fast as fingernails, or about 0.5 centimeters every three months. Like fingernails, toenails can develop other disorders, lines, ridges, discolorations, and even come loose during chemotherapy. To keep your toenails healthy during treatment and recovery, try these tips.
During Chemotherapy Infusions

During a chemo infusion, you may wish to try soaking your fingers and toenails in ice water. Like sucking on ice while having chemo, this can help prevent nail problems as well as mouth sores. That said, keeping your feet in an ice bath can be very unpleasant, and taking care of your nails in other ways (as well as considering the use of PolyBalm) may be a better experience.
Basic Toenail Care During Chemo

Clip toenails straight across, keeping them short. This helps prevent breakage and splitting, as well as ingrown toenails. Try soaking your toes in warm water for a short period of time before clipping your nails, as this will soften them and may prevent splitting or cracking.

Keep your toenails clean and moisturized. Many oncologists recommend avoiding pedicures, as this is one thing you can do yourself to lower your risk of infections during chemotherapy. If you do choose to have a pedicure or do your own, sterilize your tools in bleach and water beforehand to prevent infections. Cut away any loose cuticle but don't rip, as this may cause bleeding (especially if you have a low platelet count or chemotherapy-induced thrombocytopenia) and leave you prone to infection.
Try Strengthening Your Toenails

Fragile nails may be strengthened with biotin, a water-soluble B-complex vitamin at 5 mg per day, but talk to your oncologist first. Some vitamin supplements may interfere with chemotherapy.2 Tea tree oil has been used for fungal infections in toenails, but an anti-fungal medication may be needed. Clear polish may also help protect toenails during treatment. (If you will be having surgery, you should avoid colored nail polish.)
Protect to Prevent Injuries

Try to avoid injuries to your toes, as bruises will heal very slowly. If you like to walk around barefoot, make sure you watch for any obstacles in your way. In some occupations, steel tip shoes are used to avoid injuries, and in healthcare workers, open-toe shoes are discouraged for the same reason. Think about the footwear you use and make good choices that are most likely to protect your feet. For example, sandals are nice in the summer months, but if you hike in the woods you risk not only irritating bug bites (that could become infected), but injuries from rocks and sticks as well.

That said, open-toed and/or wide toed shoes improve circulation and provide protection for loos or fragile toenails. Even small cuts on your toes or feet (especially if you also have diabetes) can lead to infection.
Seek Professional Attention for Calluses and Cracks if Needed

If you tend to develop thick calluses and heel cracks on your feet, take special care. It's usually recommended that people avoid filing calluses during chemotherapy (using an instrument that isn't sterile can lead to infections even in people who are not immunosuppressed). Using a nail file or having a doctor trim your feet should ideally wait until you have completed your infusions. If you have painful heel cracks, a cream such as Glysolid applied at night may help. When you apply this cream, however, putting on socks can be wise. Socks will both help retain the ointment against your skin and prevent it from ending up on your sheets.

A Word From Verywell

Toenail problems may seem minor relative to the other potential side effects of chemotherapy, but can reduce your quality of life and potentially raise your risk of an infection. An ounce of prevention is worth a pound of cure, and fortunately we now have a topical, non-toxic option for reducing the damage. That said, prevention isn't fool-proof, and following the care tips above is still important. Who knows, you may not be the first person to adopt healthy changes to protect yourself during chemotherapy that make a difference even after you're done receiving infusions!