Fox Mill Foot and Ankle Center

Nails are made of keratin, a material also found in hair and skin. The nail plate grows from a shallow pocket or fold of skin behind the cuticle. This pocket is lined with specialized cells which produce nail tissue, much like a hair follicle. This region is called the nail root or matrix.

Paronychia - Infected Ingrown Nails
An ingrown nail can occur in one of several ways. The skin along side the nail plate can be thick, causing pressure against the nail and eventual abrasion or cut into the skin. The nail plate can develop a curved shape, due to trauma or fungal infection, which again can cut into the adjacent skin. The nail can also become ingrown as a result of aggressive trimming of the nail corners. Bacteria enter the skin after an abrasion occurs. If the cut remains open due to pressure from the nail, an infection can develop (see photo). Unless the nail is cut back from the open wound, treatment with antibiotics will not offer long term benefit.

Because the skin fold can lean in when the adjacent nail is cut back, it is recommended that the entire nail border and associated root be removed (matrixectomy) to prevent future recurrence. This procedure is routinely performed in the office under local anesthesia and requires minimal post operative care. Antibiotics are also prescribed if infection is present.

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Onychomycosis - Fungal Nail Infection
While there are many kinds of fungus, “Tinea” or skin fungus is a microscopic organism which feeds on keratin. Skin, nails and hair are made in part of keratin. Fungus prefers a moist dark climate to grow, which makes the foot prone to infection. Skin chemistry can change in subtle ways from one person to another or from one age group to another.

...there is no guarantee that medical treatment of a nail fungus will result
in a permanent cure, just as pulling weeds out of the garden does
not guarantee that weeds will not come back the next season....

Just as weeds in the garden prefer certain soils and climates, different skin types will be prone to fungal growth and others will not. This is why one person in a household may have an infection and another may not.

Because fungus is present in the environment, there is no guarantee that medical treatment of a nail fungus will result in a permanent cure, just as pulling weeds out of the garden does not guarantee that weeds will not come back the next season.

Because fungus grows in and under the nail plate, topical medications do not usually cure this condition (see photo). Oral medications such as Sporonox and Lamisil offer the best treatment option, however these medications can have side effects including reversible liver damage, and abnormalities of taste. If treatment is undertaken with them, periodic blood tests are required to monitor liver function.

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Onychodystrophy - Rams Horn Nails
Abnormal thickening of a nail can occur following trauma to the nail root (matrix). Trauma to the nail root can be acute, such as a heavy object falling on the toe. Nail root damage can also result from repetitive micro trauma, such as a use of a tight fitting shoe or one with a shallow toe box, used on long hikes or playing tennis.

Typically the nail will turn black and blue due to bleeding under the plate. If painful, the underlying blood should be drained by burning a hole through the nail plate. This can be performed by your local podiatrist.

Following such trauma, the nail root will go into shock. A new nail plate will begin to grow and may push out under the old nail. The old plate usually falls off in two to three months.

If this trauma also damages the nail root, the newly formed nail can grow in an abnormal direction, and or become markedly thickened. The injured nail can even curl up and over into the end of the toe. Because of its appearance this deformity is termed a Rams Horn Nail (see photo).

Traumatic nail deformities are not reversible. Treatment of deformed nails involve either trimming the nail or permanently removing the nail root (matrixectomy).

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