Foot and Nail Care During Chemotherapy

Chemotherapy can affect the feet and toenails, increasing the risk of nail damage, nerve problems, and infections. Early foot care, regular monitoring, and timely podiatry support can help prevent complications and keep cancer treatment on track.

Patients seeking a second opinion about cancer care and its side effects can call City of Hope at 800-826-4673.
Cancer treatment brings changes that most patients anticipate, such as fatigue, nausea, hair loss and changes in appetite. The feet are rarely on that list, so foot and nail problems tend to go unnoticed until they hurt or start to spread. Chemotherapy alters how toenails grow and how the nerves in the feet work, and both of those changes carry more risk during treatment than they would for an otherwise healthy person. Knowing what to watch for, and who to ask for help, keeps a small problem from turning into an infection during the months when the body is least able to fight one.

Why does chemotherapy change the toenails?

Many chemotherapy drugs work by killing cells that divide quickly. Cancer cells divide quickly, but so do the cells in the nail matrix, the tissue at the base of the nail where a new nail is made. When those cells are disrupted, the nail that grows out afterward can look and feel different for several months.

Common nail changes during and after chemotherapy include:

• Horizontal ridges or grooves, known as Beau’s lines, that mark the weeks when nail growth slowed
• Separation of the nail from the nail bed, called onycholysis, which can leave the nail lifted or ready to fall off
• Discoloration, from white patches to brown or bluish tones
• Brittleness and splitting, along with noticeably slower growth
• Bleeding or a dark spot under the nail, which the taxane drugs used for breast and other cancers are known to cause
• Greater susceptibility to fungal infection, because a lifted or damaged nail gives fungus an easier entry point

The National Cancer Institute lists nail changes among the recognized side effects of taxane and anthracycline chemotherapy. Most of these changes are temporary and resolve once treatment ends and a full nail has regrown, which takes roughly six to twelve months for a toenail.

What foot symptoms come from peripheral neuropathy?

Chemotherapy-induced peripheral neuropathy is one of the more common reasons patients report foot trouble. Certain drugs, including the platinum agents and the taxanes, damage the small nerves that carry sensation from the hands and feet. The feet are often affected first because those nerves are the longest in the body.
Patients may notice:

• Numbness or a loss of feeling, often starting in the toes
• Tingling or burning, sometimes with a pins-and-needles sensation
• Sharp or shooting pain
• Trouble sensing hot and cold
• Reduced balance and a higher risk of tripping

The loss of sensation is the part that matters most for foot health. A patient who cannot fully feel their feet may not notice a blister, a cut from a nail edge, a pressure sore from a tight shoe, or a burn from water that is too hot until it has already broken the skin. Peripheral neuropathy can persist for months after the last treatment, and in some patients it never fully resolves, so foot care stays relevant well into survivorship.

Why do minor foot problems become serious during treatment?

A cracked heel or an ingrown nail is a nuisance for most people. During chemotherapy it is a different situation. Many regimens lower the white blood cell count, a state called neutropenia, which leaves the body less able to contain bacteria. Wounds also heal more slowly when the immune system is suppressed.

Put those factors alongside reduced sensation in the feet, and a break in the skin that the patient cannot feel can progress to a local infection, and occasionally to a bloodstream infection, before anyone notices. This is why oncology teams treat any sign of infection in a neutropenic patient as urgent. Preventing the break in the skin in the first place is far simpler than treating what follows.

When to see a podiatrist during cancer treatment

A podiatrist is worth adding to the supportive care team when nail or nerve changes make routine foot care harder or riskier to do at home. Chemotherapy can leave toenails brittle, lifted, discolored or slow to grow back, and reduced sensation from peripheral neuropathy means small cuts and pressure injuries on the feet often go unnoticed. A podiatrist can cut nails safely with sterile instruments, monitor skin and nail changes between oncology appointments, spot early pressure injuries a patient cannot feel, and treat problems such as ingrown or fungal nails before they become an infection risk for immunosuppressed patients. Established clinics such as Capital Podiatry, a podiatry clinic in Canberra that has provided fungal nail and ingrown toenail care, plus senior nail-care services, since 2005, manage these conditions as part of routine practice.

Patients should tell the podiatrist they are undergoing cancer treatment, and ideally have the podiatrist and oncology team communicate. The reason is practical. During neutropenic periods some clinicians prefer to avoid procedures that could break the skin, so timing a nail treatment around blood counts matters. Trimming nails straight across rather than curved, keeping the feet dry, wearing well-fitted shoes, and checking the soles daily with a mirror or a family member’s help are simple measures a podiatrist will reinforce.

When should patients call their care team?

Some foot symptoms warrant a same-day call rather than waiting for the next appointment. Patients should contact their oncology team promptly if they notice:

• Redness, warmth, swelling or pus around a nail or a wound
• A cut or sore that is not healing
• A fever, which in a neutropenic patient is treated as an emergency
• Numbness or pain that is getting noticeably worse or spreading up the leg
• A nail that has lifted with signs of infection underneath

Foot and nail changes during chemotherapy are usually temporary and manageable, and they rarely signal anything more serious than the treatment doing its work on fast-growing cells throughout the body. Watching the feet closely keeps a minor, expected side effect from becoming the reason treatment has to pause.

Patients seeking a second opinion about cancer care and its side effects can call City of Hope at 800-826-4673.

Source-Medindia