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 toenails in the pink, as can wearing well-fitted,
low to moderately heeled shoes.
Ingrown Nail
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 nail's contour also can lead
to an ingrown toenail. Toe deformities (such as a bunion that forces the big toe to lean toward 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:
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.
Surgery is often necessary to ease the pain and remove the offending nail. Only a portion of the nail
may be removed. If the entire nail is affected or there is a severe nail deformity, the nail plate and
matrix (the cells that grow the nail) may be completely removed.
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 can invade through minor cuts, or after injury or repeated irritation
to the toes have caused the nail to separate from the bed. 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.
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, the surgeon may reduce its thickness
by filing the nail plate down with a surgical 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. Your podiatric foot and ankle surgeon will monitor the results of oral prescriptions
carefully, and will explain any possible side effects.
While topical ointments usually do not eliminate the fungus, they may be effective when used directly
on the nail bed, after the nail plate has been removed. Eliminating the infection, in some cases, can
only be achieved by permanent removal of the nail plate.
Blood Beneath The Nail (Hematoma)
A very common
result of active lifestyles is blood, or a hematoma, beneath the toenail. Hematomas are especially common
among people who jog or play tennis, caused by the toes repeatedly rubbing against the shoe. 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 podiatric foot and ankle surgeon, who may take an
X-ray to determine the most appropriate treatment.
If the hematoma is treated within the first few hours of forming, the podiatric foot and ankle surgeon
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. Some podiatric foot and ankle surgeons prefer to remove the nail
plate whenever blood forms beneath it, because the blood can attract fungi and lead to infection.
The nail may also be removed to treat a bone fracture beneath the hematoma. If the bone has fractured
but has not moved out of its normal position, a splint may be used to keep the toe aligned during healing.
Nail plates that have been removed will grow again within three to six months.
Surgical Treatments for Nail Disorders
If the problem is severe or chronic, surgery to remove all or a portion of the nail may be recommended.
Most surgeries are performed very comfortably under local anesthesia, and require less than one hour
at the podiatric foot and ankle surgeon's office. Laser surgery, because it requires special equipment,
may be performed at a hospital.
Partial Nail Removal
For some cases of ingrown nails, only the portion of nail that is growing into the skin is removed.
If both sides of the nail are ingrown, they may be removed during one procedure.
After the affected portion of nail (one-eighth to one-quarter inch) is taken, the nail bed is removed
along with any enlarged tissue adjacent to the nail plate. The nail root and matrix are then destroyed
by phenol, surgical removal or laser heat. Finally, the skin may be remodeled around the nail.
Permanent Nail Removal
Complete
removal of the nail plate is a common remedy for fungal infections and ingrown nails. During this procedure,
the nail plate is removed and the nail matrix is destroyed by one of three methods:
Phenol - An acidic chemical called phenol is applied only to the nail matrix. This destroys
the growth cells of the nail.
Surgical removal - The nail matrix and bed is cut away. Stitches are only occasionally necessary.
Laser - A form of burning in which laser heat is focused on the matrix cells.
Removal of Bone Overgrowth
Bone directly beneath the nail plate may become enlarged, developing a spur or outgrowth that can deform
the nail plate or lead to an ingrown nail. Removal of excess bone may be performed concurrently with
surgery to partially or permanently remove the nail plate.
Most people experience very little pain immediately following nail surgery, and during the healing
process, which lasts approximately two to three weeks. If bone has been removed during surgery, a longer
healing process should be anticipated.
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.
Will the Nail Regrow After Removal?
Partial growth of the nail plate after permanent removal is rare, but possible. Because the nail matrix
has been destroyed, the nail should not grow again.
While these are some of the most commonly prescribed treatments for nail disorders, others may be used.
The podiatric foot and ankle surgeon will determine which treatment is likely to be the most successful
in each case.
Ask your physician about surgical procedures to correct nail disorders at Lourdes.