The Normal Nail
Toenails are hard, highly keratonized cells of the epidermis. This forms a hard, clear protective cover which serves to protect the underlying epithelium of distal phalanges, protects nerve endings, adds strength to the digits and assists in sensory perception.

Nail growth occurs beneath the eponychium (cuticle). As the nail grows, cells change to form the nail plate and existing nail is pushed forward.

The rate of growth varies, children generally grow a complete toenail in twelve months, while an elderly person takes 18-24 months. There are many other factors which affect nail growth such as inadequate blood and nerve supply, trauma, infection, nutritional deficiencies to name a few. Nails can exhibit abnormalities due to congenital or inherited factors, although not common.

Principles of Cutting Nails

Cautionary Note:
Unskilled or careless cutting of the toenails can be dangerous. There should be no pain or bleeding when cutting toenails. Broken skin can be a source of infection.

Things To Remember:

Maintain sufficient length to the nail. It is important to protect the hyponychium (the thin band of thickened epidermis which lies beneath the “free edge” of the nail). Ideally the length should be 1-2mm beyond the free edge to prevent trauma. The free edge is where the nail breaks away from the nail bed.

Never cut down the sides of the nail (sulcus). It is important to maintain the shape of the nail plate in the sulcus. Removal of nail in the sulcus causes tissue to migrate into the area of nail growth. As the nail grows, it can pierce the skin and result in an ingrown toenail (onychocryptosis).

Ensure all edges and corners are smoothed. Leaving hooks, spikes or rough edges on the nail can threaten the integrity of the surrounding tissue. It can also catch on socks or bedclothes and cause the nail to tear.


A footcare practitioner needs to know what to cut, how to cut and who will cut. If a foot poses a challenge greater than the practitioner’s skills, a referral should be made.