Toenail diseases

Toenail diseases often remain undiagnosed, misdiagnosed or untreated. This situation continues until it leads to significant pain, bad foot odor, and nail deformities. To keep your nails healthy, you need to know the symptoms of their diseases, as well as precautions.

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Problems with nails

The American Podiatric Medical Association recently conducted a study with alarming results - they found that 75% of Americans experience problems with their toenails. Most of these problems are due to improper foot care, and only a small portion are caused by congenital defects and deficiencies.

The human foot is one of the finest engineering creations. Each foot has 33 joints, eight arches, 26 bones, over a hundred muscles, ligaments and tendons, all working together to distribute the body's weight and allow a person to make quick and agile movements. Unfortunately, many people don't pay attention to their feet - until they start to hurt. There are also 10 toenails on the feet, which we don't always give the attention we deserve.

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Structure of toenails

When we talk about nails, we often mistakenly consider only the nail plate, which we cut, paint, wash and which we consider beautiful or ugly, to be a nail. But in fact, a nail is a much more complex natural structure than it seems to us. From a medical point of view, it is an independent living organ of the human body!

The thickness of a toenail and its area depend directly on what a person eats, what their hereditary characteristics are, their gender, type of activity, age and the structure of their fingertips, of course. In addition, each nail has its own unique pattern that no one else has. This pattern consists of indentations and protrusions. When a person is healthy, their toenails are smooth, without grooves or thickenings, they shine, they are almost transparent and have an even, beautiful shade.

Interesting facts about the nail plate

Translated from Greek, nails are onyx. They are skin appendages, like our hair. Nails are horny formations with a lamellar structure, they develop from the exodermis. Nails on the feet and hands begin to form in the fetus in the womb when it is almost three months old. At this time, nails grow very slowly, but thoroughly.

First, the bed around the nail grows and forms (the periungual bed), then the nail ridges begin to form, and the nail plates grow and take shape only in the seventh or eighth month of the baby's development inside the mother. Only when the baby is born do his nails begin to grow fully.

The nail consists of a nail bed, a nail plate, and nail folds. The nail has one posterior fold and two lateral folds. The nail plate is 0.5 to 0.7 mm thick and 10-17 mm wide. The nail plate is made up of horny cells that are superimposed on each other in many layers – at least 150. They are called corneocytes. When the nail plate is formed, the corneocytes can no longer reproduce because they lose their cell nuclei.

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Nail ridges

What are nail folds? These are skin formations that form sinuses where they pass into the nail plate. And it is divided into the nail body, the nail root and the free edge of the nail, which lies under the back fold. And only a small part of the nail root that is visible to us is visible from the outside, it looks like a lunula. This is a small lunula in the shape of a semicircle of white color.

Nails grow when the epithelial cells of the matrix (it is located under the back of the nail) begin to divide. They are called onychoblasts. What is the matrix? It is part of the nail area on the foot or finger. The condition of the matrix determines how the nail plate will develop and grow. The shape of the nail, the speed at which it grows, and its structure also depend on the matrix.

If the matrix is damaged, the shape and structure of the nail plate changes. This threatens that the toenail will grow much slower, waves, depressions will appear on it, and eventually the nail plate may begin to collapse or disappear altogether. But if there is a serious injury to the nail, and the matrix is not damaged, then the nail will soon grow back like new.

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Cuticle

The nail matrix gradually passes into the nail bed, along which the nail plate moves lengthwise. And the cuticle is formed from the horny layer of the epidermis, which is located on the back nail fold. The cuticle serves to cover access to the nail root. If the cuticle is damaged during manicure manipulations, the nail root will stop growing.

Tissues around the nail

The tissues that surround the nail are permeated with tiny blood vessels and a large number of nerve endings. This is why, when the cuticle is damaged, blood can often flow from the tissues around the nail. Damage to the nails and the tissues around them requires very careful diagnosis before they become very painful.

In some cases, painful nail problems are signs of more serious illnesses, such as diabetes, circulatory diseases, nerves, and other problems.

