At our clinic in Congleton we see an extreme case of thick nails approximately once a month. Treatment for it is usually painless and straight forward yet without treatment people can be chair bound.
If you have elderly parents or relations that do not walk around much and you have not seen their feet for a while, check their feet. They could have a nail condition that can be easily and painlessly managed.
Onychogryphosis (aka thick curly nails or rams horn nail) is a very common condition where the nail thickens and curls, making it look like a rams horn. It can affect any nail but it is the big toe nail that is most commonly affected. Due to cutting the nail with regular nail clippers or scissors being near enough impossible people, especially the elderly tend to neglect them until they become painful and problematic. However these nails can be easily and painlessly managed and made to look normal by a podaitrist.
Causes of onychogryphosis include:
- Neglect – especially in the elderly who can not get down to their feet to look after them.
- Repetative microtrauma to the nail, such as ruing on the inside of a steel toe capped boot.
- Damage to the nail matrix (where the nail grows from, under the skin).
- Pressure on the nail over an extended period, usually from poorly fitted shoes.
- Peripheral Vascular Disease which compromises blood flow to the nail.
- Fungal infection.
Unfortunately once a nail has turned gryphotic it will never be cured. However there are 2 main ways to manage the nail.
The most common way is for the podiatrist to grind the nail down and trim it. This is painless, safe, cheap and leaves the nail looking normal. The only down side is it needs to be done regularly as the nail will continue to grow in a thick and curled fashion. However it is highly recommended for the elderly and people with peripheral vascular disease to have regular foot checks.
Another, far less common treatment is permanent removal of the nail. This is a permanent solution to the problem but it does mean the person loses their entire nail forever. The removal of the nail is done under local anaesthetic so the procedure itself does not hurt but it does involve having a dressing on the toe for 4-6 weeks after.
Long Term Prognosis and Complications
The long term prognosis all depends on how well the nail is looked after. Unfortunately it often goes unnoticed in the elderly until they end up in hospital or in care.
If the nail is managed regularly, every 6-8 weeks there are rarely any complications at all. If the nail is neglected (which is very common in the elderly) it can grow into the skin making walking painful and can lead to infection. The thickness of the nail also causes pressure on the underlying skin which can lead to cubungual corns (corns under the nail) or ulceration.