Many people make enquires or come to see a chiropodist because they suffer from problematic nails. The mains conditions seen at the clinic are Thickened Nails, Fungal Nails and Ingrowing nails. Many patients visit the clinic for simple routine nail care purely because they struggle to attend to their own feet.
The main function of nails is to protect the distal (ends) tissues of the fingers and toes from the physical trauma of every day life. Therefore this means that wearing shoes, walking, playing sports etc all can have a direct effect on how nails can appear and grow, and therefore nails are subject to change in thickness and colour. Changes in nail shape colour and appearance need correct diagnosis. Colour changes in the nail bed arrive through alteration of the nail bed or the nail plate and sometimes both.
There are literally hundreds of conditions and diseases than affect nail and severe systemic inflammatory diseases can be associated with nail changes that may be severe enough to affect function and quality of life. However such nail conditions are rarely seen in the clinic. In truth many self (patients) diagnosed or suspected nail conditions turn out to be relative to normal trauma of the nails as a result of daily living and having to wear footwear.
However it is always important to make sure you get a correct diagnosis from a HCPC registered qualified chiropodist/Podiatrist before under going any physical treatment.
Damaged Thickened Toe Nails
What causes a thickened nail and why do they form?
A thickened nail is where the nail plate is thicker than the normal nail. As the title suggests thickened nails are usually caused by damaged or trauma. Chronic trauma or multiple minor prolonged repetitive damaged caused by ill fitting footwear or sporting activity is often a major cause. Significant damage such as a single traumatic incident, like something heavy dropping on the toes or a crush injury can cause extensive nail plate thickening. In some cases the nail can loosen and fall off, the damaged nail then usually grows thickened and deformed from the base upwards and the whole nail is affected. Fungal infections sometimes causes a nail to thicken. Very rarely systemic illness can cause nails to thicken.
The nails and nail plates can thicken and become yellow in a wide range of diseases, but importantly it is also part of the normal ageing process in life that nails dry out and appear thickened.
Treatment available for Thickened Nails.
The chiropodist will first have to assess your general health and whole feet and establish any causative factors involved, before coming to a clinical diagnosis.
Routine chiropody treatment is the usual course of action required. The chiropodist can cut shape and use a specialist drill to gently thin and reduce any affected nails. Self treatment at home by gently filling nails is also beneficial.
If a thickened damaged nail is chronic, it will usually not return to its original shape and thickness. But your chiropodist will over time be able to manage any painful problematic nails simply by correctly cutting and filling the nails. For more problematic cases of thickened nails which are causing significant pain and discomfort, nail surgery may be a solution. Nail surgery is a simple minor surgical procedure (carried out in the clinic) where problematic painful edges of nail or whole nail is removed, a local anaesthetic is required and careful after care needed.
If you are suffering from problematic thickened nails then please contact the clinic for an appointment.
Fungal infection of the nail can cause the affected nail/nails to thicken and become discoloured. Fungal nail infections are a very common complaint, affecting nails and skin. There are several types of fungi that can affect the feet skin and nails. For example athletes foot, is a common form of fungal infection found usually between the toes, this can easily spread into the nails and skin. Fungal infection usually looks unpleasant and unsightly but does not always cause pain.
Fungus is an organism that can cause infection of the skin and nails. Fungi thrive in moist dark environments, the conditions within socks/tights and footwear and ideal for the growth. A fungal nail infection looks unsightly to the patient and causes the nail to become thickened and discoloured. The nail will often change colour at the site of infection, it can turn white, yellow, black, brown or green. The affected nails can sometimes become brittle, and split with pieces breaking off, they can turn soft and even completely fall off. If one nail is infected with fungus it easily spreads to the other toes and eventually all nails. Fungal nail infection is typically seen in previously traumatised nails.
Treatments available for Fungal nail infections
A correct clinical diagnosis is the key to treating fungal nail infections. Naturally thickened nails can often be miss diagnosed by the patient as fungal. This is where the experienced chiropodist will usually be able to tell between thickening nails due to increased subungual (external) pressures and actual changes in the nail plate due to infection. This means that clinical diagnosis of fungal nails can usually be done by the chiropodist during routine treatment and sight examination alone. In most cases the chiropodist can provide treatment initially to help restore to a certain extent a normal appearance of infected nails. They will offer advice on other treatment available and manage nails through on going care with the ultimate aim being to cure and eliminate the infection.