Infected toenails

Sometimes, what you do to keep your nails clean can do more harm than good. Improper painting, thoughtless use of varnish with harmful substances and other improper measures can cause toenails to throb, swell, the nails become infected and can lead to more serious foot problems, such as ingrown toenails.

The same thing happens when you cut your nails incorrectly - the toenail grows into the corners, causing ingrown toenail disease.

When treating these conditions, professional help from a podiatrist or even a surgeon is recommended. In some cases, you may need to take antibiotics. In the worst case, you may have to undergo a simple surgery to remove the stuck area of the toenail to cure it.

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Claws on feet

Claws on the feet are the result of flexion of the metatarsophalangeal joints of the toes. The middle of the bone, the so-called middle phalanx, is especially affected. Claw toes can become a serious problem and a reason for treatment. The sooner claw toes are treated, the easier they can be corrected.

Claw toes can be deformed in two ways. The first is when the toes remain mobile. The second option is when the toes are immobile. If claw toes are mobile, they can be straightened with manual manipulation. If the joints of the toes are immobile, they hurt a lot, movements are limited, and the person may need surgery. Sometimes, walking movements are impaired, they become painful, the metatarsal bones are subject to a lot of stress, and corns and calluses also appear on the ball of the foot.

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Consequences of claw-shaped fingernails

Nail deformities that develop into claws on the toes are caused by muscle imbalances. People with flat feet (a condition also called pes planus), people who have had foot injuries, and people with underlying chronic conditions are particularly at risk, as they are more likely to develop claw toes.

Patients with inflammatory diseases such as diabetes, rheumatoid arthritis and psoriasis are at increased risk, as are those with neuromuscular diseases such as cerebral palsy and multiple sclerosis.

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How to diagnose claw toes?

Malformed toes are very visible, but additional physical examination is required. Most doctors will also measure the foot for stability and flexibility, and look for signs of pain in the toes during the examination.

Doctors will also check for swelling, erythema (or abnormal redness of the finger or tissue under the nail), and calluses.

In some cases, doctors require patients to undergo x-rays to determine the exact position of the toes, as well as the condition of any bones, whether there is inflammation, arthritis. Blood tests may be necessary to rule out diseases such as diabetes and other infections.

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What treatment options are effective for claw toe?

When detected early, claw toes can be corrected without surgery. When claw toes are detected late and the soft tissues that attach to the claw have already become deformed, surgery becomes necessary. There are two types of surgery that can correct crooked toes and claw toes.

Arthroplasty

This type of surgery seems minor because it is a simple incision along the legs. The head of the proximal phalanx is used and then trimmed, allowing the phalanges to be straightened. Progressive surgeries may be necessary until doctors achieve the desired degree of straightening. If this is not successful, the patient may be asked to undergo arthrodesis.

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Arthrodesis

This type of surgery is for more severe cases of claw toe. The middle phalanges and proximal tubules are joined together. Cartilage is removed from the middle phalanx of the toe, and then the two bones are fixed together (usually removable) until they fuse.

Patients who undergo arthrodesis cannot walk for several weeks. Like any type of surgery, arthrodesis has its complications. Some patients suffer from infections after the surgery. Some also suffer from numbness in the toes.

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What is an ingrown toenail?

Ingrown toenails are nails that dig into the skin, causing pain in the toes. The sharp, curved corners of ingrown toenails prick the skin on the outside of the feet, causing the punctured areas to swell and become painful. Technically, any nail can become an ingrown toenail, but big toenails are more susceptible to injury.

About 20% of patients have problems with ingrown toenails. Ingrown toenails occur when the skin is punctured in the corresponding area of the nail plate, as a result of penetration of foreign bodies, as well as inflammatory, infectious and reparative processes.

Ultimately, this can lead to painful and foul-smelling lesions of the fingertips (most often the nails), bacteria that have penetrated the soft tissues (hypertrophy around the nail plate).

Never underestimate ingrown toenails due to infections because if this condition is not treated quickly and correctly, it can develop into more serious infections. In some cases, ingrown toenails progress to an abscess, a condition that requires surgery.

What are the symptoms of ingrown toenails?

