Skin and Nail Conditions

Skin and Nail Conditions

At Kansas City Foot and Ankle, we see a variety of skin and nail conditions regularly.  Below are some common conditions we see at our office and treat with great results.

Ingrown Toenails

Ingrown toenails are usually excessively incurvated borders on either side of the toe, which commonly affects the great toenails.  Ingrown toenails are a very common and often a very painful condition seen in kids and adults alike.  The borders of the big toenails are most commonly affected, and can be curved downward excessively.  While poor trimming habits seem to get the blame for most ingrown toenails, the most common culprit is hereditary.
Usually the nail border is excessively curved all the way back to the base of the nail, under the cuticle.  That means that the growth center for the nail or nail matrix is also excessively curved downward.  When the matrix produces a new nail, it produces it with an excessively curved shape at the borders.  As the nail then grows out it cuts into the skin like a knife, which can certainly be painful and lead to infection.
Many patients have performed “bathroom surgery” for many years not realizing that a simple, in office and permanent procedure is available.  A minor procedure can be performed in the office under local anesthesia to remove the ingrown border permanently.  After the offending nail borders are removed, a chemical is applied to prevent the ingrown portion of the nail from coming back.  We leave the normal portion of the nail and growth center alone.  No incisions are made.  No stitches are needed.  And most people are more comfortable after the procedure than they were before.  You’re wearing normal shoes right away, and minor daily care with a topical antibiotic and a band-aid is all that’s needed.  Once it heals it will look like a normal nail, but more importantly the painful ingrown portion of the nail is gone, permanently.

Fungal Toenails

Fungal toenails also go by the name onychomycosis.  Fungus in the toenails is a very common condition.  Fungus loves moist, dark environments, and can be found around swimming pools, community locker rooms, athletic facilities, and community showers.  As we age, we become more susceptible to the fungus.  Studies have shown there is a hereditary component to developing fungus, and some people are more susceptible than others.  Also, as we age we become more susceptible to the fungus, and it may be a result of decrease in circulation, which limits the body’s ability to fight the fungal infection.
Fungus gets in between the layers of the nail and grows.  As it grows it spreads the layers apart causing the nails to become thickened, brittle, and discolored.  Often they are painful, especially if they are thickened and abnormally shaped.  Fungus can easily spread from nail to nail, and even to the skin causing athlete’s foot.  It is difficult to permanently get rid of athlete’s foot if fungus is present in the nail as it continually re-infects the skin.
Over-the-counter remedies may be successful in treating toenail fungus if caught early.  However, most over-the-counter topical medications do not penetrate through the nail very well to get to the fungus, and tend to have limited success.  We recommend a topical medication called Forumla-3 that is specifically formulated to penetrate the nail to get to the fungus, and has shown better success than over-the-counter medications.  Formula-3 is only available in podiatry offices and no prescription is needed.  Prescription oral antifungal medications are available and have shown a very good success in appropriate patients.


Plantar Warts

Warts are caused by a virus and you must come in direct contact with the virus, such as when walking barefoot.  The virus gets into the skin and causes the skin to grow abnormally, which is the abnormal area of the skin seen as the wart.  On the top of your foot, or any other non-weight bearing area, such as your hands, the wart grows out away from the skin and is usually not painful.  However, on the bottom of your foot, because you’re constantly bearing weight, the wart cannot grow out and it instead grows inward and can make weight bearing and ambulation very painful.  The virus can spread easily to other areas of the foot and even your hands if you’re not careful.
There are many treatment options for plantar warts including topical medications, burning treatments, freezing treatments, excising the warts, and laser treatments.  It is important to be evaluated early before the legions become larger and spread to multiple areas.