What are the most common toe nails conditions

The toe nails in the feet may have a great deal of different problems that will affect them and become uncomfortable. The toenails are put through a lot of force and load from sneakers and daily activities. The toenails get knocked around a lot and also get objects dropped on them a lot. It is no wonder that there are plenty of conditions that podiatrists treat in their clients with difficulties of the toenails.

The ingrown nail is probably the most recognized painful problem with the toenails. An ingrown toe nails occurs when a edge of the toe nail penetrates the skin and creates an inflammatory reaction. This is often usually due to a rounded structure to the toenail and a inadequate nail clipping technique which leaves a sharp corner. A skilled podiatric physician may easily clear away that offending piece of toenail and provide just about instant relief with this. However, the condition may usually be recurrent, so a minor operation to remove the edge of the toenail should be considered.

Most likely one of the most widespread factors that cause symptoms about the toe nails can be a problem that is technically known as onychophosis. This is where there’s a lot of pressure down the edges of the toe nail that can causes a callus to build within the toenail groove. This callus or onychophosis will become so built up that it will become very painful. This is regularly wrongly identified as an ingrown toenail. This kind of disorder requires the knowledgeable abilities of a podiatrist to very carefully eliminate the callus from the nail groove and also file the toe nail away from the painful area. Long term if the onychophosis happens to be an ongoing problem a minor operative treatment to get rid of the edge of the nail can be done.

Trauma to a toe nail plate by, for example, repeated banging of the toe against the end of the shoe or the one off trauma of, for instance, dropping a heavy object on the foot can bring about a disfigured toenail plate that grows in a deformed shape. The technological phrase with this is onychogryphosis. If the toe nails begins to develop like this, it cannot be resolved. The best way to handle this is often to on a regular basis reduce the nail, probably by a foot doctor or to have the nail permanently removed by minimal surgery.

A different very common problem with the nails is a fungal infection or onychomycosis which can cause the nail plate to take on a white or yellowish colour which could crumble and become distorted. The exact magnitude of deformation of the toe nail and what colour it becomes may be based upon the precise fungi that infects the toenail. Regretably for our feet fungi love darkness and dampness and that is the exact atmosphere that you have got in the feet when it’s in footwear. This particular inhospitable ecosystem definitely makes the therapy troublesome. Often, the therapy will involve regular debridement of the toenail plate and the use of a topical ointment in an attempt to stop the growth of the fungus infection. Other options consist of laser treatments or oral agents. Treatments can last many months and a lot do have a tendency to happen again.

Do foot corns have roots?

No they don’t.

Its a common myth that corns on the foot have roots that they grow back from. They really don’t. Corns are caused by too much pressure on an area. Corns are easy to remove by simple debridement, but come back again because that pressure that caused them is still there. How do you get rid of corns? Its simple, you need to remove whatever is causing that excessive pressure where the corn is. That could mean a surgical correction of, for example, a hammer toe. It could mean the use of better fitting footwear, It could mean the use of padding to offload the pressure from the area. Unless that pressure that is causing the corn is removed it will keep coming back. It does not keep coming back because it has a root that was not removed.

If you have a problem with corns on your feet, then see a podiatrist to discuss the best options to get rid of that pressure that is causing them.

Do bunion correctors work?

That is a question we get asked a lot and you see being asked online a lot and they have been around for a long time.

Bunion correctors are splints that are supposed to hold the toe in a correct position and so correct the bunion. They are worn at night. There are plenty of before and after photos that allegedly claim they work. Many of them are fake.

The don’t really work that well. Any correction that occurs overnight is going to be undone the next day with the pressure from the shoe, so if they do “correct” anyone’s bunion, its not going to be by much. However, bunion correctors still can be helpful to manage some of the aches that occur inside the joint.

If you do want to use them, then there is nothing wrong with them, just be realistic about your expectations as to what they will achieve.

How to Use Podiatry Felt

This is the mainstay of some conservative treatments used by podiatrists to off load painful areas on the foot and toes. The felt is cut to shape so as not to cover the painful area, but be thicker besides and behind the painful area. The painful area could be a corn or callus or something more serious like a foot ulcer. The podiatry felt padding is stuck on the foot was it usually has a self adhesive backing. This video explains how you can use podiatry felt to help self treat a painful area on your foot:

Understanding Supination Resistance

This is a concept based on how much force is needed to supinate the foot. The concept is that different feet need different forces to supinate them. This means that different structures will be overloaded if that force is high or low. It also means that different amounts of force are needed from foot orthotics if that force is high or low if the foot orthotic is going to change the position or alignment of the foot or if it changes it too much.

By way of example, if the force to supinate the foot is low, then the peroneal muscles have to work harder, predisposing the tendons to peroneal tendinopathy. If the force supinate the foot is high, then the posterior tibial muscle has to work harder, which might increase the risk for posterior tibial tendonitis. If that force is high, then a more rigid inverted foot orthotic that supplies more force is going to be needed to overcome that force.

