Subungual Exostosis
Subungual exostosis- is an overgrowth of bone along the dorsal aspect of the distal phalanx, the bone that sits under the toenail plate. A subungual exostosis can cause severe curvature of the nail plate which can lead to pain, onychocryptosis and infected ingrown toenails. Pain associated with an subungual exostosis can be addressed by padding the toe, removing the exostosis and/or the toenail plate.
Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.
He has office located in McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Subungual Hematoma
Subungual Hematoma – this is a collection or pooling of blood underneath the nail plate. This is usually associated with blunt trauma such as dropping an object directly onto the toe. As more and more blood collects underneath the nail plate, pressure increases. This increase in pressure is very painful unless the blood is drained.
It is noted that if more than 25% of the nail plate has blood underneath it, the toenail should be removed to examine the nail bed or the skin underneath the nail. If more than 25% of the nail bed has blood underneath it, it is highly likely that the nail bed is lacerated or cut. This must be examined, because if the nail bed is lacerated, it is considered an open fracture and the nail bed must be appropriately cleaned, disinfected, and sutured.
If the hematoma is less than 25% of nail plate involvement, the blood can then be drained and the nail plate left intact. This is performed in our office with either a hand-held cautery tool or a sharp blade to bore a hole into the nail plate and allow the blood to escape.
If you develop a subungual hematoma, please seek assistance from our physicians. Call 972-542-2155 for an appointment today.
Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.
He has offices located in McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today
Traumatic Nails
Traumatic Nails- Trauma can occur to the toenail as a result of chronic trauma or from acute injuries. Chronic or low grade trauma can be caused by tight shoes that place pressure on the toenail or from running with improper shoes. This can injure the toenail and may cause the nail to form a blister under the nail plate which can lead to a paronychia. In turn, this can be a painful condition and may necessitate the need to have the toenail taken off.
Acute trauma often is the result of dropping an object onto the toe or stubbing the toe against something that forces the nail plate to become separated from the nail bed. Blunt trauma can cause subungual hematoma’s which is a collection of blood from under the nail plate. This can cause pain and also can lead to infection. If a subungual hematoma develops, the collection of blood will need to be drained by either creating a hole in the nail plate or by removing the toenail. If it is not drained, the pressure will continue to build up and cause pain to the toe. This can be done by using a needle, cautery or a laser. Even though the hematoma is evacuated, lysis or separation of the nail plate from the nail bed can still occur and the nail plate may come off prior or during the re-growth of a new nail plate.
Blunt trauma can also lead to laceration of the nail bed that would warrant repair but suture. In addition, blunt trauma can cause a fracture to the underlying bone (distal phalanx) that would also require treatment. If the nail bed is traumatized along with a fracture to the distal phalanx, it is classified as an open fracture.
Open fractures have a high risk for infection. If the bone becomes infected, IV antibiotics and/or removal of infected bone may be necessary. This could lead to loss of a toe in extreme cases.
Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.
He has offices located at both McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Mycotic / Fungal Nails
Onychomycosis- is a condition that we refer to as a fungal infection of the nail plate. It is the most common infection of the nail plate. About 8% of the adult population suffer from fungal infections of nail plates. The nail plates often present as yellow, thick, flacky, and misshapened and my also become lifted from the underlying nail bed. In severe cases, there also may be an odor to the nail plate.
There are four different types of categories of onychomycosis.
1. Candidal Onychomycosis occurs when Candida (yeast) infects that nail plate.
2. Superficial White Onychomycosis (SWO) occurs when fungus infects the top layers of the nail plate. One will see white islands of infection along the nail plate.
3. Proximal Subungual Onychomycosis (PSO) and it occurs when the nail plate along the cuticle becomes infected with fungus. This type of onychomycosis occures more commonly in immunocompromised individuals.
4. Distal Subungual Onychomycosis (DSO) and is the most common cause of onychomycosis. The nail infection will begin along the tip of the nail plate and work its way back towards the base of the nail plate.
Onychomycosis can be caused by dermatophytes, Candida, and non dermatophytic molds. The most common dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. Candida infections are more often aquired in people that work with water. Onychomycosis caused by molds is often seen in more tropical parts of the world.
Factors that place an individual at risk are occlusive footware, age, medical conditions such as diabetes and poor circulation, immunosuppression (HIV), trauma and warm climates.
North Dallas Ingrown Toenail Specialists recommend nail plate samples to be sent to histology lab for confirmation of onychomycosis. This is done by taking a sample of the infected nail plate and sending it to a dermatopathologist for examination.
Treatment of an onychomycotic nail plate can be a long process since the infection is within the nail plate. Current treatment options include topical medications such as Penlac which is a prescription topical nail lacquer and non-prescription, Formula 3 that is available at North Dallas Ingrown Toenail Specialists.
