Toenail Problems (Pathology)

Ingrown Toe Nails

An ingrown toenail is a common condition that involves the corner of the toenail growing into the skin of the toe, causing pain, swelling and infection. This can occur as a result of wearing shoes that are too small or tight, cutting the toenails too short, injury to the toenail or a naturally curved toenail. While this condition can affect any toe, it most commonly affects the big toe. If left untreated, an ingrown toenail is likely to develop an infection and may even require surgery to remove the nail.

Most ingrown toenails can be treated at home by soaking the foot in warm water, applying antibiotic cream to the area and wrapping the toe in gauze or bandages. It is important to keep the area clean to help prevent infection. Your doctor may also place a piece of cotton under the nail to separate it from the skin that it is growing into, encouraging growth above the edge of the skin. For more severe or recurrent cases, part of the nail and the underlying tissue may be removed in order to remove the infection. Removal can be done through a chemical, laser or other methods.

Patients can prevent ingrown toenails by protecting the foot from trauma and by wearing comfortable, well-fitting shoes. Patients with diabetes may be at a higher risk for infection or other complications of ingrown toenails, and should take special precautions to prevent them from occurring.

Fungal Nail Infections

Nail fungal infection, also known as onychomycosis, is a common condition among people of all ages. These infections are caused by certain bacteria that may be due to genetics, aging, trauma or poor foot care. They may also be related to diabetes. Fungal infections occur under the toenails as a result of exposure to a warm, moist environment like sweaty shoes or shower floors. Athlete’s foot and other fungal infections of the skin may spread to the toenails as well, causing them to change color, thicken or crumble.

Toenail infections affect an estimated 40 million people in the U.S. Risk factors for contracting fungal infections include keeping the feet wet for long periods of time, walking barefoot in wet public places such as pools or showers, wearing closed shoes that do not allow the feet to “breathe” and having sweaty feet.

Symptoms of a toenail fungus infection vary depending on the type of infection, but are usually mild. These fungal infections often begin as a yellow or white spot under the nail, and develop into thickened, brittle and distorted nails that sometimes split. They may also turn your nails a darker color as a result of the debris that builds up.

Nail fungal infections should be treated immediately as they may cause permanent damage and are likely to recur. Treatment options include oral anti-fungal medications, anti-fungal nail polish or other topical medications. Surgery is also performed in severe cases to remove the entire nail or the infected portion.
Patients can reduce the risk of fungal nail infections by wearing clean shoes and socks that fit well and by attending to any nail injuries as soon as possible. Fungus is present nearly everywhere and may be difficult to avoid, but with proper foot care, patients can benefit from a reduced risk of infection.