Nail Conditions

Nail conditions include any development in the nail or nail bed that adversely affects the health of the toe. While there are a multitude of nail conditions that can be listed the most common afflictions will be listed in this article:

Ingrown Toenails

This is by far one of the most common conditions seen by doctors and podiatrists. It is most often causes by incorrect nail trimming techniques (nails being cut too short or in an unorthodox fashion), trauma to the toe, wearing tight shoes, and in some cases, nails that naturally curve sharply into the skin and can cause severe foot pain. The level of treatment depends on the level of injury and whether or not infection has developed. The ingrown nail is usually lifted out of the skin using various methods although nails are sometimes completely removed. This nail condition can be prevented by trimming toenails straight across and wearing comfortable shoes that fit well.

Fungal infections

Fungal infections are usually indicated by the presence of a discoloration or thickening of the nails that also causes them to separate from the nail bed. Nails may turn white, yellow, or green and a foul odour and/or discharge may be present as well. If nail fungus isn’t treated the nail bed itself may become infected, which tends to be more painful and more difficult to treat. Antifungal creams or pills are usually the first line of treatment and professional treatment of the nails is often recommended as well. Keeping feet and socks clean and dry is usually sufficient enough to reduce the risk of developing a fungal infection on the foot.

Deformed Nails

Deformed nails can occur for a variety of reasons but barring an underlying illness it is usually caused by a high-impact toe-stubbing or dropping a markedly heavy object onto the foot. Generally speaking, accidental trauma is one of the major causes of deformed nails, which may become thickened or develop ridges. There is little to be done in this instance except protect the injured toe/foot and try to be more careful in the future.

Black or Blue Nails

Unless the nails are a light blue color (which may indicate respiratory or circulatory issues) black or blue nails are usually the result of an acute or chronic injury to the toe and signal that blood vessels have broken. The biggest culprits are sports activities that involve sudden stops and a high volume of lateral motion, such as basketball and tennis. Black and blue nails are also often caused by a heavy objects being dropped on the foot. Regardless of the reason for the discoloration the toe often becomes quite sore due to the build up of blood, and a hole may be drilled in the nail to allow for drainage, which reduces pressure and pain. The nail will often fall off during healing and a new nail will grow to replace it.

Most conditions can be prevented by keeping the feet clean and dry, by wearing clean and dry socks, and by investing in shoes that provide proper cushioning and support. Orthotic devices may also help to keep the foot stable and well supported. Trimming the nails properly is absolutely essential, and diabetics should take extra steps, as nail conditions can become bigger health issues if not properly treated. 

Suzy Pickhall, who has been a foot care expert over the past thirty years has written a viable guide on how to combat Insoles for Plantar Fascitis, and a guide on Orthotics for Over Pronation.

Ingrown Toenails

Ingrown toenails are an extremely common foot problem that occurs when corners or edges of the toenail grow into the soft tissues of the toe. The nail first pierces the skin and then continues to grow inward if the problem is not corrected. The medical term for this condition is onychocryptosis, and it primarily affects the big toe although it can develop in the other toes as well, though it very rarely occurs in the fingers.

This condition is often quite painful and the affected area will often become tender, swollen and red, the skin surrounding the nail may become hard, and a clear or yellow suppuration may also occur.  If the nail becomes infected the wound may become warm to the touch, and it may bleed and produce foul smelling pus. If signs of infection are present or if the patient also suffers from diabetes or peripheral vascular disease then medical attention should be sought as soon as symptoms present themselves, as complications and infection are much more likely to occur.

Ingrown toenails can be caused by a variety of factors, and the most common causes are nail trauma caused by athletic activities, wearing tight or constrictive shoes, injury to the feet or toes, having unusually long toes (which causes uneven ‘hot spots’ to occur), poor foot hygiene, congenital toenail malformation, diabetes, nail fungus infection, nail surgery (past or present), excessively sweaty feet, arthritis, and poorly trimmed or cut toenails. Improper cutting of the toenails causes problems on two fronts: the nails may be cut excessively short and they may leave behind jagged edges, both of which increase the risk of developing ingrown nails.

