Toenail Tuesdays – a breakdown of different toenail conditions! PART 2

We know that it can be concerning when you look at your toenails and they just don’t look right! You may find yourself asking Dr. Google one of the following questions… (we’ve all been there!)

  • What are clubbed toenails? Why do I have them?
  • My toenail has ridges in it, what is this?
  • My toenails are lifting, what is this?
  • My toenail has a darkened spot on it, help!
  • Should I see a GP?!
  • Should I see a Podiatrist? When should I see a Podiatrist?

No need to turn to Dr. Google, our Podiatrists are here to answer your questions about different toenail conditions. In this post, we break down the different toenail conditions, show examples in photos and discuss causes and treatment options for each conditions.

 

 

Beau’s Lines 

Beau’s lines are horizontal depressions or ridges that can appear on the nails and toenails. The cause is due to a temporary interruption in growth.

Reasons why nail growth stops and starts again when experiencing Beau’s Lines can include:
  • Physical trauma to the nail, nail bed, nail matrix (where the nail grows from) or surrounding skin e.g. dropping someone on your toe.
  • Chemotherapy as these drugs affect the growth of nails (and cancers).
  • Illnesses such as infection, high fever or medical conditions such as heart/arterial disease, autoimmune diseases, hormonal imbalances and gastrointestinal conditions that affect nutrition absorption.
  • Malnutrition of nutrients required to grow healthy nails such as protein, iron, zinc and biotin.

How a Podiatrist or other health professional can treat Beau’s Lines includes:

  • Address the underlying cause if possible, for example, if there is a lack of protein in the diet, consult a dietician on the best ways to increase protein intake.
  • See a podiatrist for toenail care and recommendations including filing the toenail so the lines are smoothed out and recommending topical paints or creams to improve the integrity of the toenails e.g. Dr Remedy’s ridge restore which helps heal damage and reverse discoloration and can smooth out any rough spots on your nails.
  • Patience as the nail takes time to grow out the lines.

 

 

Subungual Melanoma

There is skin under your nails so melanomas can form there too! Medical professionals call these subungual melanomas. Skin cancer on or under your nail is a rare occurrence, but it does happen.

The signs a Podiatrist looks for when looking for melanomas include:
  • A dark streak or band under the nail that may initially be mistaken for a bruise but unlike bruises, this dark streak does not grow out.
  • Lifting of the nail from the nail bed.
  • Easily split.
  • Feel bumpy under the nail.
  • Change in texture such as thickening or crumbling.
Early detection and treatment are crucial for a favourable outcome.
Ways to prevent or easily identify a subungual melanoma include:
  •  Remove nail polish when you go get your skin checks done by your doctor.
  • Regularly self-exam your own skin and nails for pigmentation changes.
  • See a doctor, dermatologist or podiatrist for any new or unusual pigmentation or changes in the nails.
  • Wear opaque nail polishes because the colour will reduce the sun’s rays reaching the nail bed where skin cancers can form.
  • Prior to sun exposure, apply sunscreen to the nails which may absorb to the nail bed and offer UV protection.
  • Also look for nail polishes that are labelled as UV protected so the colour is protected and lasts longer. These clear or light coloured nail polishes might be a good option for people who don’t want to wear nail polish but want some UV protection. Maybe in the future nail polishes will have SPF testing and labelling like sunscreens.
Treatment options for subungual melanoma can include:

Treatment for Subungual Melanoma typically involves surgical removal of the affected tissue. If the melanoma has spread extensively, amputation of the affected toe or finger may be required. Additional treatments such as chemotherapy, radiation therapy, or immunotherapy may also be recommended depending on the stage and extent of the cancer.

 

 

Clubbed Toenails (Hippocratic nails)

The medical term for clubbing of the toenail is called ‘hippocratic nails’. What that means is exaggerated longitudinal curvature of the nail.

The cause of clubbed toenails is:
  • Usually associated with longstanding pulmonary or cardiac disorder.
  • Has also been linked with thyroid disease, cirrhosis & ulcerative colitis.
The podiatry management for clubbed toenails:
  • Identify cause and treat (if possible).
  • Reassurance that nail clubbing is not usually painful and harmful but should still be checked by the GP for possible underlying medical condition.
  • Provide general nail and skin care.
  • Refer if systematic cause is likely.

 

 

White Toenails (Leukonychia)

Leukonychia or white toenails are a common nail presentation and, whilst they may look unusual, white toenails are usually not a cause for concern.
White toenails can affect people of any gender, ethnicity or age.

Leukonychia can be further broken down into two categories based on how much of the nail is affected (total = whole nail is affected) and the overall appearance of the white nails (Partial = Punctate, Longitudinal or Striate).

There are several reasons why white nails (leukonychia) may develop. Reasons such as
  • systemic conditions
  • trauma
  • chemical exposure
  • genetics
    are common causes.

Sometimes it can be difficult to determine the cause however, nail clipping tests can rule out things like Onychmycosis (fungus) and blood tests can check for systemic conditions.

Treatment options for white nails (Leukonychia) can include:

Treatment for white nails depends on what the underlying cause is. If you’ve developed white lines or spots on your nails, it’s best to get them checked so an individually-tailored management plan can be made for you.

 

 

Lifted Toenails (Onycholysis)

A Lifted Toenail in medical terms is called Onycholysis.

The definition is a separation of nail from its bed at the end of the nail. The detachment of the nail plate leads to greyish-white colour.

There are multiple causes of lifted nails (onycholysis), this includes:
  • Local causes: Trauma, infection, exposure to irritants.
  • Peripheral arterial disease (poor blood supply), iron-deficiency Anaemia.
  • Psoriasis (scaly), eczema (itchy, inflamed with blisters), hyperhidrosis (moist, excess sweating)
  • Drug-induced
The podiatry treatment includes:
  • The podiatrist can remove all detached portion of the nail. This would help prevent trauma from hosiery or bedclothes and permits application of local agents e.g. if infection is present.
  • If there is a systemic cause, we would refer to the general practitioner.
If you have any of the above toenail conditions, or are concerned about the appearance of your toenails, book in now to see one of our Podiatrists to help put your mind at ease! Our podiatrist’s can diagnose, treat and help manage chronic toenail conditions.

 

Your condition not listed above? Not to worry! Check out part 1 here. Check out our social media for more Toenail Tuesday posts and stay tuned for Part 3!

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