Foot and Ankle
High Blood Pressure
On-the-Job Foot Health
Rear Foot Surgery
Barometers of Health
Most people donít give much
thought to the value of their toenails. They have to be trimmed
occasionally, often considered more of a nuisance than anything else,
but that may be the limit of attention from many.
In reality, because they
are at the far point of our circulatory system, they often serve as
barometers of our health, diagnostic tools providing the initial signal
of the presence or onset of systemic diseases.
Pitting of nails and
increased nail thickness, as examples, can be manifestations of
psoriasis. Concavity -- nails that are rounded inward, instead of
outward -- can foretell iron deficiency anemia; red discoloration
beneath the rear of the nail could be a sign of impending heart failure.
Toenails grow constantly.
Some conditions make them grow faster than usual, such as an excess of
thyroid hormone, and the injury recovery process. A lot of energy is
required for toenail growth relative to the small amount of tissue
involved. This high level of metabolic activity makes them sensitive to
outside influences, resulting in abnormalities -- deformity,
discoloration, and related infection. Some nail problems can be
conservatively treated, others require partial or total removal of the
The major parts of the toenail are the nail itself (nail plate), its
root, or nail bed (matrix), rear area (lunula) or cuticle, underside of
the nail (nail bed) and nail side or groove (sulcus). Healthy nails are
pink, free of dirt and impairment, and grow into the grooves normally.
Because of their association with health-related diseases, toenails of
persons of all ages can undergo an array of changes, some of which are
relatively common. They can become brittle, curved, discolored,
infected, clubbed, pitted, and grooved. In some cases, the nail falls
off and a new one grows in. These conditions may be caused by injury,
warts, tumors under the nail, infection, poor circulation, poor foot
hygiene, and congenital problems with parts of the nail that normally
grow into the skin.
Older persons with poor circulation are prone to
having their nails become discolored or darkened, thick, or brittle.
Another disorder of aging is the formation of narrow ridges running from
the nail matrix to the sides.
Many older persons do not have the strength, skill,
eyesight, or tools to trim their nails, especially if the nails are
deformed, and should seek podiatric medical care for those services.
Ingrown nails, the most common toenail impairment, are nails whose
corners or sides dig painfully into the soft tissue of nail grooves,
often leading to irritation, redness, and swelling. Usually toenails
grow straight out. Sometimes, however, one or both corners or sides
curve and grow into the flesh. Ingrown nails are varied in shape; some
appear flat, others are C-shaped, a problem more commonly of older
persons. Itís usually the big toe thatís the victim, but other toes
can be affected.
Ingrown toenails may be caused by:
Fungal And Other Infections
- Improperly trimmed nails
- Shoe pressure; crowding of toes
- Repeated trauma to the feet from normal activities
associated with work, sports, and other leisure-time and fitness
pursuits, such as aerobics
Toenails are hiding places
for dirt, and can serve as breeding ground for infection-causing
bacterial and fungal organisms.
Fungal infections are
among the most troublesome of nail conditions to treat. They are often
characterized by thickening, discoloration, and separation of the front
of the nail from the nail bed. In some cases, the nail crumbles.
If treatment with
medication is unsuccessful, the nail may have to be removed. However,
removal does not necessarily prevent the nail from growing back, or
fungal infection from recurring. In older persons with impaired
circulation, such as diabetics, medical treatment is generally
preferable to surgery.
Some other infections
cause inflammation of the matrix (onychia) and inflammation of the
tissue adjacent to the nail (paronychia), which often lead to serious
complications, including more widespread infection extending up the leg.
When ignored or treated without medical attention, infections of these
types may result in loss of toes, a foot, or even a leg.
Podiatric Medical Care
If you suspect an infected
toenail, you can immerse the foot in a warm salt water soak, or a basin
of soapy water, then apply an antiseptic and bandage the area. These are
only temporary measures, for relief of discomfort before you consult a
podiatrist. Other "do-it-yourself" treatment -- including any
attempt to remove any part of an infected nail -- and use of
over-the-counter medications should be avoided.
Sudden changes in color
or shape, or any drainage from infection, should be discussed with a
doctor of podiatric medicine. The podiatrist can diagnose the ailment,
and then prescribe medication and/or another appropriate treatment.
An injury can cause
bleeding under the nail plate, for example, and the podiatrist might
need to create a hole or holes in the nail to remove the blood.
For nail injuries or
conditions that cannot be permanently cured by medication or removal of
part of the nail, as in the case of ingrown nails, the podiatrist may
have to surgically remove the nail plate and/or its matrix. As part of
the surgery, the nail bed can be treated in a variety of ways, including
electric cauterization, application of chemicals, or use of a laser.
To Avoid The Woes Of Toes
- Trim toenails straight across, slightly longer than
the end of the toes. Do not round off corners; this can be the cause
of ingrown nails.
- Clip nails with toenail clippers.
- After clipping, smooth nails with a file or emery
- Wear only properly fitted shoes, not short or
- Wash feet regularly, especially between toes, and
- Wear hosiery that is not constrictive.