Toenails of people of all ages can undergo a range of changes, some of which are relatively common. They can become thick, brittle, curved, discoloured, infected, clubbed, bumpy and grooved. Toenail problems may be caused by warts, tumours under the nail, infection, or poor circulation. Major toenail problem culprits are incorrectly fitting shoes, which press too tightly on the toenails. Injury, such as bruising under the nail and infection, can cause permanent nail deformity.
Common conditions and treatment
Ingrown toenails - This is the most common toenail problem. Ingrown toenails may be caused by improperly trimmed toenails, very curved edges of nails, shoe pressure or repeated trauma to the feet from normal activities. They may also be inherited. Frequently, the pain is due to a corn or callus in the groove (or sulcus) of the toenail. Most cases will require conservative treatment, while others may need a minor surgical correction, which can be conducted in your podiatrist's rooms using a local anaesthetic.
Thickened nails - This is a common condition. It is usually the result of injury to the nail bed, such as dropping something heavy on your toes, or fungal infection. Thickened nails can be thinned down by a podiatrist easily and painlessly.
Fungal infections - Fungal infections are among the most troublesome of nail conditions to treat. They are often characterised by thickening, discoloration and separation of the front of the nail from the nail bed. In some cases the nail crumbles. These infections tend to stay in the nail if they are not treated, and can infect the nail bed. There is a range of antifungal medications available for treatment, so see your doctor. Your podiatrist can assist with trimming and care of out-of-shape nail plates.
Trauma - Trauma to the nails may lead to permanent nail deformity. This can be cared for by regular, non-painful podiatric treatment, involving filing and possibly the use of a special drill.
Older people and nail problems - Older people with poor circulation are prone to fragile or brittle nails. Many older people do not have the strength, flexibility, or eyesight to trim their nails, especially if the nails are deformed. They should seek podiatric care for these services, and advice regarding safe self care.
Any sudden changes in colour or shape of the nail, sign of infection, development of a freckle under the nail, or pain should be discussed with your podiatrist. Your podiatrist can diagnose the problem and then recommend an appropriate treatment
A corn is a small area of skin which has become thickened due to pressure on it. A corn is roughly round in shape. Corns press into the deeper layers of skin and can be painful.
Hard corns commonly occur on the top of the smaller toes or on the outer side of the little toe. These are the areas where poorly fitted shoes tend to rub most.
Soft corns sometimes form in between the toes, most commonly between the fourth and fifth toes. These are softer because the sweat between the toes keeps them moist. Soft corns can sometimes become infected.
A callus is larger and broader than a corn and has a less well-defined edge. These tend to form on the underside of your foot (the sole). They commonly form over the bony area just underneath your toes. This area takes much of your weight when you walk. They are usually painless but can become painful.
What causes corns and calluses?
The small bones of the toes and feet are broader and more lumpy near to the small joints of the toes. If there is extra rubbing (friction) or pressure on the skin overlying a small rough area of bone, this will cause the skin to thicken. This may lead to corns or calluses forming.
The common causes of rubbing and pressure are tight or poorly fitting shoes which tend to cause corns on the top of the toes and side of the little toe. Also, too much walking or running which tends to cause calluses on the sole of the feet. Corns and calluses are more likely to develop if you have very prominent bony toes, thin skin, or any deformities of the toes or feet which cause the skin to rub more easily inside shoes.
What are the treatments for corns and calluses?
Advice and treatments usually considered include the following:
- Trimming (paring down) by a Podiatrist
- Shoes and footwear adjustments
- Footpads and toe protection
If you develop a painful corn or callus it is best to get expert advice from a Podiatrist to diagnose and treat foot disorders. You should not cut corns yourself, especially if you are elderly or have diabetes.