Toenails often serve as barometers of our health; they are diagnostic tools providing the initial signal of the presence or onset of systemic diseases. For example, the pitting of nails and increased nail thickness can be manifestations of psoriasis. Concavity-nails that are rounded inward instead of outward-can foretell iron deficiency anemia. Some nail problems can be conservatively treated with topical or oral medications while others require partial or total removal of the nail. Any discoloration or infection on or about the nail should be evaluated by a podiatrist. The most common nail problems include the following: ingrown toenails , fungal nails and blackened toenails.

Ingrown toenail

An ingrown toenail is a painful condition characterized by the nail digging into the surrounding skin, leading to inflammation and possible infection of the toe. This is a serious condition for people with impaired circulation, diabetes, or other systemic diseases.

Causes of ingrown toenails

• Heredity
• Improper nail trimming
• Trauma
• Pressure from ill-fitting shoes
• Biomechanical foot imbalances

What can you do?

• Trim toenails straight across as a preventative measure.
• Select the proper shoe style and size.

What can a podiatrist do for you?

• Perform a physical examination.
• When Necessary request an X-ray, bone scan, CT, MRI or other imaging studies.
• Remove the ingrown portion of the nail.
• Culture the nail.
• Prescribe appropriate medications, such as antibiotics.
• Perform surgical correction of the nail when indicated.

Fungal nail

A fungal nail is an infection characterized by a change in the toenail's colour, thickness, and quality. It may cause pain and difficulty in walking. Studies estimate that fungal nail infections affect three to five percent of the population. However, podiatrists believe that because so many cases go unreported, the incidence is much higher.

Causes of fungal nails

• The spread of athlete's foot to the nails.
• Shoes and socks create a warm, dark and humid environment, which encourages fungal growth.
• Systemic disease.
• Trauma.
• Heredity.

What can you do?

• Practice good foot hygiene, including daily washing of the feet with soap and water; drying feet carefully, especially between the toes; changing shoes regularly.
• Keep shoes and socks dry as a preventative measure.
• Wear shoes made of materials that breathe.
• Wear socks made of fibres that "wick" away moisture faster than cotton socks.
• Avoid wearing excessively tight hosiery, which promotes moisture.
• Shower shoes should be worn when possible in public areas.
• Disinfect home pedicure tools and instruments used to cut nails.
• Don't apply polish to nails suspected of infection-those that are red, discoloured or swollen.

What can a podiatrist do for you?

• Perform a physical examination.
• Culture the infected nail.
• Prescribe appropriate antifungals.
• Perform debribement or removal of the nail as indicated.

Blackened toenail

A blackened toenail is caused by pooling of blood, or a hematoma, beneath the toenail. Hematomas are very common result of an active lifestyle, especially among people who jog or play tennis.

Causes of blackened toenails

• The repeated rubbing of the toes against the shoe (top, end or bottom).
• A fracture, especially after an injury (such as dropping a heavy object on the end of the toe).

What can you do?

• Wear properly fitting shoes that don't rub
• Wear hard-top shoes if there is a job-risk to your feet
• Keep toenails trimmed short

What can a podiatrist do?

• Perform a physical examination.
• Request an X-ray, bone scan, CT, MRI or other imaging studies if the hematoma is the result of a trauma injury.
• Create a tiny hole in the nail to release the blood and relieve the pain, if the hematoma is treated within the first few hours of forming.
• If several days have passed and the blood clot becomes painful, the nail may require removal so that the nail bed can be cleaned. Some podiatric surgeons prefer to remove the nail whenever blood forms beneath the nail because the blood can attract fungi and lead to infections.
• Remove the nail to treat a bone fracture beneath the hematona. Nails that have been removed will grow again within three to six months. If the bone has been fractured but has not moved out of its normal position, a splint may be used to keep the toe aligned during healing.

Sources: B.C. Association of Podiatrists, American Podiatric Medical Association, American College of Foot and Ankle Surgeons