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Toenail Conditions

Alternate Names

  • ingrown toenail
  • abnormal nails
  • black toe
  • runner's toe
  • toenail infection

Definition

Toenail conditions can stem from many different sources. The most common cause of toenail problems is fungal infection. Other causes include abnormal growth, trauma, and skin conditions such as psoriasis.

What is going on in the body?

Toenail conditions are usually recognized when a person has pain or odd sensations while walking or exercising.

Risks

What are the causes and risks of the condition?

Different toenail conditions present different risks. These risks can range from chronic low-grade pain to life-threatening infection. Fungal infections, bacterial infections, damage to the nail from injury and other illnesses within the body may cause nail problems.
Skin conditions such as psoriasis, which causes a flaking of the skin around the elbows and hairline, can first show up as thickened nails. Other possible causes include several rare dermatological problems.

Prevention

What can be done to prevent the condition?

Prevention is based on good nail hygiene. Dirt and other foreign matter should not be allowed to build up underneath the nail. The feet should be kept very clean.
Nails should be trimmed straight across. The corners of the nails should not be trimmed back. The reason for this is that as a person walks on the toes, the flesh under the nails is pushed upward. If the nails are trimmed back, the flesh can be pushed up into the nail, and cause a painful ingrown toenail.

Diagnosed

How is the condition diagnosed?

Most nail conditions are easily diagnosed by looking at the nail. A diagnosis of thickened and discolored nails may be more difficult. Most of the time, nail conditions are the result of a fungal nail infection. Sometimes, however, they are a sign of an underlying disease.
Healthcare professionals, such as primary care physicians, dermatologists and podiatrists, healthcare professionals trained in the care of the feet, can diagnose nail conditions. A history and physical exam, and sometimes a biopsy, are done.

Long Term Effects

What are the long-term effects of the condition?

The most common long-term effect is pain with walking or exercise. The pain goes way when the nail condition clears up. In some cases, bacteria may infect a nail, and sepsis, an infection of the bloodstream, may occur.

Treatments

What are the treatments for the condition?

Treatment depends on the condition. Nails that are bruised and have an underlying blood clot can be extremely painful and often need to be drained. Because of the risk of an infection, this is usually best done by a healthcare professional with appropriate equipment.
Nails that have been injured and are loose can sometimes be taped in place. The new nail grows in behind the old nail, pushing it away from the nailbed. If the nailbed is too unstable, the nail may need to be trimmed or removed by a healthcare professional.
Ingrown toenails can be trimmed and carefully lifted up to place cotton underneath. This allows the nail to grow out straight rather than into the flesh. If this is not enough, just the ingrown portion of the nail can be permanently removed. Local anesthesia is used to numb the toe, and the ingrown portion of the nail is removed. The growth tissue underneath is killed with a chemical or by laser surgery
If an ingrown nail has caused an infection, the ingrown nail acts as a chronic source of irritation, and the infection can not be cleared until the nail is temporarily removed. At times a person will need to take oral antibiotics. Rarely, if the nail has been a constant source of trouble, it may be permanently removed after the infection is over.
In some cases, the nail is curved like a tunnel because of an underlying bone spur. The bone spur is removed to allow the nail to grow back in a flatter shape. Thickened nails that have suffered trauma, or are affected by psoriasis, can just be filed flat. There may be no way to treat these nails and still allow them to grow back in a more normal fashion.
If simple filing and cutting of the nail do not work, then permanent removal of the whole nail should be considered. Non-fungal causes of nail thickening should be diagnosed and treated by a podiatrist or other healthcare professional.

Side Effects

What are the side effects of the treatments?

Side effects of these nail conditions usually involve pain with walking or exercise. Very thickened nails or ingrown nails can become infected.

After Treatment

What happens after treatment for the condition?

Once the nails have been treated, they will need to be trimmed regularly. Good nail hygiene is very important for these nails. A nail brush, a sturdy nail file, and clippers designed for the toenails are used to maintain good hygiene. A good pedicurist, a person skilled at trimming and cleaning nails, can often help.

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