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Nail diseases can affect the appearance, health and strength of the toenails. The following are some of the common nail conditions, causes, symptoms and treatments we will treat as foot health professionals.
A normal, healthy toenail is a shade of pale pink. It is normal, however, for the nails to become thicker and brittle as people get older.
These nails are thickened, discoloured and overgrown, usually due to continued trauma. They often look like a ram’ horn, hence the common name. The big toe nail is the one usually affected. They can also be caused by psoriasis, circulation, acute injury or genetics. They are usually conservatively managed by regular podiatry/foot care appointments but can also be removed surgically to prevent regrowth.
These nails can be mistaken for fungal nails. However, unlike the fungal nail they are usually pitted; they are also discoloured, possibly with bleeding under the nail plate and can separate from nail bed. They usually affect most of the nails, rather than 1 or 2 as in fungal infection. A referral to the GP is usually sensible where blood tests can rule out psoriatic arthritis. They can be managed within the foot health practitioner/ podiatry clinician.
This is a condition where the nail/s are brittle and splitting. The usual cause is constantly having wet feet that are then drying out. They can also be caused by an underlying illness or iron deficiency. Keeping the feet and nail moisturised with cream and oils, and keeping exposure to water at a minimum, can help prevent the problem.
This is usually the result of poor cutting, tight socks or shoes, injury and genetics. There is swelling, pain, redness and possible infection. The options are regular foot health care maintenance, nail bracing, nail surgery, saltwater baths 3-4 times a day and wider/deeper footwear. Also see paronychia.
Several different moulds and fungal spores can affect nails. Following nail trauma (this can be caused by rubbing on tight or restrictive footwear), fungi can penetrate the break between the nail plate and the nail bed. Sweat, athlete’s foot and poor pedicures can also put people at risk. Recent research has also shown that there is a genetic predisposition for fungal infections. Eradication is difficult. Symptoms include a thickened, discoloured, fragile, crumbling nail plate. Treatments can include oral Terbinafine prescribed by the GP following diagnosis. However, regular blood tests are required to check liver function. The nail can be removed surgically and treated by the patient as it is regrowing. There are also topical treatments and, more recently, the use of a variety of lasers.
This condition is where there is separation of the nail plate from the nail bed, usually over a period of time. It can be caused by an acute injury or an underlying health condition. Excessive filing of the nail, the use of nail gels and acrylics, contact dermatitis, constant submersion in water, psoriasis, fungal infection and a severe reaction to some medications often cause this problem. Chemotherapy frequently results in a shedding of all toenails. Treatments can include medications if the cause is related to oral antifungals, iron deficiency or psoriasis. Onycholysis can also be prevented in some cases by correct nail trimming (with careful, one direction filing), avoiding chemicals to the nails (including some nail gels/acrylics), avoiding submersion in water for long periods and treating underlying conditions.
This can be acute or chronic. The skin around the area of the nail becomes red, swollen and infected. It can cause the nail to lift and can be caused by poor nail cutting, ingrowing toenail, extended periods of having feet in water, retronychia, picking or chewing the nail or skin around the nail or direct trauma. Bacteria enter through broken skin, usually at the base of the nail. Chronic paronychia is more commonly caused by irritation from occupational or environmental exposure. Paronychia is usually the result of a staphylococcus aureus infection and can be helped by 3-4 times daily saltwater baths. If the problem remains, antibiotics will be needed.
Many diseases can affect the nails, and it is always helpful to talk to a foot health practitioner/ podiatrist or doctor if there are changes to the nail, or there are concerns. The condition can then be diagnosed quickly, and the appropriate treatment advised.
