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.
