#T4TD onychogryphosis


When last did you cut your toenails? 

In patients who I  think are vulnerable, I always try to take the time to look at their feet. Unfortunately, because of COVID-19-induced NHS service changes, this is very difficult using telemedicine.

Poor foot hygiene and uncut toenails are in my experience an integrator of neglect. As the feet are generally hidden from view people with MS often neglect their foot hygiene more than other aspects of their grooming. Poor foot hygiene is not intentional, but simply represents the reality of living with a disability. Poor eyesight, double vision, oscillopsia, weakness, tremor, loss of feeling in the hands, slow movement, incoordination, obesity, etc. are all more common in pwMS and make cutting your own toenails difficult. 

During COVID-19 lockdown nail bars have been closed and podiatrists have not been seeing patients; therefore, I suspect general foot hygiene may have deteriorated in many people with more advanced MS. 

There is little doubt that MS or physical disability is a risk factor for onychogryphosis; in plain English overgrown and neglected toenails. Onychogryphosis makes it difficult to wear shoes, causes pain and may even put mobile patients at risk of falls. So if you can’t manage to look after your own feet I suggest post-lockdown setting-up regular appointments to have your toenails cut and your feet examined by a podiatrist. Please note in the UK podiatry is an NHS service. 

Marginal gains, i.e. focusing on small differences which add up can make big differences to the quality of life and health outcome for people with MS, and this should include foot hygiene and taking care of your toenails. This is just another factor that HCPs need to consider if they want to manage MS holistically. 

#T4TD = Thought for the Day

CoI: nil in relation to this post

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • An electric nail filing, pedicure device such as that made by Beurer can be very helpful for keeping toenails nice and healthy, e.g. if you have tremor and are afraid of cutting yourself with clippers, scissors.

  • I’m very fortunate that I see an NHS podiatrist every 6 weeks and have seen them during lock down. My biggest problem is actually painful hard skin because of the way I walk. Not something I can manage on my own. Hard enough reaching to get socks on sometimes.

  • My nurse always comments on my manicured toe nails at my annual review with the neurologist. I always thought it was a throwaway comment but after reading this perhaps it isn’t after all!

  • Indeed, it is the same with a lot of chronic health conditions and foot care, a sign of neglect for both physical and/or psychological reasons. Not sure what the literature says in relation to MS immunosuppression and common opportnisitic foot and nail infections. Certainly, in terms of RA and biologics, we there are interesting reports around onychocryptosis, onychomycosis and subclinical infections. It is good that you have raised this issue.

By Prof G



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