TOENAILS AND FEET
48 Why do I keep getting in grown to e nail infections?
INGROWN toenails are more common if you have naturally more curved, or dome-shaped nails, says Michael O’Neill, a consultant podiatrist at the Princess Margaret Hospital in Windsor. The edges of the nail are more likely to grow into the skin. ‘The problem can be exacerbated by repeated poor nail care — picking toenails or poor cutting may leave sharp spikes.’
Injury or infection changes the shape of the nail bed and infections are also more common in people with diabetes because of poor blood supply.
If the nail has become ingrown several times, or the shape of it is so badly deformed that it is likely to recur, a decision may be made to remove part of the nail root.
This is available on the NHS or privately. The offending nail or nail section is removed using phenol — a chemical that destroys part of the nail bed. ‘In about 95 of cases, this is completely successful and there is little discomfort afterwards,’ says Michael O’Neill.
49What can I do about the fun gal infection in my toe nail?
‘UNLESS it’s really bad, I would suggest leaving it alone,’ says podiatrist Michael O’Neill. ‘Although a fungal infection can be unsightly, it usually poses no threat to health and the treatment is quite difficult.’
The infection affects the middle, spongy layer of the nail and can turn it brown or yellow. ‘It usually occurs after trauma — such as banging the nail or ripping a bit off,’ he says. ‘People with diabetes or compromised immune systems are more likely to develop an infection. One option is over-the-counter treatments such as Loceryl, or Curanail which contain amorolfine. They work if only part of the nail is affected and it isn’t too thick. But if a large area is affected, or the infection appears to be spreading faster than the nail can grow out, see a podiatrist.’
One treatment involves drilling little hopeless into the nail so antifungal treatment can be applied directly to the area. Or the entire nail may be removed.
‘If three or more nails are infected and it's more chronic, or the infected nails are very thick, a GP can prescribe oral terbinafine [brand name is Lamisil],’ adds Mr O’Neill.
This is usually taken for three to six months but can cause quite significant side-effects such as liver damage, stomach and skin problems. ‘Another option is laser treatment, said to destroy the cells responsible
for the infection. But I don’t believe there is enough evidence to show it’s effective in the long-term.’
50 What can I do about painful swelling on the side of my toe? I si tab union?
A BUNION is a bony bump that forms on the joint at the base of the big toe — it’s caused by the big toe moving towards the second toe, says Kaser Nazir, a consultant podiatric surgeon at Guy’s and St Thomas’ NHS Foundation Trust in London. ‘Bunions aren’t growths, but a dislocation of the toe.’
‘Though high heels make bunions worse, they don’t cause them: the real cause is genetic, though the defect can skip a generation. Men get as many bunions as women, but only one in ten seeks treatment, mainly because they wear wider shoes and it doesn’t affect them as much.
‘In the past we encouraged people to wait until bunions were really bad before surgery, but now we know the longer you leave it, the more damaged the toe becomes and arthritis can set in.’ Surgery is still available on the NHS — usually within 18 weeks of referral provided it’s not just cosmetic.
Mild cases can be treated with splints and insoles to stabilise the arch of the foot (to stop the big toe rolling inwards) and selfhelp measures include wide-fitting shoes with a small heel — 1in to 2in (but not completely flat, to protect the arch).
Around nine in ten bunion operations are performed via a procedure where the first metatarsal (the foot bone that connects to the big toe) is cut and reset with screws so it’s straight, says Mr Nazir.
It can be done under local anaesthetic and you can usually bear weight immediately.
You can be back at work if you have a deskbased job in weeks in some cases — though returning to the gym takes longer.
A tenth of bunion operations are now performed using keyhole surgery, says Mr Nazir, ‘It’s a quicker recovery — however this is only really suitable for early stage disease.’