Nail Disorders & Nail Surgery

Nails are excellent indicators of disease and provide diagnostic information.

Patients should look for some of the following nail presentations:

• Discoloration
• Brittleness
• Uplifting nail
• Pitting nail
• Splitting
• Striations
• Nail thinning
• Ridging
• Change in nail consistency
• Change in nail configuration
• Nail clubbing

Common Nail Problems:


Ingrown nails- Result from an alteration in the proper fit of the nail plate in the usual nail groove. Sharp edges of the lateral nail margin become driven into the skin of the nail groove. The nail essentially becomes a foreign body. An inflammatory response occurs in the involved nail groove. This can lead to redness, swelling, drainage, and development of granulation tissue.



Onychomycosis- Fungal infections are common, usually caused by dermatophytes.
Common causes: T. rubrum, T. mentogrophytes, and E. Floccosum.
Onychomycosis can be diagnosed by a fungal culture

Anonychia- Is the complete absence of the nail. This condition is a rare congenital anomaly.

Paronychia- Is an infection usually accompanying ingrown nails.

Beau's Lines- Transverse ridges in the nail plate.

Clubbed Digits- marked convexity of nails, with the nail becoming hard, and thick.

Eczematous Conditions- Many types of eczematous dermatitis such as atopic and contact dermatitis can affect the nail folds.

Glomus Tumor- A purplish tumor that causes pain. The nail bed will appear as a blue-red distortion.

Green Nails- Usually caused by a local Pseudomonas infection

Koilonychia- This describes a spoon shaped nail and describes a characteristic deformity in the form of a concave shape.

Onychauxis- This is the thickened, elongated, raised irregular nail.
Can be caused by trauma, fungal infection, and nutritional disturbances

Onychogryphosis- Is an exaggeration of onychauctic condition.

Onychomalacia- Refers to softness of the nails.

Onycholysis- Detachment of the nail bed from the overlying plate creates a space between nail plate and nail bed.

Splinter Hemorrhages- These are caused by capillary fragility in the longitudinal vessels of the nail bed.

Nail Anatomy


The matrix- is a stratified epithelium that produces hard keratin. The proximal matrix forms the superior nail and the distal matrix forms the lower nail.

Hyponychium- is an epithelial layer of the nail bed

Nail plate- can be separated into zones with predominantly different beginnings. The uppermost layer is generated by the proximal nail fold, the plate by the matrix, and the deepest section of the nail plate is contributed to by the nail folds and bed.

Lunula- is a white semi-lunar area corresponding to the anterior matrix.

Nail bed -consists of the hyponychium and corium over the matrix.

Surgical Nail Procedures:


Nail problems that dictate surgical intervention can include:
Abscess/ Paranychia

Persistent pain

Persistent ingrown nails

Some cases of fungal nails



Procedures:

Phenol and Alcohol Chemical Matrixectomy:

After the toe has been anesthetized, a portion or the whole nail is removed after a sterile preparation of the toe. Next 3 applications of phenol are used at the level of the matrix. The phenol is used to destroy the tissues of the matrix which will prevent further growth of the nail. The area is then flushed with alcohol and a dressing with antibiotic ointment is applied. The patient is given post operative soaking and dressing instructions.

Sodium Hydroxide Matrixectomy

Is a process similar to the phenol and alcohol chemical matrixectomy but uses sodium hydroxide and acetic acid to neutralize. The same criteria apply as for Phenol-Alcohol procedure.

Common Symptoms for Foot Ailments Part 2

Do any of your toenails curl into the fleshy part of your toe causing pain?

You could have an ingrown toenail. This can occur from cutting your toenails rounded at the corners instead of straight across, tight shoes, injuries, toenail fungus, or infections. Do not attempt to cut the toenail out yourself. If you notice your toenail curling even before it is painful call a podiatrist to get this nail removed.

Do you have stinky feet? Do your feet sweat profusely?

You might have Hyperhidrosis or trench foot. This is caused by sweat glands on the bottom of your foot creating more sweat than necessary. What may start off as just an annoyance or unpleasant smell can cause skin to become thick, macerated or painful.

Do you experience a feeling of sharp pain, cramping, or burning in your feet?

You might have a neuroma. A neuroma is when the nerves are pinched by your toe bones. This pinching commonly occurs between the third and forth toes. Tight shoes irritate the symptoms.

Do you have wounds on your feet that do not seem to be healing in a normal amount of time?

You might have chronic wounds or ulcers due to poor circulation or increased pressure on the wound site. These can be very dangerous if they are continuously left untreated. They can become seriously infected or even gangrenous and in severe cases can lead to amputation. Treatment plans can be offered by podiatrists to help the healing process and in most cases can heal in a few months.

Do you have painful growths on the underside of your heel bone? Do the arches of your feet hurt when you get up in the morning?

You might have heel spurs also known as Plantar Fasciitis. This is caused by a strain on the ligaments and muscles attached to your heel bone that lead to the membrane covering the bone to tear. This leaves the ligaments becoming inflamed and the heel bone lacking its natural protective barrier.

If you are experiencing any of these symptoms please call our office and make an appointment today. Don’t live with foot pain any longer! The sooner you get into an office and get your foot pain diagnosed the sooner something can be done about it.