This video from PodChatLive on the supination resistance test discussed with all the key researchers on the topic:

There have also been plenty of discussions on supination resistance on Podiatry Arena. The most comprehensive article online is this one: The concept of ‘Supination Resistance’ and this encyclopedic entry on supination resistance.

Peroneal Tendonitis in Runners

Peroneal Tendonitis is not that common in runners, but it probably is the most common cause of pain on the outside of the ankle area in runners.

Peroneal Tendonitis

This usually starts of as just an ache either just above or below that lateral malleolus (ankle bone) where the tendon runs past. It will get worse with activity and is helped with rest. The most common cause of the problem is simple overuse – too much load is applied to the peroneal tendons when they have not been given enough time to adapt or get used to the loads. It is also more likely to occur in those with ankle that roll outwards easily (lower supination resistance) as this makes the peroneal muscles work harder resulting in the inflammation of the tendon that is peroneal tendonitis.

The simplest solution to peroneal tendonitis is simply reducing load and putting a lateral wedge in the shoe to make the foot roll inwards so that the peroneal muscles do not have to work so hard. Loading programs and strengthening of the peroneal muscles are also helpful as that can help the tendon adapt to the loads of higher volumes of running.

Arch Supporting Flip Flops

Foot orthotics are a very effective modality used by podiatrists to treat a wide range of foot problems. All the clinical experiences and research evidence is that they are pretty effective. However, one problem with them is that they need to be worn in shoes. That is obviously a lifestyle choice, but sometimes the choices and the environment do not necessarily accommodate the use of the right footwear which foot orthotics can be worn in.

One question that you see asked often is that are those flip flops that have an arch support built into them, can they be used instead of foot orthotics. There are a number of brands on the market of flip flops that have varying amounts of arch support built into them.

Arch Supporting Flip Flops

Are they as good as foot orthotics?

Probably not. The support that is built into them is comparable to what you would get from a prefabricated foot orthotics or one of the common over-the-counter type of foot supports. That is fine if you have an average arch shape. However, that is no good if you don’t. Foot orthotics are usually designed to be specific to your foot type.

Should you use them?

There is no harm in using them and they certainly can be used as an adjunct to foot orthotics when you are not wearing shoes. As if they can be used as an alternative, you would need to discuss that with your podiatrist.

I do keep hearing about the Archies online, but I have not seen them as they are from Australia. Apparently a lot of podiatry clinics in Australia sell them.

Dealing with Sever’s Disease

Sever’s disease is a common problem in children who are still growing. The medical terms for Sever’s disease is calcaneal apophysitis. It is an overuse injury of the growth plate at the back of the heel bone. This is a self limiting problem, in that the child will always grow out of it when growth in the bone stops, usually around the mid-teenage years. The classic symptoms are pain at the back and sides of the heel bone, especially after exercise. The definitive cause is not totally clear, but it is an overuse injury as it is more common in children.

One of the best resources or discussions on this condition is this video on Calcaneal apophysitis (Sever’s disease) from PodChatLive:

The treatment of Sever’s disease is basically a matter of managing the loads and the lifestyle, perhaps with heel pads and just waiting for the natural history of the condition to takes its course. This can at times be difficult as children tend not to be too compliant with advice to cut back on activity levels when their parents are not around.

Plantar Plate Dysfunction

Plantar plate dysfuncion is a common strain or tear of the strong ligament that is under the metatarsophalangeal joint of the foot and forms part of the joint capsule. The classic location of the symptoms are typically just over and just distal to the joint on palpation (see the typical area in the diagram below):

Plantar Plate Dysfunction

A rather odd symptom that some with plantar plate dysfunction can describe is that it can feel like a sock is bunched up under the area, but when they check the sock is not like that at all. The cause of a plantar plate tear is not really clear, but it occurs in people with a number of risk factors and is an overuse problem.

Fixing a plantar plate tear is not that difficult, but it can take a long time and patient is needed. The best approach is to use strapping to hold the toe plantarflexed. The tape needs to be used for quite a few months to rest the area to allow it to heal. A rocker sole shoe and also help restrict movement at the joint further rest the injured area. Surgery to repair the tear is indicated if this conservative approach does not help.

Chilblains in Miami!

This is not something that happens in Miami. Chilblains are a common vasospastic problem of the toes in the colder climates, so not our problem. The cause is the microcirculation of the toes not responding to changes in temperature properly and so cause an inflammatory reaction. That causes a painful and itchy red spot on the skin that eventually becomes a darker color if the chilblain becomes chronic.


However, one thing that is starting to show given the issues surrounding the coronavirus and COVID-19 is the issue that has been given some mileage in the media and called ‘COVID toes‘. This is the occurrence of chilblains type lesions on the toes in those infected with the virus which is showing up in the not so cold climates. This means that a suspicious red patch on the toes need to be investigated properly, especially if it looks like a chilblain in Miami!

See this video from PodChatLive for more on the chilblains that are occurring in those with COVID-19:

All of the latest research on chilblains is covered on Podiatry Arena and these does seem to be quite a lack of it, but given its involvement in COVID toes, hopefyllu more research is done on them.