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my podiatry notes > The Nails In Podiatry > Flashcards

The Nails In Podiatry Flashcards

1
Q

Describe what involution of the nail is

A

Involution of the nail refers to a nail that increases in transverse curvature along the longitudinal axis of the nail, reaching a maximum at the distal part.

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2
Q

What are the three forms of nail involution

A

Tile Shaped, Pincer and Pilcatured

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3
Q

Describe the features of a Tile Shaped nail

A
  • Often occur in association with yellow nail syndrome
  • Can affect both finger and toenails
  • Nail increases in transverse curvature while lateral edges remain parallel
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4
Q

What are the features of Plicatured nails

A
  • Nail plate remains flat while both edges angle sharply forming vertical sidewalls hidden by sulcus tissue
  • Can affect both toenails and finger nails
  • Can cause considerable pain if Tonails are thickened and subjected to shoe pressure
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5
Q

Describe the features of Pincer nail (Omega)

A

Pincer nail dystrophy shows transverse curvature of the nail range=ing from minimal to servere where the lateral edges of the nail practically meet forming a cylider or roll

Lateral compression of the nail may cause soft nail bed strangulation and the formation of subungual ulceration due to reduced blood circulation

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6
Q

What is the treatment solution for more servere cases of involution

A
  • Clearing of the sulcus and the fitting of a nail brace
  • Steel or Plastic wire which applies upward and outward tension to the nail edges to correct them gradually overtime
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7
Q

What is Onychocryptosis

A
  • Ingrowing Toenail
  • The nail peirces the the epidermis of the sulcus and penetrates the dermal tissue
  • Most frequentley occurs in the Hallux
  • Often causes Paronychia (infection of the skin around the nail)
    *
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8
Q

Describe the features of Onychocryptosis (Ingrowing Toe Nail)

A
  • Red shiny tense skin and swollen toe
  • Throbbing pain, tenderness to pressure
  • Continued penetraion of the skin by the nail spike causes hypergranulation (excess tissue growth) which can overlap the nail plate
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9
Q

Describe the Aetiolgy of Onychocryptosis

A
  • Most common risk factors are faulty nail cutting, hyperhidrosis, and anything that causes abnormal pressure of the nail plate
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10
Q

How does faulty nail cutting cause Onychryptosis

A
  • When nails are cut to short normal pressure on the underlying tissue is reduced.
  • The lack of resistance provided from the nail causes the tissue to purtrude
  • As the nail grows forward it penetrates the tissue and embeds into the sulcus
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11
Q

How does Hyperhidrosis cause onychocryptosis

A
  • Moist tissue is less resistant to pressure form the nail
  • As compression forces the lateral nail fold to roll over the edge of the nail plate, the sulcus deepens and the nail may penetrate any softend tissue
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12
Q

How to treat Onchocryptosis

A
  • If there is no infection present remove the penetrating splinter with scalpel and the edge of the nail smoothed using Black’s file if the nail plate is strong enough to do so
  • The area can then be cleaned using saline solution and dried thoroughly
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13
Q

How to treat Onychocryptosis when infection is present

A
  • Local anesthetic should be given at the base of the toe away from the infected area
  • The splinter should be located and removed filing the edge of the nail to leave smooth
  • irrigate the area thoroughly with sterile solution and a light packing of sterile gauze can be applied
  • Cover with sterile dressing and advise patient to rest foot
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14
Q

Describe Subungal Exostosis and its features

A
  • Subungal Exostosis is a small outgrowth of bone under the nail plate usually on the distal phalanx of the toe
  • As the outgrowth increases the nail becomes elevated and displaced from the nail bed with the tumor emerging from the free edge
  • The epidermis covering the tumor becomes stretched and reddens but blanches under pressure (skin goes paler/whitens)
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15
Q

What is Subungual Heloma

A

A Subungal Heloma is a keratinised lesion (Corn) underneath the nail plate.

As it increases in size it detaches the nail from the nail bed and is seen as an Onycholysis (Seperation of nail from nail bed)

Yellowish grey in colour doesnt change under pressure unlike a subungal extostosis

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16
Q

What is the aetiology of Subungal Heloma

A

Prolonged Trauma usually from shoes that are to small producing abnormal pressure on the nail bed

17
Q

What is the treatment for a subungal Heloma

A
  • If near the free edge of the nail an area of the nail plate can be removed to enable the heloma to be enucleated (surgically removed, intcat from its surrounding capsule)
  • If the heloma is towrad the proximal half of the nailthe nail thickness needs to be reduced using a drill and the remaining shell using a scalpel then the area can be enucleated
18
Q

What is Subungal Melanoma

A

Skin cancer that occurs in the skin under the nail

Pigmented spot or band which appears in the nail matrix, plate, bed

19
Q

What is Onychauxis (Hypertrophied Nail)

A

Overgrowth or thickening of the nail from the base to the free edge

Nail can become discoloured often slight brown colour changes

Enlargement of the sulci due to thickened lateral edges

20
Q

What is the Aetiology of Onychauxis

A

Usually occurs following damage to the nail matrix inclauding these:

  • single major trauma or repeated minor trauma
  • Fungal infection and or chronic skin diseases eczema, psoriasis
  • Poor peripheral circulation
21
Q

What is Onychogryphosis (Rams Horn, Ostlers Toe)

A

Gross Deformity of the nail which develops into a curved rams Horn shape

Dark brown or yellowish in colour with longitudinal and transverse ridges on its surface

22
Q

What is the Aetiology of Onychogryphosis

A

Most common cause is single major trauma (heavy stubbing of the toe)

Could also be the following:

  • Fungal infection of the nail and chronic skin disease
  • Poor peripheral circulation
23
Q

What is the treatment for Onychogryphosis

A
  • Palliative treatment (relieving the pain without dealing with the cause) involves reduction of the hypertrophy avoiding hemorrhage from any nail bed tissue
  • Updating footwear if necessary to ensure adequate fit
  • Total Avulusion (Removal) with nail matrix destruction is best for providing long term relief
24
Q

What is Onychophosis

A

Is the formation of a callus and or a heloma in the nail sulcus in which may result in inflimattion of the sulci

25
Q

What is the Aetiology of onychophosis

A
  • Lateral pressure from constricting footwear or adjacent toe
  • Unskilled nail cutting, rough lateral edges may irritate the epithelium of the sulcus
26
Q

Teatment of Onychophosis

A

Soak the area with hydrogen peroxide to soften if needed

Remove callus with scalpel and check for presence of corn which must be enucleated

If neeseccary remove the pressure form adjacent toe using interdigital wedge

27
Q

What is Paronychia

A

Inflammation of the folds of tissue surrounding the nail plate

Acute Paronychia shows redness, swelling and throbbing at the side of the nail

Chronic Paronchyia develops insddiusly with redness and swelling of the proximal nail folds the earliest signs of the condition

The cuticle becomes detached and the nail shows transverse ridging which can cause shedding of the entire nail plate

28
Q

What does Subungal mean

A

Subungal refers to being under the nail

29
Q

What is Onychia

A
  • Inflammation of the nail matrix and nail bed
  • Commonly originates from paronychia (Skin infection around nail)
  • Infection causes pus producing discolouring of the nail plate
30
Q

What is the Aetiology of Onychia

A

Trauma introducing bacteria into the tissue

Any number of systemic diseases

31
Q

Treatment of Onychia

A
  • Removal of as much of the nail plate as possible in order to provide drainage

Further treatment for paronychia

my podiatry notes (8 decks)

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