How to manage a thickened toenail

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A. This may be a status known as onychographosis, where typically the toenail becomes thickened and grows at an angle. The nail tin become discolored and, in some cases, hypertrophy can crusade the nails to grow in a claw-like shape.

Injury (eg, dropping an object onto the toe or years of impact against the toe box of a shoe) can damage growth cells, causing the blast to thicken. Typically the big toe is affected but ill-fitting shoes can crusade onychogryphosis in several nails. The condition becomes more common with historic period.

Management depends on the severity of the condition and whether the nail is causing pain or difficulty with wearing shoes. If the status is caused past repetitive micro-trauma avoiding pressure can sometimes improve the condition but onychogryphosis is rarely cured. The afflicted nail can be cut and then that it is more manageable.

Products containing urea or salicylic acrid are available to soften the smash for cutting just I would suggest against using whatsoever chemical keratolytic unless under supervision of a podiatrist. It is much amend to file the nail on a regular basis to keep information technology manageable. Yet, filing the nail thinner is also probably best left to a podiatrist because the inadvertent impairment this might crusade to the soft tissue under the blast can lead to infection. A podiatrist will grind the nail at frequent intervals.

In some cases, trauma to the nail is permanent and the nail may crave removal nether local analgesia. In such cases the nail root matrix will need to exist destroyed because damaged growth cells will go along to produce a thick new toenail. This can be done surgically by podiatrists who oftentimes apply a saturated solution of phenol after the nail is removed to forbid information technology regrowing.

When to refer

The chemist should bear in mind that fungal infections and psoriasis tin can also lead to thickening of the nail. Even if the patient were in the pharmacy and the nail could exist seen a civilisation would be needed to ostend a fungal infection. If keeping the nail cut and avoiding any trauma does not improve the condition, referral to a GP is recommended to rule out fungal infection.

As with whatsoever foot complaint, people with diabetes should always be referred. It is possible for a thickened blast to lacerate the nail bed, leaving the patient at risk of infection. Patients with weather involving loss of sensation in their feet — particularly those with nails that are difficult to cut — are best having their nails cut past a podiatrist.

Concluding updated

Commendation
The Pharmaceutical Periodical, PJ, May 2022;()::DOI:ten.1211/PJ.2021.1.72782