Last updated date: 04-Jun-2022
9 mins read
The usual reason for visiting the podiatrist is a change in the appearance of the toenails, or their complete loss after injury, or fungal and bacterial infections. In many cases, disruptions in the growth and appearance of the toenails can cause pain, as well as being esthetically displeasing. This greatly affects a person's overall health and performance.
The toenail has a protective function. Having a missing or deformed nail may lead to the nail bed being exposed, which threatens the health of the distal phalanx and the toe as a whole. In such cases, it is possible to end up with a reduced sensation to touch, toe or foot position changes, or a change in gait.
In more serious cases, partial damage or complete loss of the nail plate allows an infection to penetrate into the deeper tissues, even leading to osteomyelitis (a suppurative necrotic process that develops in the bone and bone marrow, as well as the surrounding soft tissues) or gangrene of the lower extremity (necrosis of tissues in a living organism, with black or very dark tissue discoloration).
Any changes in the nail can also be caused by genetics, orthopedic disorders, medications, smoking, or exposure to harmful substances. Often the cause of damage to the nail plate is incorrectly selected footwear that is too small, too tight, too narrow at the front or has excessively high heels. A detachment of the nail from the nail bed can also be common in spiritualistic hyperkeratoses, warts or hyponichial corns. It is particularly important to know that a trivial, but, unfortunately, very common cause of nail damage is a badly done pedicure.
The most common complication of this is an ingrown nail and paronychia (inflammation of the nail border, caused by infections such as Pseudomonas aeruginosa, Staphylococcus, Streptococcus and Cryptococcus).
Diseases that causes nails changes
Onychomycosis is a fungal infection of the toes or fingers that can affect any component of the nail unit, such as the matrix, bed, or plate. Onychomycosis can cause pain, discomfort, and deformity, as well as severe physical and vocational limits and a decrease in quality of life.
Onychomycosis affects roughly 10% of the adult population, with older persons being more likely to be afflicted. Males are more frequently impacted than females. Onychomycosis accounts for around 50% of all nail diseases. Georg Meissner was the first to discover that it was caused by a fungal infection in 1853.
The most typical sign of a fungal nail infection is thickening and discoloration of the nail, which can be white, black, yellow, or green. As the infection advances, the nail might become brittle, with portions falling off or fully separating from the toe or finger. If the condition is not addressed, the skin beneath and surrounding the nail can become irritated and uncomfortable. A bad odor may accompany white or yellow areas on the nailbed or scaly skin close to the nail.
Unless the condition is severe, there is generally no pain or other physiological signs. People with onychomycosis may face severe psychological issues as a result of the look of their nails, especially if their fingers, which are constantly visible, are damaged rather than their toenails.
Dermatophytids are fungus-free skin lesions that can develop as a result of a fungus infection elsewhere in the body. This might manifest as a rash or itching in a non-fungus-infected part of the body. Dermatophytids are a kind of allergic response to the fungus.
The diagnosis is usually assumed based on appearance and verified by laboratory tests. A potassium hydroxide smear, culture, histological inspection, and polymerase chain reaction are the four primary assays. Nail scrapings or cuttings are commonly inspected samples. These are taken from as high up the nail as feasible.
The periodic acid-Schiff stain on nail plate biopsies appears to be more beneficial than culture or direct KOH testing. Several samples may be required to successfully identify nondermatophyte mould.
The most often used oral medications for onychomycosis therapy include griseofulvin, terbinafine, itraconazole, and ketoconazole. The downsides of oral antifungal medications include a longer treatment term and greater side effects, such as terbinafine (Lamisil®).
Onycholysis occurs when the nail plate separates from the nail bed in the fingers and toes. The pale appearance of the detached nail plate from the nail bed is used to diagnose it. The majority of finger injuries are caused by trauma, manicuring, occupational or self-inflicted conduct. Psoriasis and pustular psoriasis are the most prevalent causes of fingernail onycholysis. Drug-induced phototoxic dermatitis can potentially cause finger onycholysis.
When the separation occurs, the environmental flora establishes a temporary colony in the vacant space. Women are more likely than males to suffer from finger onycholysis. Candida albicans is frequently recovered from the onycholytic environment. Many studies seek to link the yeast as a cause and effect, however the facts are inadequate, and candida therapy does not improve finger onycholysis.
The close closeness of the fingers to the vaginal and gastrointestinal tracts may explain the frequent isolation of Candida and Pseudomonas in fingernail onycholysis in women. C is present in 50% of individuals. albicans in the GI tract, and it is commonly transferred to the vagina during hygiene procedures.
Because all colonizing biota are moisture lovers and die in a dry environment, treating finger onycholysis with a hair blower is the best way to treat it. The pathogenesis of toenail onycholysis is somewhat diverse. It is mechanical, caused by pressure on the toes from closed shoes when walking, as a result of the prevalent uneven flat feet, resulting in an asymmetric gait with more pressure on the foot with the flatter bottom.
