Techniques

Footcare

Nail Cutting

Some nails can be difficult to cut. The most common nail issues people struggle with are: onychocryptosis, involuted nails, onychauxis, and onychomycosis.

Onychocryptosis is the medical term for what people sometimes describe as an “ingrowing toenail”. The term “ingrowing toenail” is often mistakenly applied to involuted nails (more on this to follow). Onychocryptosis occurs when a spike, serrated edge or shoulder of nail pierces the tissue of the toe. This often arises from poor nail cutting techniques, wearing footwear that is a poor fit, from hyperhydrosis (a nice way of saying “sweaty feet”), or from trauma. This wound will not heal until the offending piece of nail is removed and may become infected if allowed to persist for some time. Hypergranulation tissue may also arise, making it difficult to see the edges of the nail beneath the swollen, tender hypergranulation tissue.

Involuted nails can become “ingrown” but are often painful or uncomfortable even if they do not pierce the surrounded tissue. Involuted nails have curled in at the sides, either one or both, and vary in degrees from slightly curved to both sides touching, forming a tube. This can be very painful and difficult to cut and often requires long term management or surgery to correct.

Onychauxis means a nail that has become thick and hard, often following trauma, either a single trauma like dropping a paving slab on the toe, or from repeated minor trauma, such as tight-fitting shoes. These can become very difficult to manage, looking like marbles rather than nails, and require special equipment and skills to manage effectively.

Onychomycosis is the medical term for a fungal nail infection. There are several organisms that may be responsible, but the most common are dermatophytes, accounting for as many as 90% of cases. Fungal nails infections are notoriously resistant to treatment, both topically and with oral medication. Fungal nail infections can cause thickening and/or discolouration of the nail plate.

Our therapists are trained to deal with all the above issues (and more). They can offer practical assistance, such as cutting and reducing the thickness of the nails, as well as evidence-based advice on the treatment options that are available. Thick and difficult nails are cut with a combination of a nail nipper, a black’s file and a nail file. If it is necessary to reduce the thickness of the nail plate, a nail drill can be used. A nail drill is a high-speed, low-torque drilling device with a special hand piece which houses an attachment for a drill bit as well as an opening leading to a vacuum in the main unit. A typical drill can rotate a bit from 4000 to 25000 rpm, making short work of thick, hard nails.

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