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Last Updated: Nov 14, 2008 - 12:49:26 PM |
Fingernails and toenails are specialized extensions of our skin. Though people can live without them, they make it easier to manipulate objects that we pick up, make the digits more sensitive to touch, and help to protect the tips of the fingers and toes. They also make scratching our skin much more satisfying.
The nails are made of a tough protein called keratin. On average, the nails grow about three millimeters per month. It can take up to six months to completely grow back a lost nail. There are no nerve endings in the nails; therefore, we can cut them without feeling any pain.
A common malady of the nail is the ingrown toenail. This occurs when the nail edge irritates or grows into the surrounding skin. A normal nail will lie within the groove at its edge called the paronychium. An ingrown nail no longer fits properly into this groove.
The two most common causes of ingrown toenails are poorly fitting shoes and improper trimming of the nail. Shoes that are too tight will compress the sides of the nail into the skin. Nails that are trimmed too short, are peeled off, or torn can develop a pointy edge called a spicule that pokes into the surrounding skin.
Anything that gets into the skin that is not supposed to be there will cause irritation and inflammation. For example, a splinter within the skin produces pain, swelling, and redness, and will fester until it is removed. The same reaction is produced by the ingrown nail.
Other causes of an ingrown toenail include chronic skin conditions and trauma to the nail, both of which can alter the normal growth of the nail. Sports activities that involve repeated kicking, running, or sudden stopping can also predispose to ingrowing of a nail.
Ingrown nails can also lead to an infection of the digit. Breaks in the skin caused by the nail can allow the skin’s normal bacteria to enter the wound. In susceptible individuals and people who have diabetes or poor circulation, this can become a potentially serious problem.
As always, prevention is the key. When trimming your nails, allow the nail to grow out past the groove on each side of the nail and cut the nail straight across. Don’t trim the nails by peeling or tearing them off. Wear comfortable shoes that have a wide toe-box; that is, the end of the shoe doesn’t force or crowd your toes together.
If you notice a nail is starting to cause irritation of the surrounding skin, you can soak the foot in warm water three to four times daily. This will soften the nail and the skin. A piece of dry cotton can be placed under the edge of the nail to keep it from poking into the skin. Don’t try to dig or cut out a piece of nail within the skin, as this can leave a spicule and/or cause infection.
If the inflammation is persistent, progressive, or if there is obvious drainage or pus, it is best to see your doctor for treatment. Antibiotics may be needed if there is infection. Surgery to cut out the embedded nail may be necessary when conservative measures and antibiotics fail. Diabetics, those with impaired circulation, and immunosuppressed individuals should see their doctor at the first sign of a problem.
The content in this column is for informational purposes only. Consult your physician for appropriate individual treatment. Dr. Reynolds practices Family Medicine in Chesterfield.
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