The Nails In Podiatry Flashcards
Describe what involution of the nail is
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.
What are the three forms of nail involution
Tile Shaped, Pincer and Pilcatured
Describe the features of a Tile Shaped nail
- Often occur in association with yellow nail syndrome
- Can affect both finger and toenails
- Nail increases in transverse curvature while lateral edges remain parallel
What are the features of Plicatured nails
- 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
Describe the features of Pincer nail (Omega)
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
What is the treatment solution for more servere cases of involution
- 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
What is Onychocryptosis
- 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)
*
Describe the features of Onychocryptosis (Ingrowing Toe Nail)
- 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
Describe the Aetiolgy of Onychocryptosis
- Most common risk factors are faulty nail cutting, hyperhidrosis, and anything that causes abnormal pressure of the nail plate
How does faulty nail cutting cause Onychryptosis
- 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
How does Hyperhidrosis cause onychocryptosis
- 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
How to treat Onchocryptosis
- 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
How to treat Onychocryptosis when infection is present
- 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
Describe Subungal Exostosis and its features
- 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)
What is Subungual Heloma
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
What is the aetiology of Subungal Heloma
Prolonged Trauma usually from shoes that are to small producing abnormal pressure on the nail bed
What is the treatment for a subungal Heloma
- 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
What is Subungal Melanoma
Skin cancer that occurs in the skin under the nail
Pigmented spot or band which appears in the nail matrix, plate, bed
What is Onychauxis (Hypertrophied Nail)
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
What is the Aetiology of Onychauxis
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
What is Onychogryphosis (Rams Horn, Ostlers Toe)
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
What is the Aetiology of Onychogryphosis
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
What is the treatment for Onychogryphosis
- 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
What is Onychophosis
Is the formation of a callus and or a heloma in the nail sulcus in which may result in inflimattion of the sulci
What is the Aetiology of onychophosis
- Lateral pressure from constricting footwear or adjacent toe
- Unskilled nail cutting, rough lateral edges may irritate the epithelium of the sulcus
Teatment of Onychophosis
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
What is Paronychia
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
What does Subungal mean
Subungal refers to being under the nail
What is Onychia
- 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
What is the Aetiology of Onychia
Trauma introducing bacteria into the tissue
Any number of systemic diseases
Treatment of Onychia
- Removal of as much of the nail plate as possible in order to provide drainage
Further treatment for paronychia