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Burton J. Katzen, DPM
Conditions Of the Toenail
Metro Foot Care Centers
. http://www.marylandfootdoctor.com

Conditions Of the Toenail

Toenail problems are the most common foot conditions seen in the podiatrist's office. The human toenail is one of the fascinating structures of the human body. Its position on the toe, together with its being encased within the toe box of the shoe, exposes it to frequent micro trauma, which may affect the appearance and health of the nail. Many systemic diseases such as diabetes, psoriasis, dietary deficiencies, and decreased circulation can manifest themselves early by changes in the appearance of the nails.

Disorders of the toenails are most common in the elderly. They may result from bacterial or fungus infections, repeated trauma, metabolic diseases such as diabetes, and vascular insufficiency. It is extremely important, especially in those people with compromised circulation, to adequately diagnose the etiology of the deformed nail and treat it promptly. Any delay may lead to a disastrous outcome.

Ingrown Nails

An ingrown nail is a condition in which a portion on the nail presses into the flesh, causing pain, redness, and sometimes infection. They are most commonly associated with the inside or outside of the great toe, but may occur in any toe. Contrary to popular belief, most ingrown nails are caused by a growth disturbance at the base or root of the nail, not by improper cutting. As the nail plate penetrates the adjacent tissue, it may cause irritation, inflammation, and eventually infection.

A permanent cure is easily obtained by removing the irritating portion of the nail and chemically cauterizing the corresponding portion of matrix (root). There are no stitches involved, and the patient may leave the office in normal shoe gear.

Onychogryphosis (Club Nail, Ram's Horn Nail)

Trauma to the nail matrix (root) may cause the toenail to become enlarged, sometimes over a period of many years. The nail becomes hooked at its distal end and may eventually encroach on adjacent toes causing lacerations and infections. If neglected the nail may actually resemble a club or a ram's horn.

Treatment may involve periodic palliative reduction of the thick nails by the skilled use of nail clippers and podiatric burrs usually every two to three months. Permanent cure in healthy individuals may be obtained by avulsion of the nail and chemically cauterizing the entire root of the nail. This will lead to a non-painful and cosmetically acceptable result in most people.

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