Nail Disorders

For Problem Toe Nail Solutions, Call West Vancouver Foot Clinic

Nail Disorders and Treatments

Early care is best for nail health. The nail has several distinct anatomical areas. The hard nail plate grows from a nail matrix that is made of specialized epithelial cells. The nail bed is beneath the nail plate and has a good blood supply. It provides adherence and support to the nail plate. The nail folds help to seal the nail plate in place. 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 and wearing well fitted, low to moderately heeled shoes can help keep the toe nails in good shape.

Fungal Infections

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 that invades through minor cuts, after injury or repeated irritation to the toes, can cause the nail to separate from the nail bed. Fungal infections of the nail plate and nail matrix are quite common. 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.

Treatment 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 a more serious bacterial infection that can spread beyond the foot. To reduce pain associated with a thickened, infected nail, the thickness may be reduced by filing the nail plate down with a special burr. Filing will not, however, prevent the infection from spreading. Oral and topical medications may be prescribed when:

  • Only a small portion of one nail is infected
  • Several nails are affected
  • Keeping the nail is desired

Medication may or may not completely eliminate the fungus. Often, after medication is discontinued, the fungus recurs. Oral prescription antifungal medication must be monitored very carefully for possible side effects.

Nonyx nail plate gel and Penlac nail lacquer are quite effective topical antifungal medications.

Ingrown Toe Nail Disorders

Blood Beneath the Toe Nail is Known as a Hematoma

A hematoma might indicate a fractured bone, especially after an injury (such as dropping a heavy object on the end of the toe). The toe should be examined by the podiatrist who may order an X-ray to determine the most appropriate treatment. Hematoma treatments: If the hematoma is treated within the first few hours of forming, the podiatrist will create a tiny hole in the nail plate using a fine point drill or scalpel. This releases the blood and relieves pain. If several days have passed and the blood clot becomes painful, the nail plate may require removal so that the nail bed can be cleaned. Podiatrists often prepare to remove the nail plate whenever blood forms beneath it, because the blood can be a source of infection.

Ingrown Toe Nails

Painful ingrown nails may be congenital, caused by an overcurvature of the nail, or an imbalance between the width of the nail plate and the nail bed. Toe injuries that change the nails contour also can lead to an ingrown toe nail. Toe deformities (such as bunions that force the big toe to lean to the second toe), high heeled or narrow pointed shoes can put pressure between the nail and soft tissues, eventually forcing the nail to grow into the skin. Symptoms such as redness, swelling and infection make the toe very painful. Ingrown nails can be accompanied by other toe disorders, such as excess surrounding tissue or an outgrowth of bone beneath the nail plate.

Treatments for the Ingrown Toe Nail

Minor cosmetic toe nail surgery, under local anesthesia infiltration, is often necessary to ease the pain and remove the offending nail border. Only a portion of the nail may require removal. If the entire nail is affected or there is severe nail deformity, the entire nail plate and matrix (the cells that grow the nail) may be completely removed.

Partial Nail Removal

For most cases of ingrown toe nails, only the portion of the nail that is growing into the skin is removed. If both sides of the nail are ingrown, they may be removed during one procedure. The nail root and matrix are then destroyed so that regrowth of the offending nail border does not occur. The procedure is usually permanent.

Care After Surgery

Gentle care and precision is used to anesthetize the patient’s foot and so most people experience very little pain immediately following nail surgery, and during the healing process, which lasts approximately three weeks. It is recommended that the patient wear open-toe sandals during the healing process.

How Will the Toe Look After Surgery?

After surgery to permanently remove the nail plate, the body generates a hardened skin covering over the sensitive nail bed. When this covering has developed, normal activities can be resumed. Women can also use nail polish on this area.

Tibialis Posterior Tendonitis, or painful flatfoot, can also develop into a major problem if left untreated.
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