Nail Care

Podiatrist using nail nippers to cut toe nails

Nail conditions can cause discomfort, pain and can be unsightly.

Which nail conditions do we treat?

Fungal infections, thickened nails, damaged nails and ingrown nails. Nail care for those that can no longer reach are all offered by podiatrists.

What nail treatments are there?

Fungal Nails

Fungal nails are a common problem and yet some people are embarrassed to talk about them. They occur as a result of fungi which infects the nail and/or skin. The infection occurs when the nail plate is damaged, this is how the fungus invades the nail, and it then spreads due to the dermatophytes ability to take nutrients from keratin. Keratin is a protein found in the skin and nail.

There are two types of fungi responsible for fungal nails:

  • Yeast
  • Dermatophytes

Prior to treatment it is necessary that these two are distinguished. The treatment is different for yeast and dermatophyte infections. Fungi thrive in warm, moist dark environments, therefore footwear; particularly trainers provide the perfect breeding ground. The Big toe nail is most commonly affected.

The signs of a fungal nail vary, but may include:

  • Thickened nails
  • Discoloured nails
  • Debris beneath the nail plate
  • Cracks in the nail

It is important to remember that the treatment of fungal nail takes time and patience; this is because it takes time for new, uninfected nail to grow through. If the whole nail is infected this can take up to one year.
The podiatrist will discuss all the options available to each patient on an individual basis.
Many options are available for treatment from self care to podiatry treatments, including the Lacuna treatment. The Lacuna method is a relatively new treatment and works by painlessly drilling many tiny micro holes across the infected nail plate. A terbinafine spray is then applied to the nail where it will penetrate through the holes. As the patient you will have to spray the nail DAILY between 6 weekly visits to ensure best results.

Ingrown Nails

Ingrown toe nails occur when the sides of the nail curves around or a nail spike, pierces and grows into the surrounding skin. Some people are more prone to ingrown toenails than others. Causes may include:

  • Natural nail shape
  • Poor nail cutting
  • Ill-fitting footwear
  • Tight fitting socks and hosiery
  • Fungal infection
  • Poor foot hygiene and excess sweating

Anyone can get an ingrown toenail. They are frequently seen in teenagers, older people and those who participate in certain sports.

A podiatrist can help relieve the pain and discomfort of an ingrown toenail. They can also provide information to reduce the occurrence of ingrown nails. Advice such as, correct nail cutting techniques, foot-care and advice on footwear are available.

Podiatrist filing toe nails

 

The severity of the ingrown toenail presented depends on the treatment offered. It may be that surgery is not necessary in all cases. To reach a decision on what is best for you, your podiatrist will take a medical history and perform vascular and neurological assessments. The results and options will be discussed and agreed with you before starting any treatments.

If your nail is infected it may be necessary to take antibiotics prior to a treatment beginning. Ingrown toenails can be treated either conservatively or surgically.

Removal of nail spike. In some cases, particularly in the early stages, the ‘nail spike’ can be removed in clinic by the podiatrist. This can sometimes be a little uncomfortable, however it provides instant relief as the spike is removed. This, along with advice on nail cutting and footwear may be enough to prevent the need for nail surgery in the future.

Packing. Packing involves placing tightly packed sterile gauze beneath the nail. The purpose of this is to allow the nail to grow up and over the gauze as opposed to into the skin. Again, this can be a little uncomfortable at first; however it may be a good option when conservative treatment is wanted and/or needed.

Nail surgery. This involves removing either, part of the nail or the entire nail. This is performed under local anaesthetic. If part of the nail is removed the remaining skin will eventually heal snug to the side of the nail, resulting in a ‘normal’ slimmer looking nail. Removing all or part of the nail has no effect on the function of the toe.

Thickened Nails

Thickened toenails can be unsightly and, in many cases, painful and uncomfortable. The big toenail is most commonly affected. The main causes of thickened toenails are trauma and fungal infection. Thickened toenails are not generally harmful; however, they can be unsightly, uncomfortable, difficult to trim, and can make finding footwear difficult
Trauma to the nail is the most common cause of thickened toenails. This could be due to a single event such as stubbing the toe. Other causes of thickened toe nails can be repetitive trauma, from for example, sporting activities or ill-fitting footwear.
Other causes include:

  • Fungal nail
  • Aging
  • Inability to care for them
  • Certain skin conditions; e.g. psoriasis & eczema
  • Tight fitting footwear
  • Poor circulation

If you have thickened toenails your podiatrist can help you by providing treatment that will help improve appearance and reduce pressure on the nail bed.

Unfortunately, in many cases where the toenail has thickened the result is permanent. There are a few treatment options available, however, the main thing your podiatrist can do is cut back the nail and reduce its thickness.
It is essential that thickened nails are managed with routine podiatry treatment. Your podiatrist can reduce the thickness of the nails and keep them to a reasonable length. Routine and regular treatment is recommended.
You can help prevent thickened nails by applying the following:

  • Good foot hygiene
  • Wear well fitted and fastened shoes
  • Avoid excessive wear of tight shoes or high heels

Your podiatrist will provide you with all the advice you need during your appointments.