Barometers
of Health
Toenails
often serve as barometers of our health; they are diagnostic
tools providing the initial signal of the presence or onset
of systemic diseases. For example, the pitting of nails
and increased nail thickness can be manifestations of psoriasis.
Concavity—nails that are rounded inward instead of
outward—can foretell iron deficiency anemia. Some nail
problems can be conservatively treated with topical or oral
medications while others require partial or total removal
of the nail. Any discoloration or infection on or about
the nail should be evaluated by a podiatric physician.
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Nail
Ailments
Ingrown
Toenails
Ingrown
nails, the most common nail impairment, are nails whose
corners or sides dig painfully into the soft tissue of nail
grooves, often leading to irritation, redness, and swelling.
Usually, toenails grow straight out. Sometimes, however,
one or both corners or sides curve and grow into the flesh.
The big toe is usually the victim of this condition, but
other toes can also become affected.
Ingrown
toenail may be caused by:
- Improperly
trimmed nails (Trim then straight across, not longer than
the tip of the toes. Do not round off corners. Use toenail
clippers.)
- Heredity
- Shoe
pressure; crowding of toes
- Repeated
trauma to the feet from normal activities
If
you suspect an infection due to an ingrown toenail, immerse
the foot in a warm salt water soak, or a basin of soapy
water, then apply an antiseptic and bandage the area.
People with diabetes, peripheral vascular disease, or other
circulatory disorders must avoid any form of self treatment
and seek podiatric medical care as soon as possible.
Other
"do-it-yourself" treatments, including any attempt
to remove any part of an infected nail or the use of over-the-counter
medications, should be avoided. Nail problems should be
evaluated and treated by your podiatrist, who can diagnose
the ailment, and then prescribe medication or another appropriate
treatment.
A
podiatrist will resect the ingrown portion of the nail and
may prescribe a topical or oral medication to treat the
infection. If ingrown nails are a chronic problem, your
podiatrist can perform a procedure to permanently prevent
ingrown nails. The corner of the nail that ingrows, along
with the matrix or root of that piece of nail, are removed
by use of a chemical, a laser, or by other methods.
Fungal
Nails
Fungal
infection of the nail, or onychomycosis, is often ignored
because the infection can be present for years without causing
any pain. The disease is characterized by a progressive
change in a toenail's quality and color, which is often
ugly and embarrassing.
In
reality, the condition is an infection underneath the surface
of the nail caused by fungi. When the tiny organisms take
hold, the nail often becomes darker in color and foul smelling.
Debris may collect beneath the nail plate, white marks frequently
appear on the nail plate, and the infection is capable of
spreading to other toenails, the skin, or even the fingernails.
If ignored, the infection can spread and possibly impair
one's ability to work or even walk. This happens because
the resulting thicker nails are difficult to trim and make
walking painful when wearing shoes. Onychomycosis can also
be accompanied by a secondary bacterial or yeast infection
in or about the nail plate.
Because
it is difficult to avoid contact with microscopic organisms
like fungi, the toenails are especially vulnerable around
damp areas where people are likely to be walking barefoot,
such as swimming pools, locker rooms, and showers, for example.
Injury to the nail bed may make it more susceptible to all
types of infection, including fungal infection. Those who
suffer from chronic diseases, such as diabetes, circulatory
problems, or immune-deficiency conditions, are especially
prone to fungal nails. Other contributing factors may be
a history of athlete's foot and excessive perspiration.
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Prevention
- Proper
hygiene and regular inspection of the feet and toes are
the first lines of defense against fungal nails.
- Clean
and dry feet resist disease.
- Washing
the feet with soap and water, remembering to dry thoroughly,
is the best way to prevent an infection.
- Shower
shoes should be worn when possible in public areas.
- Shoes,
socks, or hosiery should be changed more than once daily.
- Toenails
should be clipped straight across so that the nail does
not extend beyond the tip of the toe.
- Wear
shoes that fit well and are made of materials that breathe.
- Avoid
wearing excessively tight hosiery, which promote moisture.
- Socks
made of synthetic fiber tend to "wick" away
moisture faster than cotton or wool socks.
- Disinfect
instruments used to cut nails.
- Disinfect
home pedicure tools.
- Don't
apply polish to nails suspected of infection—those
that are red, discolored, or swollen, for example.
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Treatment
of Fungal Nails
Treatments
may vary, depending on the nature and severity of the infection.
A daily routine of cleansing over a period of many months
may temporarily suppress mild infections. White markings
that appear on the surface of the nail can be filed off,
followed by the application of an over-the-counter liquid
antifungal agent. However, even the best over-the-counter
treatments may not prevent a fungal infection from coming
back.
A
podiatric physician can detect a fungal infection early,
culture the nail, determine the cause, and form a suitable
treatment plan, which may include prescribing topical or
oral medication, and debridement (removal of diseased nail
matter and debris) of an infected nail.
Newer
oral antifungals, approved by the Food and Drug Administration,
may be the most effective treatment. They offer a shorter
treatment regimen of approximately three months and improved
effectiveness. Podiatrists may also prescribe a topical
treatment for onychomycosis, which can be an effective treatment
modality for fungal nails.
In
some cases, surgical treatment may be required. Temporary
removal of the infected nail can be performed to permit
direct application of a topical antifungal. Permanent removal
of a chronically painful nail, which has not responded to
any other treatment, permits the fungal infection to be
cured, and prevents the return of a deformed nail.
Trying
to solve the infection without the qualified help of a podiatric
physician can lead to more problems. With new technical
advances in combination with simple preventive measures,
the treatment of this lightly regarded health problems can
often be successful.
