Nail Problems

What are ingrown nails?

An ingrown nail is the result of a nail growing into the skin that surrounds it. This often occurs at either edge of the big toe. Ingrown nails may be caused by improper trimming, inherited nail deformities, injuries, fungal infections, or pressure.

Symptoms
Ingrown nails may cause pain at the tip of the toe or all the way to the base of the toe. The pain is often worse while walking. An ingrown nail may also lead to infection, inflammation, or a more serious condition. If it’s infected, you might see pus or redness.

Evaluation
To determine the extent of your problem, your podiatrist examines and possibly palpates (presses) the painful area. If other problems are suspected, blood tests, cultures, or x-rays may be done as well.

Treatment
If the nail isn’t infected, your podiatrist may trim the corner of it to help relieve your symptoms. He or she may need to remove one side of your nail back to the cuticle. The base of the nail is then treated with a chemical to keep the ingrown part from growing back. Severe infections or ingrown nails may require antibiotics and temporary or permanent removal of a portion of the nail. To prevent pain, a local anesthetic may be used in these procedures. This treatment is usually done at your podiatrist’s office.

What are thickened nails?

Abnormally thick or crumbling nails may be caused by injuries, pressure from shoes, fungal infections, or conditions such as diabetes, psoriasis, or vascular disease. Eventually, the nail may loosen and fall off.

Symptoms
Along with thickening, the nail may appear ridged, brittle, or yellowish. The nail may also feel painful when pressure is put on it.

Evaluation
Since thickened nails may be a symptom of an underlying medical condition, it’s important for your podiatrist to look at your medical history for possible related problems. To check for a fungal infection, a culture may be done. The thickness and color of the nail are also examined carefully to determine possible infections or other conditions.

Treatment
If the nail isn’t infected, your podiatrist may be able to thin it by trimming, filing, or grinding. If a fungal infection is present, oral or topical anti-fungal medications may be needed. This can help prevent ulcerations under the nail while keeping the fungus from spreading to other nails. If pain is still present, the entire nail or part of it can be surgically removed. Do not remove the nail by yourself.

What are black and blue nails?

A black-and-blue nail is usually caused by sudden or repetitive injury to a toe. This might occur during sports that involve running or stopping quickly. The injury may also result from a heavy object falling on a toe. If your toe is black and blue but not injured, see your doctor immediately.

Symptoms
The big toe is most often affected. Bruised, broken blood vessels cause the black-and blue colors under the nail. If the condition is the result of a sudden injury, pain may be severe.

Evaluation
Your podiatrist talks with you about your symptoms and physical activities. He or she may palpate (press) the area at the end of the toe to determine the extent of the pain. Your toe and foot are examined for any signs of infection. If a fracture or bone spur is suspected, x-rays may be needed. If small black spots are present under the nail, other problems may need to be ruled out.

Treatment
If pain is severe, the nail may be removed, or a hole may be drilled in the nail to allow drainage, which relieves the pressure. A local anesthetic may be used. Pain may also be relieved with prescription medications, or by soaking or icing the area. If pain is not severe, you may not need treatment. The nail can be thinned or left alone to fall off. A new nail should grow to replace it.

How can I prevent nail problems?

Many nail problems can be prevented by wearing the right shoes and trimming your nails properly. To help avoid infection, keep your feet clean and dry. If you have diabetes, talk with your podiatrist before doing any foot self-care.

The Right Shoes
Get your feet measured (your size may change as you age). Wear shoes that are supportive and roomy enough for your toes to wiggle. Look for shoes made of natural materials such as leather, which allow your feet to breathe.

Proper Trimming
To avoid problems, trim your toenails straight across without cutting down into the corners. If you can’t trim your own nails, ask your podiatrist to do so for you.