Nail & Skin Disorders

The Doctor Is In

With Dr. Rich and Dr. Bronow.

What can a nail tech do to help a client with ingrown toenails? Is there anything she can do prevent it in the first place?

Dr. Phoebe Rich: Ingrown toenails can be very painful due to the growth of the sharp nail into the flesh of the lateral nail fold. This nail spicule acts like a foreign body and usually causes the skin to become infected and inflamed, accounting for the pain. Several common sense things can help prevent ingrown nails. Cut the nails straight across and not down into the corners. Advise the client who is prone to ingrown nails to wear shoes that are not constricting or pointed. When an ingrown nail first occurs, soaking in warm water helps. Once there is an infection, an antibiotic and even surgery may be necessary, and a prompt referral to a podiatrist would be judicious.

Please explain why a foot file must not be used on diabetic patients.

Dr. Bronow: Diabetic patients can have circulatory or neurological disorders, which can leave them open to infection if the skin is broken by rough filing. The neurological problem (diabetic neuropathy) can cause decreased sensitivity to pain, so the patient could be injured and not know it. Be careful (Editor’s note: For more information on servicing the diabetic client see “A Pedicurist’s Education in Diabetes,” March 1996.)

I have a client with very soft nail beds, especially near the cuticle area. Three of the nails have cracked up the middle starting at the cuticle upto the free edge. She feels a little soreness around the cracks, but has no redness or soreness anywhere else. She won’t go to the doctor. What do you think is wrong?

Dr. Bronow: The cracks up the middle of the nail are known as median nail dystrophy. Some people think that this results from damage to the nail matrix. It may spontaneously clear or can be permanent. There is no relationship to soft nail beds.

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