Toenail Problems

Ingrown Toenails

Ingrown toenails are toenails that have grown into the skin of the toe, causing pain, swelling and, frequently, infection. Usually, it is the corner of the big toe that is affected by this condition, although the smaller toes can also develop this problem. Ingrown toenails may occur as a result of tight-fitting shoes, a curved growth pattern of the nail itself, an injury or improper toenail cutting. If left untreated, an ingrown toenail is likely to develop an infection and may even require surgery to remove the nail.

Ingrown toenails present with pain, swelling and redness. Many ingrown toenails, particularly when they first develop, can be treated at home by soaking the foot in warm water, keeping the area clean, applying antibiotic cream to the area and wrapping the toe in gauze or bandages. However, if there are signs of active infection, such as pus, or if the patient has diabetes or another disorder that interferes with proper circulation or immune response, a physician should be promptly consulted.

The doctor may place a piece of cotton under the nail to separate it from the skin that it is growing into, encouraging growth above the edge of the skin. For more severe or recurrent cases, part of the nail and the underlying tissue may have to be removed in order to eliminate the infection. Removal of an ingrown toenail may be partial or complete and is performed under local anesthetic. The procedure can be done surgically or using chemical techniques.

Patients can prevent ingrown toenails by protecting their feet from trauma, using extreme care when cutting their toenails and by wearing comfortable, well-fitting shoes. Patients with diabetes and other underlying conditions that put them at greater risk for infection or complications should take special precautions and visit a foot-care specialist at regular intervals.

Fungal Nail Infections

Fungal, or mycotic, nail infections are very common. Although they can occur on the fingernails, they are more commonly found on the toenails because fungus grows more readily in warm, dark, moist areas like enclosed shoes. Infected nails appear discolored, thick and brittle and may at times be painful. Fungal nail infections most frequently appear in adults.

Risk factors for developing fungal infections of the toenails include:

• Having athlete’s foot
• Sharing socks, shoes or other personal belongings
• Walking barefoot at public pools, gyms or shower rooms
• Having a tendency to sweat excessively
• Getting manicures or pedicures
• Having deformed or diseased nails
• Wearing closed footwear
• Having a damaged immune system

It is impossible to avoid contact with fungal organisms since they are found almost everywhere. Keeping the feet clean and dry, wearing clean socks and well-fitted shoes and taking care of any injuries promptly can all lessen the risk of developing a fungal nail infection.

Nails infected by fungus appear abnormal in shape and texture. They may be brittle or crumbly and there may be debris trapped under them. Mycotic nails are lusterless, thick and discolored, usually appearing yellow or brown. They may separate from the nail bed, loosening or lifting from their normal position.

Although observation is usually sufficient to provide a diagnosis of fungal nail infection, confirmation can be made by obtaining a laboratory culture of nail scrapings. Results of such a culture may take a few weeks to be reported.

Fungal nail infections are notoriously resistant to treatment. Over-the-counter ointments are likely to be ineffective in combating the fungus, although prescription ointments may promote healing and keep the infection from spreading. There are a number of oral medications that can be administered to treat fungal nail infections, but these must be taken for 2 to 3 months. The oral medications can also have serious side effects, including possible liver damage, so patients taking them must undergo regular testing.

Laser treatments are often successful in treating fungal nail infections and have no damaging side effects. If none of these remedies are effective in eliminating the infection, it will be necessary for part or all of the affected nails to be removed. Unfortunately, even with treatment, fungal nail infections have a tendency to recur, so patients are advised to be conscientious in their efforts to avoid the development of a chronic problem.