Foot-Related Skin & Nail Conditions

Onychomycosis is an infection of the toenail with fungus. Fungal infections can disfigure and deform the nails. These infections can also cause pain as toes touch or rub together inside shoes. Fungal infections may spread from nail to nail and from foot to foot.

There are several types of fungal infections:

• DSO (distal subungual onychomycosis): This is where the fungus invades the space between the tip of the toe and the nail tip or the skin folds at the sides of the nails. The toenails turn yellow and separate from the nail bed beneath them.
• PSO (proximal subungual onychomycosis): This is the least common of nail fungi and may first appear as a white or yellowish spot on the nail close to the cuticle. From there, it can progress into a plaque that collects on the underside of the nail. Debris may collect under the nail, and the nail may lift off its bed and even be shed entirely.
• WSO (white superficial onychomycosis): This affects only the surface of the nail. The nail turns white and crumbly in spots or all over. This is the most easily treated infection --we can simply scrape off the infected area and apply a topical antifungal medication.

If you have a fungal toenail infection that causes pain or discomfort, you may need treatment. Some of the treatment options our doctors use for these infections include:

• Trimming or thinning the nails to relieve pain
• Topical ointments and antifungal powders to contain or cure a fungal nail infection
• Oral medications -- your primary care doctor can prescribe these, though you may need blood tests while you take the medications
• Surgical nail removal – either temporarily or as a permanent solution

Ingrown toenails occur when one or both edges of the nail penetrate the skin and cut into the soft flesh of the toe. Any toenail can become ingrown, but this condition most often affects the big toe. People between the ages of 10 and 30 are the most common sufferers of ingrown toenails.

The most common causes are:

• Hereditary effects
• Improper cutting of the nails
• Tight shoes and stockings

An untreated ingrown toenail can result in complications. These can range from simple inflammation (swelling) to more severe problems, including serious infection, ulcerations, and even gangrene. That’s why it’s important to have a doctor examine and treat any ingrown toenail.

Treatment of an ingrown toenail involves removing the imbedded portions of the toenail. For chronic or serious ingrown toenails, our doctors may recommend additional surgical procedures to remove:

• Part of the nail
• Part of the nail matrix, the nail’s growth center
• Part of the underlying nail bed
• Some of the adjacent soft tissue

A subungual exostosis is a bone spur under the nail. It’s a relatively uncommon condition. But when it occurs, it can be very painful, particularly if something presses straight down on the nail. The main characteristics of this condition are a painful toenail and swelling in the toe that raises or elevates the toenail.

Patients between the ages of 20 and 40 suffer most often from this condition. Most cases of subungual exostoses happen in the nail bed of the big toe. Researchers have found that about one-third of patients with a subungual exostosis have had an injury or infection at the site of the condition.

You’ll need an X-ray in order for your doctor to confirm a diagnosis of a subungual exostosis. Treatment can include the use of padding to help relieve some of the pressure from the nail plate. However, the most effective treatment is surgery.

Ulcers are a result of a breakdown of the skin. Diabetic ulcers are the most common form of ulcers on the feet. These ulcerations occur on areas of the foot that are under too much pressure. They also can develop because of irritation from a shoe rubbing on the skin.

The best way to treat ulcers on the feet is to prevent them from happening in the first place. If you have diabetes, make sure to inspect your feet daily. Get help from a doctor if you notice anything suspicious or see an ulcer starting to form.

Once an ulcer has started, the treatment strategy relies on reducing pressure to the area with the ulcer. Otherwise, it won’t heal. Your doctor may use orthotics to reduce abnormal pressure on the bottom of your foot, especially in areas with calluses or ulcerations. There also are several different topical medications available to treat ulcerations.

Warts are caused by a virus that enters the body through a break in the skin. Although they are benign, plantar warts are often painful because they are on the bottom (plantar surface) of the foot. Normal walking, standing, and weight-bearing activities are often uncomfortable.

Warts may eventually disappear over time without any treatment. Your doctor may recommend treatment to remove a wart if it:

• Continues to grow larger
• Doesn’t go away on its own
• Is particularly painful

Treatments to remove warts include a wide variety of mild topical agents available over the counter in the pharmacy or drugstore. The treatment has to be gradual to prevent the formation of painful scar tissue.

We can also use more powerful options at Henry Ford Dermatology, depending on your particular needs. Some of the treatment options we offer for warts include:

• Electrocautery (burning)
• Liquid nitrogen (freezing)
• Strong prescription medications
• Surgical removal