Foot Treatment Case Studies

Foot Health Report | Ingrowing Toenail

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FOOT HEALTH REPORT
Presented by Mr Frank Dowling,Podiatrist

Case Study No.2 Ingrowing Toenail

Conor H a 17-year-old West Dublin youth came to my surgery last march complaining of a very painful ingrowing toenail on his big toe of his right foot. When I looked at his nail I could see that the nail was digging in to the skin on the side of his toe, it looked very red and angry
Connor said that his toe began to hurt several months ago after he had worn old football boots which were a little too small for him but as they were his lucky boots and he had a big match coming up he wanted to wear them anyway.

Luckily for him there was no infection present otherwise he might have had to go to his family doctor for a prescription of antibiotics, I explained to Conor that ingrowing toenails can be caused by a number of factors including injury to the toenail, wearing shoes that are too tight around the toe, causing damage to the toenail by constantly picking at the nail (which Conor assured me he never did) the trait for ingrowing toenails can run in families and as it happened both Conors dad and older brother had suffered with that same complaint previously. Years ago when he was a teenager Conors dad had to go to hospital for an operation on his nail.

With conor sitting comfortably I used a weak solution to irrigate the area around his toenail and then gently removed a piece of nail which had grown down the side of his toe before applying a sterile dressing.

Unfortunately, I explained, sometimes the nail has become too far embedded in the side of the toe and although removing part of the nail brings some relief it is only temporary as the nail will continue to grow in.

The treatment of ingrown toenails takes up a large part of a podiatrists time, they are very common, and are usually seen in young people who have a family history of them. Most of the time they can be cured with conservative treatment and advice about wearing correct footwear, I believe that there is no truth in the old wives tale that cutting a “V” in the nail will cure an ingrowing toenail.

A few weeks ago Conor arrived back in the surgery with his toenail as ingrown as ever, he said he had got some relief for a couple of months but it had begun to hurt again and he felt that it was ingrowing as even the pressure of the bedclothes was hurting it,never mind trying to play football .After a brief chat about a more permanent solution to this problem he decided to opt for a partial nail avulsion which is a small surgical procedure performed under local anaesthetic to freeze the toe so a small section of his nail could be removed permanently. This operation is not at all uncomfortable as there is no stitches are suturing involved, a special chemical is applied to the nail bed to prevent the nail from regrowing, it is a very successful procedure with about 95% success rate .The procedure itself takes about one hour in total. Conor played on his DS throughout the procedure and said he did not feel a thing “ it’s over already” said he when I had finished. His dad who came with him for support remarked that it was a different experience from the one he had years ago when he had to go to hospital, have a general anaesthetic and was on crutches for a week after.

When I checked his wound 48 hours later at his redressing appointment everything looked fine and he had no pain or discomfort whatsoever and was looking forward to playing football again in a couple of weeks when the wound healed, needless to say, wearing his new proper fitting football boots. Lucky football boots.

Foot Health Report | Fungal Toenail Infection

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FOOT HEALTH REPORT
Presented by Mr Frank Dowling,Podiatrist

Case Study No.3 Fungal Toenail Infection.

Alana mac, a thirtysomething businesswoman from Maynooth, presented at my surgery in August complaining of thickened discoloured toenails on both feet. Several years ago she noticed that her big toenail on her left foot had become discoloured at the tip of the nail as time passed she discovered it had spread to other toe nails.

Many people come to my surgery with this lady’s problem it is a very common condition, the fungus concerned is a member of the dermatophyte family and lives in moist damp areas such as swimming pool changing rooms and hotel showers. It is easily picked up and spread from one person to another walking barefoot or something as easy as trying on another person’s shoes. The fungus usually presents on the foot and is known as “athletes foot” it can spread under the nail where it becomes very difficult to treat as the nail is made up of several layers on top of each other and the fungus exists between the layers and under the nail eventually taking hold in the nail bed.

When Alana came to the surgery I informed her of my opinion and we decided to take a sample of nail for testing, to rule out other conditions such as psoriasis or nail trauma ,this is a painless procedure and does not hurt at all. Three weeks later the sample of nail Tissue was cultured and proved positive for a fungal infection.

There are many treatments for nail fungus the most effective of which involve taking a course, usually 12 weeks, of an antifungal tablet, this treatment is the most effective but there are many side-effects of this therapy including nausea, upset stomach and headaches, in addition contraindications include anybody who is pregnant or breastfeeding or has a history of gastrointestinal
The problems such as reflux, stomach ulcers and digestive trouble. also available are a range of antifungal nail lacquers which can be applied directly to the affected area but these are far less effective as it is very difficult for them to penetrate through the nail according to some research less than 30% of people who applied the nail paint for three months noticed any difference. Although the nail paint is usually very well tolerated there have been reports that overuse can cause irritation around the nail.

It is important to remember that toenail fungus is generally confined to the toenails and in very rare cases is seen on the fingernails, although it is very unsightly it is not in anyway dangerous it will not cause any other sinister illnesses or lead to other health problems and in most cases is not painful nor make it uncomfortable to wear shoes which is why it is often ignored by a lot of people.

As with all unhealthy conditions prevention is better than the cure, the best way to avoid picking up a fungal infection is to wear flip-flops when bathing in public areas. By paying particular attention to the risks involved when away from home by using an antifungal spray such as” mycil”
keep in mind that the athletes foot fungus can live in footwear for months after last being worn. To ensure eradication of this bother some problem it is advised to apply an antifungal cream or spray directly to the foot daily for at least four weeks and in addition neutralise any fungal spores in footwear by spraying inside the shoes you are wearing that morning for a about a month, although there are products on the market which claim to eradicate the fungus with one treatment the problem is that the fungus lives in the shoes and there is a very high chance of reinfection.

Alanna decided she would try to get rid of the nail fungus by using an over the counter product. Latest developments in America using laser have proved to be quite successful and have little side-effects so perhaps this will be the treatment of choice in time to come.