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The Foot And Ankle Healthcare Center
Metro Nashville - Madison, TN
Dr. Carmen April
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 disease. For example, the pitting of nails and increased nail thickness can be manifestations of psoriasis. Concavity of the nails - 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 such as Dr. Carmen April.
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, heredity, shoe pressure, crowding of toes, and repeated trauma to the feet from normal activities can lead to ingrown nails. Be sure to trim nails straight across and not longer than the tip of the toes. Do not round off corners and use toenail clippers. If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak then apply 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.
Dr. April may 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 ingrown, along with the matrix or root of that piece of nail, are removed by use of a chemical, resection or other methods.
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 the 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 fungus. 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 the other toenails and even the skin. If ignored, the infection can spread and become painful. This happens because the resulting thicker nails are difficult to trim and make walking painful and causes pain 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 disease, 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.
Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails
Clean and dry feet thourghly
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 at least 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
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.
Treatment of fungal nails
Treatments may vary, depending on the nature 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 anti-fungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.
A podiatric physician like Dr. Carmen April can detect 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.
Oral antifungals, approved by the FDA, 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 mail 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 help of a qualified podiatric physician such as Dr. April, can lead to more problems. With new technical advances in combination with simple preventive measures, the treatment of this health problem can often be successful.