Superficial fungal infections
Some fungal nail and skin infections are classed a superficial, meaning that they will respond well to anti fungal agents/treatment, for example nail ointments and anti fungal creams. Most topical treatments usually require sustained application. Treatments will be required for many months to fully clear any infection.
However with heavily infected fungal nails many topical applications even with a strict regime of application do not resolve the problems, as many nail ointments are meant for superficial infections only.
The chiropodist will be able to advise you on correct diagnosis and correct treatments and products. Some success can be achieved with superficial infections if thickened affected nails are reduce (drilled) during routine treatment, this allows nail treatments to penetrate the nail more effectively.
With mild cases of fungal nail and skin infections topical treatment and creams are usually effective. However if yo fail to treat these minor infections there is a chance it will become more severe, for example athletes foot can spread to the nail and heavy infection can happen.
Moderate/Severe fungal infections
If a fungal nail infection is not responsive to topical treatments or the chiropodist diagnoses matrix involvement (full onychomycosis fungal infection of all the nail cells). The chiropodist will recommend oral medication. This is available prescribed through the G.P. Lamisil (Terbinafine) tablets taken for a period of 3/6 months is the required course of treatment. Sometimes the doctor will want to send off affected clipping for correct confirmation, however usually the chiropodist can visually identify the infection. With severe infections, tablets is the most effective method of treatment and will be necessary if all other treatments have been exhausted.
If you are prescribed tablets you will have to take them for several months until the infection is completely clear. If you stop taking the tablets too soon and the infection may return. One major advantage of using anti fungal tablets is that they will also clear up any superficial fungal infections of the skin at the same time. If treatment is successful you should start to see a new healthy nail growing from the base of the nail bed. This is a clear sign that the tablets are working as the infected nail gradually works its way up. Along with routine treatment any fungal infections should soon be cleared.
Anti Fungal Tablets
Taking anti fungal medication in the form of tablets means that the treatment reaches the nails through your bloodstream. Terbinafine and Intraconazole are the two main tablets prescribed for fungal nail infections and usually they are effective. The chiropodist will recommend tablets if necessary, however you will have to visit your G.P as current prescribing legislation doesn’t allow chiropodists/podiatrist to prescribe such medication at this time.
Anti Fungal products available in the clinic
The following are used to treat superficial fungal infections and athletes foot.
Lamsil gel or cream
Daktarin spray, powder, cream
Curanail available with consultation with the chiropodist.
Many other brands or products are available on the market but the above are the leading brands preferred by chiropodists.
Please contact the clinic for a appointment if you are suffering from fungal nails.
An ingrowing toe nail is where a nail digs into the flesh along the edge of the nail plate. The most common site affected is the big toes, but the lesser toes can sometimes be ingrowing. An ingrowing nail is usually incredibly painful when any pressure is applied anywhere near the toe. If the condition becomes chronic the toe will throb, become red, hot, swollen and inflamed, puss and discharge will happen and often ingrowing nails become infected and can require antibiotics.
Ingrowing nails develop when the sides of the toe nail grow into the surrounding skin/tissues. Either one or both side can be affected.
What causes an ingrowing nail?
There are multiple reasons why a nail may become ingrown. The following are the most common causes for an ingrowing nail to develop and become uncomfortable, and ultimately need treatment.
Poor nail cutting or incorrectly cut nails
Poor nail cutting technique, nails cut too short and cut incorrectly down the edges. Not cutting nails fully, leaving the remaining edges sharp to grow into the flesh.
wearing tight-fitting inappropriate shoe/footwear, socks, tights, stockings
Wearing overly tight shoes/socks etc can place increased pressure on the skin around the toe nails and feet. This pressure can cause the actual nail edges to pierce the soft toe nail bed, and caused great discomfort. Shoes that are tight in the toe box or narrow squash toes together.
To high a heel can cause the toes to be pushed forward resulting on problematic nails to physically dig in.
Wide nail plate
Some people for no reason simply have a overly wide nail plate. Wide nails can physically dig into the soft skin and flesh, even if a patient wears good quality accommodating supportive footwear.
