Preventing Diabetic Foot Syndrome Through Safe Nail Care: A Structured Manicure and Pedicure Protocol for Patients with Diabetes Mellitus

Background: Diabetic foot syndrome remains a leading cause of infection, hospitalization, and non-traumatic lower-limb amputation in people with diabetes. The International Diabetes Federation estimated that 589 million adults were living with diabetes in 2024, which makes prevention, including safe care of the nails and periungual tissues, increasingly important. This review aimed to summarize current evidence on the clinical risks of manicure and pedicure in patients with diabetes and to develop a structured nail-care protocol stratified by individual risk of diabetic complications. Methods: We conducted a narrative review of the scientific literature, international clinical guidelines, and regulatory documents. The search covered publications from 2010 to 2026 in PubMed/MEDLINE, CINAHL, Scopus, Web of Science, the Cochrane Library, CyberLeninka, and eLIBRARY.ru, together with official materials from medical and regulatory bodies in the United States, Kazakhstan, and Russia. Results: The main hazards of nail care were loss of protective sensation, impaired peripheral circulation, pathological changes of the nail plate, traumatic mechanical techniques, chemical exposure, and lapses in infection control. On this basis, we developed a structured protocol comprising pre-procedure screening, risk stratification according to the International Working Group on the Diabetic Foot (IWGDF), criteria for whether a procedure may be performed, selection of gentle techniques, hygiene requirements, documentation, patient education, and referral to medical specialists. Conclusions: The proposed protocol is a conceptual model for bringing clinical principles of prevention into nail-care practice. It may help standardize practitioners’ actions, support early recognition of dangerous conditions, and prevent procedure-related injury. Expert validation and prospective studies are needed to confirm its safety and clinical effectiveness.