See more about: Diabetes mellitus
Diabetes mellitus patients have a variety of systemic pathologic changes, which can have a significant impact on the nail unit. These discoveries range from basic onycholysis to a variety of viral mechanisms, as well as massive, permanent devastation.
Because of the nature of the disease, diabetic patients are more likely to have nail abnormalities such as onychocryptosis, onychomycosis, and other nail structural deformities and injuries. More than one-third of diabetes individuals have nail abnormalities, and they are 2.77 times more likely to develop nail mycoses than the general population.
Diabetes frequently causes nephropathy, peripheral neuropathy, retinopathy, cardiovascular disease, and poor circulation, which exacerbates secondary consequences linked with numerous nail diseases. Diabetes problems include microbial invasion, infection, ulceration, and damage as a result of these diabetes sequelae and the proclivity to develop numerous nail abnormalities.
Because of these dangers, it is critical to identify and treat nail abnormalities in the diabetic population. 3 Mycotic nails can cause adjacent nail, skin, and subungual harm, as well as serve as a reservoir for other fungi, raising the likelihood of additional sequelae and infectious dissemination. The peripheral neuropathy that accompanies many diabetic individuals can cause small abrasions and lesions to go unnoticed and untreated. When these abrasions and sores get infected, they can cause further ulceration and spread.
Nail abnormalities, such as onychocryptosis and onychomycosis, should be evaluated during diabetic foot exams. Unmonitored nail abnormalities can cause serious consequences such as ulceration and infection. Podiatric doctors should look for nail bed ulcers caused by subungual exostoses, distal osteochondromas, and endchondromas. To avoid related morbidities and consequences, therapy aims should focus prevention and active treatment of onychomycosis and other nail problems.
Mechanical intervention, pharmaceutical therapy, and surgical intervention are among treatment possibilities. Clinicians must first identify nail problems. Onycholysis, hyperkeratosis, brittle nails, paronychial inflammation, and color changes are clinical signs of onychomycosis. 8 Tenderness to touch directly on the nail plate in the presence of accompanying deformity should prompt a radiographic assessment of the distal phalanx to rule out exostoses, osteochondromas, endochondromas, and probable osteomyelitis in cases with nail bed ulcerations.
Following the exclusion of these osseous anomalies, clinicians must identify the causal microorganism. Following KOH preparation, identification starts with fungal culture or direct microscopy. Direct viewing identifies the presence of hyphal fragments but not the specific organisms. However, the results can distinguish between dermatophytic and non-dermatophytic involvement. 9 Dermatophytes, non-dermatophytic molds, and candidal species are used to differentiate pathogens that cause onychomycosis.
For temporary protection and to assist correct nail formation, you can use partial or full prostheses. A prosthetic nail involves the creation of artificial nails or their parts, as well as strengthening damaged nails with special materials. Various methods of creating prosthetic nails are used to optimally restore the nail bed, and in most cases this achieves an excellent esthetic result.
The advantages of prostheses:
- esthetic comfort;
- preventing complications;
- protecting the nail bed from deformities and infections;
- ensuring further correct formation of the nail plates.
The podiatrists at the EMC Dermatology, Venereology, Allergy and Immunology Clinic have many unique technologies to repair damaged nails and to create prostheses for the partial or complete replacement of a damaged nail. Prosthetics are done using all the latest materials:
- ready nail mass;
- two-component acrylic polymer;
- polymer plates, processed under cold pressure;
- deep fill technology for complete prostheses;
- silk prostheses;
- acrylic material;
- partial or complete prosthetic nails using a light-hardening material (hardens when exposed to UV radiation).
Where there is significant nail loss, the nail can take up to one year to grow back. During this time, the state of the natural nail must be checked regularly and the prosthesis replaced from time to time. As a rule, a prosthesis should be worn between 4 weeks to 2 months.
A properly manufactured prosthesis, in the vast majority of cases, contributes to the full restoration of the toenail and always provides an excellent esthetic effect!
Our team of doctors at the Podiatry Department strictly follows the European protocols. They are experienced specialists, recognized professionals with extensive work experience, and previous training at the leading podiatry clinics in Europe.
The EMC podiatrists have experience that is unique in Russia, through their collaboration with European experts in the field: medical research and clinical organizations, such as the GEHWOL and Greppmayr Podiatry.
EMC patients are able to take advantage of the latest medical technologies, as well as innovative and unique methods of multidisciplinary treatment at the EMC. Dermatologists, mycologists, podiatrists, orthopedic surgeons, diabetic educators, and general practitioners are all involved in the treatment.
Nail prosthetics refers to the installation of an artificial nail plate as a result of mechanical damage to the nail or. It is a nail condition. Nail prostheses are neither painful or bothersome. During therapy, life goes on as usual, with no pain or worry.
Prosthetic toenails are a new service that a podiatrist business may provide, a non-insurance service that brings in additional revenue. Prosthetic Nails can also bring in new patients for your practice. The podiatrist can apply the toenails himself or hire a medically qualified nail technician. Regardless of who performs the service, the podiatrist will see fresh and unencumbered cash enter the clinic.