Abnormal or natural shape of the nail
Some people have a naturally curved nails that are more likely to grow into the skin. An abnormal nail for example an involuted nail where over time excessive curvature of the nail causes the nail edges to dig into the soft tissues of the nail bad.
Nails also can become naturally thickened due to ageing and daily living, walking working etc.
Sweaty Feet and Fleshy Toes
Having sweaty feet can cause the skin to soften around the toe nails, thus making it easier for the nail to pierce the flesh. Similarly having fleshy toes (fatter) and thin (atrophic) nails can lead to painful ingrowing nails.
Some people have naturally very sweaty feet (hyperhydrosis) and problems like the above make it more likely to suffer from painful nail conditions.
People who wear work boots for long hour and those who play sports, work in hot environments an also suffer from ingrowing nails.
Injury and Trauma to the nails
Injury for example stubbing your toe could cause a nail to split or tear and ultimately lead to problematic nails. Tight fitting footwear is a major contributing factor to many problematic and painful nail conditions. Major trauma, eg a brick or very heavy object falling on to the nails can cause abnormal growth and make the nail ingrowing.
Fungal and Thickened Nails
A chronic long standing fungal infection which is left untreated causes the nail to thicken and widen and eventually can cause significant problems with digging into the soft sides and end of the toes.
Treatments for Ingrowing Nails
If you suffer from painful ingrowing nails it is advise you contact the clinic for a consultation and treatment of the condition. Problematic ingrowing nails are often manageable, but only with continued regular routine chiropody treatments.
For very painful inflamed swollen and infected toes immediate treatment and sometimes antibiotics and good wound care will be required. Treatment will involve conservative management, where a small slither or offending spike/piece of nail will be gently removed, where possible. The now smooth clear edge of the nail may now be able to grow back normally, or in many cases will be managed through routine chiropody care and treatment.
With more difficult chronically problematic ingrowing nails, nail surgery will be advised, This is a very simple minor surgical procedure, where the problematic edges of the nail or whole nail is removed, a strong chemical is then used to prevent regrowth. This procedure is carried out using local anaesthetic in the affected toe.
As already stated it is advised to visit the clinic if your ingrowing nail is extremely painful, inflamed, bleeding and has pus coming fro the offending toe, as it will probably be infected. Left untreated ingrowing nails become problematic and infection can easily form, making it harder to treat and manage.
Minor surgery (nail surgery) will be recommended if the problematic nail doesn’t show any signs of improvement after a course regular routine treatment, and depending on the severity of the problematic nail. The following nail surgical procedure carried out at the clinic are as follows.
PNA Partial Nail Avulsion
PNA involves removing a tiny part (slither) of nail. This is a very common surgical procedure and is considered to be around 98% effective with management of painful ingrowing nails.
TNA Total Nail Avulsion
TNA involves complete removal of a problematic nail. This is usually carried out if nails are thickened and causing constant chronic issues. Once the nail is removed the underneath will toughen up and it is perfectly safe not to have a nail at all.
For both procedures local anaesthetic is used to completely numb the affected toe. A strong chemical called Phenol is applied to the base of the nail/cells to prevent the affected nail from growing back.
Sometimes before or when a procedure is due to be done a course of antibiotics may be prescribed, this is needed to calm the toe down and reduce infection and swelling.
Prevention and advice for problematic nails
Taking good care of your feet will help prevent general foot problems such as ingrowing nails.
It is important to cut nails properly, reasonably straight (edge to edge) or shaped, not at a sharp angle or digging down the sides.
Wash and dry feet regularly using soap, and thoroughly dry afterwards, (daily).
Keep feet clean and fresh by washing them every day ensuring that you clean between the toes.
Change and replace (buy new socks) socks etc every six months.
Wear comfortable, supportive and accommodating comfy quality footwear. Get your feet properly measured when buying shoes. Ensure the correct fit and size and depth.
Problematic painful nail conditions often occur when there has been inadequate basic foot care.
Keep nails relatively short, do not cut the toe nails too short (right down) as this can precipitate nail issues.
Use daily emollients (foot creams) to prevent excessive dryness of the skin.
If you suffer from any foot problems please contact the clinic to book a consultation with one of our chiropodists.