INGROWING TOE NAILS

Symptoms;
                   An ingrown nail occurs when any part of the nail grows into the surrounding skin. This can happen slowly or seemingly "over night" and may cause irritation, pain, redness or swelling. Over time, ingrown nails may cause a deep abscess or infection and can be associated with small spurs under the nail. Thickened or fungal nails tend to aggravate an ingrown nail. Potential causes of ingrown nails include: previous injury to the toe, improper shoe gear, contributing factors due to other toe or foot deformities and certain athletic activity.

Evaluation;
                   Your Podiatrist will discuss your symptoms as it relates to your condition. The Podiatrist will then examine, palpate, probe and trim or thin down the nail or unhealthy tissue to determine the cause of the nail symptoms. The Podiatrist may take standing x-rays to evaluate the bone under the nail to rule out a subungual exostosis (boney spur or projection) which may deform the nail plate and facilitate an ingrown nail. A bone abnormality such as a curled toe, long toe, hammertoe or bunion should also be examined to determine if it is a contributing factor to the nail ingrowth.

Treatment;
                  Conservative treatment consists of addressing any predisposing toe and /or foot condition, shoe gear factors and proper hygiene habits including foot soaks at home. Your Podiatrist should also routinely cut and debride the nail and /or any debris that accumulates around the nail. There are several nonprescription and prescription antibiotic creams that may cure the very new and mild cases. More significant nail infections may require an oral prescription antibiotic.

The most definitive way to treat an ingrown nail is to remove the offending nail border causing the symptoms. Surgical treatment includes avulsion (temporary removal) of part of the nail or matrixectomy (permanent removal) of part of the nail under a local anesthetic. In this case, the nail root is removed or a chemical is applied so no nail corner grows back. Both procedures are done in the clinic where a cold spray is applied to numb the skin, the toe is put to sleep with an anesthetic and the procedure is completed. The patient is allowed to ambulate to tolerance and instruction for home care is given.

 

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FUNGAL NAILS

Symptoms;
                   Fungal nails (onychomycosis) is the most common skin disease in people of all ages. It may be caused by fungus, yeast or candida species. Initially, the disease process is hard to see due to a lack of symptoms. It may start from an improperly treated or undiagnosed case of athletes foot (Tinea pedis). In time, the fungal nail slowly becomes discolored (chalky white, yellow or brown) thickened and friable. Itching, aching or pain may occur as the nail loosens, becomes ingrown and/or thickens. The disease is usually painless, but certain shoe gear may be aggravating. The skin next to the nail may get a little swollen, red, dry or shiny.

Evaluation;
                   Your Podiatrist will discuss your symptoms as it relates to your condition. The Podiatrist will then examine, palpate and probably trim or thin down the nail to determine the cause of the nail symptoms. The Podiatrist may take standing x-rays to evaluate the bone under the nail, because sometimes a subungual exostosis (boney spur or projection) may deform the nail plate. A scraping or removal of the nail may be done for inspection under the microscope or to perform a culture to verify that it is fungus, yeast or candida and not another type of nail problem.


Treatment;
                  Conservative treatment consists of proper hygiene habits and your Podiatrists can routinely cut and debride the nail fungus. There are several nonprescription and prescription anti-fungal creams that may cure the very new and mild cases. More significant fungal nails may require an oral anti-fungal treatment that may be necessary over several months. In all cases, it is recommended that your Podiatrist routinely debride and monitor the disease.

Surgical treatment includes avulsion (temporary removal) of the nail under a local anesthetic and then applying the anti-fungal creams or taking the oral medication as the nail begins to grow back. Matrixectomy (permanent removal) of the nail under a local anesthetic can be performed. In this case, the nail root is removed or a chemical applied so no nail grows back. This treatment does not require any anti-fungal medication. A thickened skin usually replaces the nail. To perform this procedure, a cold spray is applied to numb the skin, then the toe is put to sleep with an anesthetic. Both procedures can be done in the office.

 

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VERRUCAE

Symptoms;
                   Verrucas are caused by a contagious DNA papilloma virus that spreads to the skin by contact. This usually occurs around moist areas such as: bathroom mats, tubs and showers, pools, spas and shared or public bathing facilities. The papilloma virus causes one or more flat or raised, callused or kernel-like bumps anywhere on the skin, but most often on the hands and feet. The wart itself may or may not be painful. Warts will most likely be tan to white in color and occasionally have little black spots in them or an overlying callus. Plantar warts which are seen on the bottom of the foot, tend to occur under boney weight bearing areas. The pressure in these areas pushes the warts deep into the skin.

Evaluation;
                  Your Podiatrist will discuss your symptoms as it relates to your condition. The Podiatrist will then examine, palpate and most likely scrape the lesion to determine if it is a wart and not another type of skin abnormality. The Podiatrist may take standing x-rays to evaluate the bone structure, mechanics and deformity as it appears with weight on the foot, to rule out certain bone deformities that can cause a callus which looks very similar to warts.

Treatment;
                  Conservative treatment consists of salicyclic acid or other types of cream application and debridement along with modifying hygiene habits. This usually is not effective for the deeper or clustered warts. These usually require excision and curretage, hyfercation (controlled electrical current) or electro-surgery. These procedures may be done in the clinic under a local anesthetic. Although it may take several weeks for the area to heal, the patient is able to wear loose fitting shoes immediately after the procedure and daily activities are interrupted for only a few days

 

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