Nail Problems

Barometers of Health

Toenails often serve as barometers of our health and well-being; they are diagnostic tools providing the initial signs of the presence or onset of systemic diseases. For example, the pitting of nails and increase in nail thickness can be manifestations of psoriasis. Concavity, the inward rounding of toenails instead of upward, can foretell iron deficiency anemia. Some nail problems can be conservatively treated by using topical or oral medications while others may require partial or total removal of the nail. Any infection or discoloration on or about the nail should be evaluated by a podiatric physician.

Nail Ailments

Ingrown Toenails

The most common of nail impairments, ingrown nails, are nails whose sides or corners dig painfully into the soft tissue of nail grooves, often leading to redness, irritation, and swelling. Usually, toenails grow straight out from the nail bed. Although, in some cases, one or both corners or sides curve and grow into the flesh. The big toe is commonly the victim of this type of condition but other toes can also become affected.

Ingrown toenails may be caused by:

  • Heredity
  • Shoe pressure or crowding of toes
  • Repeated trauma to the feet from normal, everyday activities
  • Improperly trimmed nails (Use toenail clippers to trim them straight across, and not longer than the tip of the toes. Do not round off corners.)

If you suspect having an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water. After soaking, apply an antiseptic and bandage the area.

People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self treatment and seek podiatric medical care as soon as possible.

Avoid all other "do-it-youself" treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications. Nail problems should be evaluated and treated by your podiatrist, who can diagnose the ailment, and then prescribe medication or another appropriate treatment.

A podiatrist will resect the ingrown portion of the nail and may prescribe an oral or topical medication to treat the infection. If ingrown nails are a chronic problem, your podiatric physician can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a laser, a chemical, or by other methods.

Fungal Nails

Onychomycosis, fungal infection of the nail, is often ignored because the infection can be present for years without causing any type of pain. The disease is characterized by a progressive change in a toenail's color and quality, which is often embarrassing and ugly.

Actually, the condition is an infection that occurs underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes foul smelling and darker in color. White marks frequently appear on the nail plate, debris may collect underneath the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If this condition is ignored, the infection can spread and possibly impair one's ability to walk or work. This happens because the resulting thicker nails are difficult to trim and make walking painful when wearing footwear. It is important to note that onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.

Because of the difficulty involved with avoiding contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot; for example, swimming pools, showers, and locker rooms. Injury or trauma to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as circulatory problems, diabetes, or immune-deficiency conditions, are especially prone to experiencing fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration of the foot.


  • Clean, dry feet are most effective in resisting disease.
  • Proper hygiene, care, and regular inspection of the feet and toes are the first lines of defense against fungal nails.
  • Wash feet with soap and water, then dry thoroughly. This is the best way to prevent a fungal infection.
  • When in public areas, shower shoes should be worn.
  • Change shoes, socks, or hosiery more than once a day.
  • Clip toenails straight across so that the nail does not extend beyond the tip of the toe.
  • Wear well-fitting shoes that are made of materials that breathe.
  • Do your best to avoid wearing excessively tight hosiery, which promotes moisture.
  • Socks made of synthetic fiber tend to "wick" away moisture faster than those made of cotton or wool.
  • Disinfect instruments used to cut toe nails and all home pedicure tools.
  • Don't apply polish to nails suspected of infection—for example, those that are discolored, red, or swollen.

Treatment of Fungal Nails

Depending on the nature and severity of the infection, treatments may vary. Daily routine cleansing over a period of many months may temporarily suppress mild fungal nail infections. White markings appearing on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal ointment. However, even the most effective over-the-counter treatments may not fully prevent a fungal infection from returning.

A podiatrist can detect a fungal infection early on, culture the nail, determine the cause of the infection, then cultivate a suitable treatment plan, which may include prescribing oral or topical medication, and debridement, the removal of diseased nail matter and debris, of an infected toe nail.

Laser treatment is the most effective form of treatment for nail fungus. The laser treatment is performed in the podiatric physician's office and all ten toenails are treated.  The treatment is painless, does not require anesthesia, and has no side effects. A single, 30 minute treatment is all that is required to kill fungus living in the nails. 

Oral anti-fungals are another form of treatment which offer improved effectiveness and a shorter treatment regimen of approximately three months. Podiatrists may also prescribe a topical treatment for onychomycosis, which can be an effective treatment modality for fungal nails.

In some cases, surgical treatment may be required to remove the fungal infection. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail that has not responded to any other treatment prevents the return of a deformed nail and permits the fungal infection to be cured.

Trying to cure the infection without the qualified help of a licensed podiatric physician can lead to more problems. With simple preventative measures in combination with new technical advances, the treatment of this lightly regarded health problem can often times be successful.

Additional Nail Care Tips

  • Sterilize your shoes with the Steri Shoe sanitizer or spray shoes with over the counter anti-fungal spray.