Most cases of ingrown toenails can be treated at home and will heal without medical intervention. The best way to treat an ingrown nail is to soak the affected foot in warm water and Epsom salts until the skin softens, then use the edge of a towel to gently push back the overgrown skin that is covering the nail. An antibacterial cream can then be applied to keep the skin hydrated and free from bacteria. If the ingrown nail requires more care a piece of cotton or dental tape can be used to very gently lift the ingrown nail out of the skin. Otherwise, this condition can be treated with regular foot soaks and gently pushing back the skin from the nail.

If symptoms do not improve with these treatments then it’s best to seek medical advice before infection occurs, as antibiotics may be prescribed to treat severe cases. Ingrown toenails can be prevented by wearing non-constrictive shoes with a wide toe, by keeping nails evenly and smoothly trimmed but not excessively short, by avoiding injury to the foot and nails, and by keeping the nails clean. Because ingrown toenails have a high rate of reoccurrence great care should be taken with the feet after the nail has healed, and any subsequent injuries or discomfort occurring in the nail or nail bed should be addressed right away.

If a patient is prone to the development of ingrown toenails special attention must be paid to foot care, especially to grooming habits and the type of footwear used. 

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Fungus Nails

Fungus nails are usually caused by the growth of fungi called dermatophytes (such as Candida) though they may also be the result of yeast or mold development as well. These microscopic organisms enter the skin through miniscule cuts or abrasions between the nail and the nail bed, and they require continuously warm and moist environments in order to survive and spread. This is why fungus more often occurs in the toenails than the fingernails; enclosed, damp shoes that maintain heat are a perfect environment for this type of infection to occur, not to mention that there is often more blood flow to the fingers than toes.

When fungus develops in the nails they often become thick and brittle and begin to crumble. They may also appear ragged and discolored and may separate from the nail-bed itself. Pain or discomfort is often felt in the fingertips and a mildly foul odor may be present as well. It is also possible for a sufferer to have a reaction to the fungus; this often occurs in the form of red, itchy patches of skin or ulcerations called dermatophtids and this reaction may develop on other parts of the body, not just the hands or feet.

While the physical symptoms of fungus nails are fairly evident doctors will often take a nail scraping in order to perform a fungal culture or potassium hydroxide (KOH) smear. It’s important to confirm that the nail infection is in fact fungus and not another skin condition such as psoriasis, lichen planus, dermatitis, eczema, or a nail bed tumour.

Fungal infections of the nail occur more frequently in men and in the elderly. Other factors that increase the risk of developing fungus nails include poor blood circulation, having diabetes, psoriasis, athlete’s foot, or an immune disorder, having a damaged or injured nail or nail-bed, humid work environments, walking barefoot in public places such as pools, gyms, and shower stalls, and wearing socks and shoes that do not allow for proper ventilation.

Nail fungus can be difficult to treat and may require the use of topical creams and oral medications, and it can up to four months before the infected nail has grown out and been replaced with a healthier, new nail. Topical creams often help with discomfort but will not likely cure the infection. In severe cases the entire nail may be removed to allow for healthier re-growth.

The risk of developing fungus nails can be reduced by keeping the nails short and clean; socks and shoes should be clean and dry at all times and antifungal sprays and powders will add an extra layer of protection as well. Sandals or shoes should also be worn in all public areas, especially pools and gym locker rooms. To protect the hands rubber gloves should be worn when exposed to water and moisture, picking or biting the nails should be avoided and manicure and pedicure tools should be properly sterilized before being used.

It’s also important to note that if an infection is already present it’s important to wash hands thoroughly after treating the infected areas as fungus nails can spread from one nail to another. 

Suzy Pickhall, who has got been a foot care expert for more many years has written a functional guide on how to combat Foot Pain in Ball of Foot , and Insoles and Shoe Inserts.