Zeehan S. Husain, DPM
Charles G. Kissel, DPM
Michael S. Schey, DPM
Angela
Stoutenburg, DPM
Board
certified by the
American Board of
Podiatric Surgery.
Toenail Disorders and Treatments
Early
Care is Best for Nail Health
In
their protective role, nails bear the brunt of daily activities. Walking,
running, wearing shoes or participating in sports are just a few of the
stresses and strains the feet must endure. All
or a portion of the nail plate can be damaged when the feet are injured or
abused. Nail problems are
commonly caused by improper trimming, minor injuries, or repeated trauma.
Some nail disorders can also be congenital.
Proper trimming (along the contour) on a regular basis can help
keep the toenails in the pink, as can wearing well-fitted, low to
moderately heeled shoes.
Subtopics
1.
Ingrown Nail
2. Nail Dystrophy (Thickened Toenails)
When a toenail is ingrown, the nail is curved downward and grows into the skin, usually at the nail borders (the sides of the nail). This digging in of the nail irritates the skin, often creating pain, redness, swelling, drainage, and warmth in the toe. If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if your toe is not painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
What
Causes an Ingrown Toenail?
Ingrown
toenails can develop for various reasons. In
many people, the tendency to have this common disorder is inherited. In other cases, an ingrown toenail is the result of trauma,
such as stubbing your toe, having an object fall on your toe, or engaging
in activities that involve repeated pressure on the toes, such as kicking
or running. The most common
cause of ingrown toenails is improper trimming. Cutting
your nails too short encourages the skin next to the nail to fold over the
nail. Another cause of
ingrown toenails is wearing shoes that are tight or short.
Bunion [link]
deformities can also lead to excessive pressure on the side of the toe
pinching the skin between the ground and the nail margin.
Overlapping hammertoe [link]
contractures of the second toe on top of the great toe can also cause a
similar problem. Certain nail
conditions are often associated with ingrown toenails.
For example, if you have had a toenail fungal infection or if you
have lost a nail through trauma, you are at greater risk for developing an
ingrown toenail.
Treatment
Sometimes
initial treatment for ingrown toenails can be safely performed at home. However,
home treatment is strongly discouraged if you suspect you have an
infection, or if you have a medical condition that puts your feet at high
risk such as, diabetes, nerve damage in the foot, or poor circulation.
Home
Care
If
you do not have an infection or any of the above conditions, you can soak
your foot in room-temperature water (add Epsom salt or dish detergent if
you wish), and gently massage the side of the nail fold to help reduce the
inflammation. Avoid
attempting bathroom surgery. Repeated cutting of the nail can cause the
condition to worsen over time and result in additional nail damage. If
your symptoms fail to improve, then it is time to see a foot and ankle
surgeon.
Physician
Care
The
foot and ankle surgeon will examine your toe and select the treatment best
suited for you. These
treatments are commonly performed in the office after numbing the toe.
Treatment may include:
 |
Oral
antibiotics
If an infection is present, an oral
antibiotic may be prescribed. |
|
Surgery
A simple procedure, often performed
in the office, is commonly needed to ease the pain and remove the
offending nail margin. Surgery
may involve numbing the toe and removing a corner of the nail, a
larger portion of the nail, or the entire nail. |
|
Permanent
removal
Various techniques may be used to
destroy or remove the nail root. This treatment prevents the recurrence of an ingrown toenail. Recurrent
conditions typically are recommended to have the permanent procedure.
Your surgeon will determine the most appropriate procedure for
you. |
Following
the nail procedure, a light bandage will be applied.
Most people experience very little pain after the procedure and may
resume normal activity the next day.
If your surgeon has prescribed an oral antibiotic, be sure to take
all the medication even if your symptoms have improved.
The toenail should look relatively the same except for the
offending ingrown nail margin. In
permanent nail procedures, the skin edge moves over and the nail
cosmetically should look normal. When
the nail is not permanent removed, the nail will grow out over a year.
Preventing
Ingrown Toenails
Many
cases of ingrown toenails may be prevented by following these two
important tips:
|
Trim
your nails properly
Cut your toenails in a fairly
straight line, and do not cut them too short.
You should be able to get your fingernail under the sides and
end of the nail. |
|
Avoid
poorly-fitting shoes
Do not wear shoes that are short or
tight in the toe box. Also
avoid shoes that are loose, because they too cause pressure on the
toes, especially when you run or walk briskly. |
Home
Treatment Myths
|
Cutting
a notch (V) in the nail will reduce the tendency for the nail to
curve downward
This does not affect the toenail growth or shape.
The nail shape is fixed. Repeated
disturbance to the nail bed will cause additional damage and worsen
the curvature. |
|
Repeated
trimming of the nail borders is a good way to treat ingrown nails
Repeated nail trimming fails to correct future nail growth and can
make the condition worse. |
|
Cotton
placed under the nail will relieve the pain
Cotton placed under the nail can be harmful. It can easily harbor bacteria and encourage infection. |
|
You
may buy effective ingrown nail treatments at the drugstore
Over-the-counter products may mask the symptoms, but fail to address
the root cause of the problem. Typically,
only temporary relief is achieved. |
2.
Nail
Dystrophy (Thickened Toenails) (top)
Not
all toenails that are thick and discolored are infected with fungus.
Repetitive nail trauma from direct injury, stubbing the toe,
pressure from tight-fitting shoes, or microtrauma from running can result
in permanent damage to the nailbed and nail root.
Typically, once this damage is done, the physical characteristics
of the toenail have been changed.
The
cause of the nail appearance can only be confirmed with a simple nail
biopsy that can be done in the office painlessly.
Unfortunately, damaged toenails rarely can be reversed.
Some topical agents can be used to soften the toenails. In severe cases that cause chronic pain, the nail can be
permanently removed to avoid continued problems. In true fungal infections of the nail, your podiatric
physician can discuss appropriate treatment options.
Various
types of fungi are present everywhere in the environment.
The dark, moist surroundings created by shoes and stockings make
the feet especially susceptible to fungal infection.
Most fungi are harmless until they penetrate the skin. A fungus can invade through minor cuts or after injury or
repeated irritation to the toes. The
fungal growth builds under the nail and can separate the toenail from the
nailbed. Fungal infections of
the nail plate and nail matrix are quite common.
Symptoms: Fungus may cause the nail to thicken and become yellow or brownish. As the fungus grows, foul-smelling, moist debris can be seen. Pressure from a thickened nail or the build-up of debris may make the toe painful.
Treatments
for Fungal Infections
Treatment
is best begun at the early stages of infection.
The accumulation of debris under the nail plate can lead to an
ingrown nail or to a more serious bacterial infection that can spread
beyond the foot. To reduce
pain associated with a thickened, infected nail, your podiatrist may
reduce its thickness by filing the
nail plate down with a surgical burr.
Periodic nail debridement with proper use of antifungal medication
is the key to successful outcomes.
Oral
and topical antifungal medications can effectively eliminate the fungal
infection. However, please
know that the appearance of the nail may or may not improve.
The goal of the medication is to eradicate the fungal infection and
not to make the nail look normal. Any
permanent nail damage already caused by the infection may still remain.
It is possible to have recurrence of the fungal infection at a
later time.
Oral
Antifungals
Oral
medication is typically only taken for three months and requires some
blood work to check the liver function.
Despite the potential risk of side effects, the oral medications
are safe and rarely cause problems provided the patient is being monitored
closely by their podiatrist.
Topical
Antifungals
Topical medications are used almost daily for nine to twelve months or until the effected portion of the nail has grown out. Nail polish cannot be used at the same time.