Ingrown nails are characterized by pain, swelling, and redness at the corner of the infected nail. In the early stages, the end of the phalanx of the infected finger will usually become red and swollen. Typically, there is no channel for the pus to pass through at this stage. As the infection of the ingrown nail progresses, the inflammation increases. In some cases, yellow or white pus will come out.

In worst cases, infection from ingrown toenails can cause fever.

What causes ingrown toenails?

The most common cause of ingrown toenails is improper nail trimming. When you trim your nails along the edge or cut them down at the corners, they can become ingrown.

Nails should be cut in a straight line. Otherwise, the corners of the nail may penetrate the skin.

Very tight shoes can also cause infections due to ingrown toenails. Tight shoes squeeze your toes together and put pressure on your toenails (usually your big toe), causing them to grow abnormally.

Ingrown toenails can also be caused by other factors, such as a fungal nail infection that is spreading more. Certain types of foot trauma in the area around the nails can also cause this same condition.

Tests and diagnostics

Doctors will typically evaluate ingrown toenails based on your medical history. Your doctor may also ask you if you have any medical problems related to your toenails, whether you are taking any medications for infection, whether you have had a recent tetanus shot, if you have any allergies, etc.

Your doctor will be able to tell if you have an ingrown toenail after doing some simple tests. If the infection looks severe, your doctor will likely check your vital signs, such as your temperature, blood pressure, and pulse. In some cases, your doctor may ask for urine tests. If you have diabetes, your doctor may order a blood test.

How to treat ingrown toenails?

If your ingrown fingernails are still in the early stages of the disease, you can treat it yourself. It will be enough to remove the parts of the nail that are digging into the skin. To do this, you need to take small swabs of gauze, or small pieces of cotton wool, and push them between your fingers to make it easier to remove the affected areas. This can be painful, so it is better to take painkillers.

You should soak the infected nails in warm water at least four times a day. It is advisable to add antibacterial solutions to this water. You should also wash the affected area at least twice a day with regular soap and water.

Stay away from tight shoes or high heels if you have ingrown toenails. Switch to sandals and other more comfortable shoes.

If the condition does not improve after two or three days, it may be a signal to call your doctor, who may suggest a surgical method. The invasive treatment method is only necessary when there is an infection in the nails. During surgery, the abscess is removed. If you have not received a tetanus shot in the last five years, your doctor will likely require an X-ray before surgery.

Toenail Fungus

Similar names: Onychomycosis, Tinea Unguium, Ringworm of the Nails, Ringworm of the Nails. Nail fungus, or the condition also called onychomycosis, is a fairly common condition that destroys (or disfigures) the affected nail.

It can be caused by many types of fungi, such as dermatophytes (including trichophyton interdigitale and trichophyton rubrum), yeasts, and molds.

These fungi thrive in the damp, dark, cramped environment of shoes and break down keratin, the protein that makes the nail structure tough as it grows. The big toe and little toe nails are more prone to developing toenail fungus because they are most exposed to the friction caused by tight shoes.

What are the symptoms of nail fungus?

Yellow and thick toenails are likely to be infected with fungi. Some fungi with a foul odor tend to infect the nails as well, especially on the sides. Fungal nails can eventually break down and sometimes start to fall off the toe as the infection gets worse. Some toenails become very thick, causing the feet to swell inside the shoe.

In cases of chronic superficial onychomycosis, the infected nail turns white (rather than brown or yellow). Its surface softens, dries out, and crumbles.

What causes fungal toenail infection?

Between 2 and 18 percent of people worldwide have fungal nails, or onychomycosis. Children are not as susceptible to the condition - only one in 200 children and adolescents (under 18) develops onychomycosis. People become more vulnerable to the fungus as they get older.

It is estimated that about 50 percent of people will develop toenail fungus at least once before they reach age 70.

Fungal nails or onychomycosis are mostly associated with tight shoes or hosiery that does not breathe. Another cause is splitting of the nails.

Nail fungi can also attack a person due to damp floors of public locker rooms, such as in a gym or swimming pool, and showers. People suffering from chronic diseases such as HIV, diabetes or cardiovascular problems are more prone to fungus.