Oral medications include Lamisil which is the most effective oral antifungal. Prior to being placed on this medication, it is highly advised that you have a blood test to check your liver enzyme levels (AST and ALT) to confirm that you are healthy enough to take the medication.
The newest form of treatment of onychomycosis is by laser. There are currently ongoing studies for this method of treatment. The physicians at North Dallas Ingrown Toenail specialist currently do not offer this type of treatment for onychomycosis since they feel that current outcomes do not justify the cost of this modality.
Dr. Kory Williams and Dr. Eric Silvers are highly-trained foot and ankle surgeons specializing in the treatment and resolution of toenail pathologies.
Both physicians are located at both McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Paronychia
Paronychia- is a term that is used to describe an infection of a nail plate at the junction where the nail and skin meet. This may be along the base of the nail or along the sides of the nail as a result of onychocryptosis. If the paronychia begins suddenly, we refer to it as “acute.” If it more of a gradual process, we refer to it as “chronic.”
The cause of the infection may be caused by bacteria or candida (yeast). Typically, a paronychia caused by bacteria will ooze a yellow or light red discharge where as a candidal infection will exude a white chalky discharge. Furthermore, fungal infections can also cause paronychias.
Along the base of the nail plate is the cuticle and if it is disrupted in any way, bacteria can work its way under the proximal nail fold and cause an infection (paronychia). Typically, the base of the toe just behind the nail plate will become red, swollen and painful. If there is a large amount of pus or yellow drainage from the nail fold, one must seek medical attention to have the toe drained.
Paronychia’s that involve the inner, outer and proximal nail folds (the skin around the entire nail plate) is referred to as a run-around paronychia.
If mistreated long enough, a local infection can manifest to more serious systemic problems such as red streaks, swollen lymph nodes, fever and sepsis. In addition, the local soft tissue infection can lead to bone infections or osteomyelitis if left untreated for a long time. Thus, it is imperative that prompt treatment of paronychias is of utmost importance. Antibiotics and foot soaks are not adequate treatment for paronychias. Proper treatment involves removing a portion of the toenail or the entire toenail that is penetrating into the nail fold(s).
In severe cases, where both borders are infected and there is severe curvature (cryptosis) of the nail plate, a total nail plate removal is advised. Most of the time however, only the side(s) of the nail plate are required to be removed. The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas, will also give you a prescription for oral antibiotics.
If the paronychia has been present for several months or even years, a radiograph or x-ray may be taken to rule out any underlying bone infection or other causes of the pain around the nail such as a bone tumor or a foreign body.
Accutane, which is a medication to treat acne has been linked to the development of paronychias. Those that frequently wash their feet regularly can cause the skin to become dry and cracked which jeopardize the seal of the cuticle. Other sources of paronychias can be industry related such as trades that involve food processing and those that work in the medical and dental fields. Certain skin cancers such as squamous cell carcinomas can resemble paronychias. It also should be noted that there is a high recurrence rate with paronychias if they are not treated permanently, with a chemical or surgical matrixectomy. More information about matrixectomies can be found under the chemical and surgical matrixectomy section of this website.
Dr. Eric Silvers and Dr. Kory Williams are highly-trained foot and ankle surgeons specializing in the treatment and resolution of toenail pathologies.
Both physicians are located at both McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Onychocryptosis
Onychocryptosis – is a curvature of the nail plate. It is often a painful condition in which the nail grows into one or both sides of the nail folds or flesh. Cryptotic nails may be either symptomatic or asymptomatic and also may become infected.
A common opinion is that nail plate enters inside the nail fold but an ingrown toenail may also be caused by an overgrown nail fold. Onychocryptosis can lead to infected ingrown toenails.
If the nail plate has irritated the nail fold for a long time, the tissue can develop increased callus or even red, beefy tissue called a granuloma. The definition of a granuloma is a “small nodule.” When granuloma tissue becomes infected, we refer to them as pyogenic granulomas.
In order for an onychocryptotic nail plate to become ingrown, it must penetrate the nail fold. This can happen simply due to the shape of the nail or due to a sliver or spicule of nail that is forced into the nail fold as the nail plate grows out.
Pain caused by an incurvated nail plate is relieved by excising or removing the portion of nail that is “dug” into the side of the nail fold.
Common causes for onychocryptosis include cutting the nails too short, fungus, tight shoes, and trauma caused the nail plate to grow ingrown.
Dr. Kory Williams and Dr. Eric Silvers are highly-trained foot and ankle surgeons specializing in the treatment and resolution of toenail pathologies.
Both physicians are located at both McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
