Medical Podiatry and Nail Disease

Abstract

As a specialist of lower extremity disorders, the podiatric practitioner has a unique perspective in the diagnosis and management of toenail disorders. Toenail disease may be caused by a variety of issues that are specifically foot related: trauma from shoes, biomechanical issues and forces, and infection compounded by shoe gear and adjacent skin conditions to the nails (i.e. interdigital tinea pedis).

Patients commonly present to a podiatric physician’s office for the care of toenail pain (both infectious and non-infectious causes), discoloration that is cosmetically displeasing, and/or thickness that creates pressure in shoes. Patients are often under the belief that their nail presentation may be the result of a fungal infection; however, it is imperative that other factors on and around the nail unit are considered: biomechanics and shoe gear. These are unique to the toenail when compared to the fingernail. Biomechanics describes both the non-pathological and pathological forces involved in the gait cycle. The pathologic forces may result in digital deformities, soft tissue lesions (i.e. corns and calluses), bunions, arch and heel pain, and even skin breakdown (in a neuropathic patient). Especially in the diabetic neuropathic population and those with painful or biomechanical issues, the practitioner should perform a biomechanical evaluation which includes gait analysis and function of the major joints of the foot and ankle.

Disclosures

Advisory Board, Speaker, Researcher for Pharmaderm and Valeant