Toenail Fungus and Its Diagnosis

The doctor will definitely conduct a survey to determine what could have caused the person to have a nail fungus. Factors such as a high risk level when wearing tight shoes, synthetic socks, stockings, poor hygiene, participation in sports games in public gyms and locker rooms, chronic diseases should definitely be voiced to the doctor.

The doctor will likely ask the patient if he or she has a family history of psoriasis, which can look very similar to a fungal infection. Some doctors may take nail samples for testing.

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How to get rid of nail fungus?

Contrary to popular belief, fungal nails are unlikely to ever heal on their own. If left untreated, the condition can gradually worsen and the fungus can spread to other toenails.

The infected parts of the nail may enlarge. The doctor may remove as much of the fungal toenail as needed. The nail may be trimmed, filed down, and the fungus may be dissolved. The treatment liquids may be used by the patient on their own, usually twice a week, until the fungal nails are completely healthy.

Some topical medications only work on milder infections. Oral antifungal medications are usually needed if onychomycosis gets worse.

Some antifungal medications have side effects, so be prepared to follow your doctor's prescription and monitor your intake. Surgical removal of part of the nail is usually done when infected nails are already interfering with walking and other functional activities.

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Trauma of the nail plate

When a nail plate is injured, a hematoma often forms - a painful condition that occurs when bleeding develops under the nail. Typically, this is due to crushing of the tissue under the nail. The hematoma becomes trapped between the hard structure of the nail on top and the distal phalanx of the toe below.

If you stub your toe or have something heavy fall on your toe, you may develop a hematoma, where blood collects under your nails. The nail turns red, black, or purple.

The pain is usually caused by blunt trauma from a heavy object or chronic friction from shoes. Hematoma types can range from a small spot under the nail to a large area. Depending on the amount of blood under the nail, the nail plate may become weakened.

But often the nail remains intact and the blood disappears once it is released by puncturing the nail. If the hematoma is large and painful, treatment will involve relieving the pressure under the nail.

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When to see a doctor after a nail injury:

If you have suffered a severe injury to your nail, such as if something heavy fell on your feet, you may want to seek treatment to rule out a fracture and treat any wound to the nail bed.

• If a nail injury results in severe swelling, pain, or redness of the foot.
• If there is any discharge from under the nail.
• If the nail falls off.

If you have neuropathy or any condition that affects healing or blood circulation, such as conditions like diabetes or peripheral arterial disease.

If the discoloration of the nail appears as a linear band or bands running the entire length of the nail plate. Although the band is often normal pigment, in some cases it may be a sign of skin cancer - melanoma.

Nail trauma may not always result in bleeding under the nail, but it can cause other predictable changes. These changes may occur due to chronic friction of the nail against shoes or in response to irritation from a fungal or bacterial infection.

Some of the most common changes

1. Thickening of the nail causes considerable damage to its growth, or nail matrix.
2. Nail dystrophy is a permanent change in the nail, such as splitting or reduction in nail size.
3. Nail tearing - all or part of the nail becomes loose or falls off

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So how can you avoid toenail injury?

Buy shoes in a larger size

Trim your toenails straight across rather than in a half circle, especially on your big toes, to prevent ingrown toenails.

Replace your shoes as often as possible and try different brands and styles until you find the shoes that work best for you.

If you are overweight, say goodbye to those extra pounds, this will reduce the impact of body weight on your fingers and toenails

If you notice any deformation of your nails or feel pain during exercise, stop the movement immediately.

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Helpful Tips to Keep Your Nails Healthy

It takes very little effort to take care of your feet and keep your nails healthy. Here are some habits you can develop and follow.

Wear only shoes that fit you. Your feet need room to breathe, don't cramp them in trendy but very uncomfortable shoes.

Keep your feet dry. Make sure that after washing, the areas between your toes are dry before you put on socks. If you have sweaty feet, you should wipe them regularly with cotton wool.

Feet need to be washed daily. A simple scrub in the shower does wonders for the health of your feet and nails.

Use only clean socks. Never use the same pair twice to avoid spreading nail fungus.