November 16, 2023
When it comes to self-care and pampering, we often focus on treating ourselves to facials, massages, or spa days while neglecting one of our body's hardest working and overlooked parts: our feet. Enter the world of medical pedicures, a rejuvenating and therapeutic experience that goes beyond the typical nail salon visit. In this blog post, we look at medical pedicures and uncover the many benefits they offer for the health of your feet. Whether seeking relief from foot-related ailments or well-deserved self-care, a medical pedicure might be the secret to the happy and healthy feet you've been waiting for. What's a medical pedicure? A medical pedicure, also known as a medi-pedi, is a specialized foot treatment performed by a trained medical professional, typically a podiatrist or chiropodist. Unlike a cosmetic pedicure you might receive at a spa or nail salon, a medical pedicure focuses on the medical aspects of foot care - there is no nail polish or foot soaking. It ususally involves the following: Examination and consultation. Before the procedure, a chiropodist assesses your feet, discusses any concerns or foot-related issues you may have, and creates a treatment plan tailored to your needs. Nail and callus care. A chiropodist trims and shapes your toenails, carefully avoiding ingrown toenails. They will also remove calluses and corns to relieve discomfort and prevent further complications. Hygiene. A medical pedicure places a strong emphasis on hygiene. The instruments used are sterilized (or disposable) to prevent the risk of infection. Skin and cuticle care. Your provider will moisturize and care for the skin on your feet, paying particular attention to dry or cracked areas. They will also address overgrown or problematic cuticles. Why should I get a medical pedicure? Only you can decide whether you need a medical pedicure, but we want to lay out the benefits to help you make an informed decision. There are several reasons why you may need one: Treatment of Specific Foot Conditions Medical pedicures are not just about pampering but about addressing specific foot conditions. Whether you're dealing with fungal infections, plantar warts, ingrown toenails, or thickened and discoloured nails, your healthcare specialist can offer treatments and recommendations for future care. Proper Nail Care While traditional pedicures focus primarily on nail aesthetics, medical pedicures focus on nail health. Sure, they will properly trim and file your toenails, but they'll also go the extra mile in preventing ingrown toenails and addressing any nail conditions like toenail fungus. Healthy Skin The skincare aspect of a medical pedicure involves moisturizing and nurturing the skin on your feet. Dry, cracked, or rough skin patches will be taken care of. Plus, we can provide product recommendations to help you maintain healthy, soft feet between appointments. Education and Guidance A significant part of a medical pedicure is education. You'll receive valuable guidance on proper foot care practices. In addition, with conditions like recurring calluses or ingrown toenails, the chiropodist can determine whether there could be any biomechanical factors at play. These insights empower you to take better care of your feet daily, reducing the likelihood of future issues.
October 12, 2023
Generally speaking, you don’t have to worry about a black spot on the toenail. Incidents like . In many cases, you can let your toenail heal naturally, but if you have a fungal infection or severe pain, you should schedule an appointment with your chiropodist. Often, incidents like stubbing your toe can cause a black toenail, but they can also be a symptom of an underlying health condition you are already aware you have. Source: istock Causes of Black Toenail If you see a full black toenail or a black spot on your toenail, it is likely for one of the following three reasons: Trauma (injury) Natural pigmentation changes Fungal toenail In some (rarer) cases, a serious illness like heart disease, diabetes or melanoma can cause a black toenail. Trauma (Injury) Sometimes our foot health takes a turn for the worse when we injure ourselves. Dropping a heavy object on your toe or stubbing your toe on a piece of furniture can cause a subungual hematoma, or bleeding and bruising under the nail. This gives it a black appearance and it is usually tender to the touch. There are certain medical procedures (like drainage and decompression) that treat black toenails caused by injury, but for minor cases, resting and using ice while elevating your injury is sufficient. Source: istock Natural Pigmentation Changes For people with darker skin tones, black patches can sometimes appear underneath the toenails over time. Medical News Today notes that this will usually happen to matching toes on each foot. So if your black spot is happening on corresponding toes, this may be the reason. Fungal Toenail Fungal toenail infections usually cause yellow or brown discolouration and thickening of the nail. But when debris builds under the nail bed, it can appear black. There are topical and oral antifungal medications you can take to treat fungal toenail. In some cases, you can even have your nail removed. But prevention is just as important when it comes to contagious foot conditions. Proper toenail care like keeping your nails (and the rest of your feet) clean can ward off infections, and for extra peace of mind, you can enjoy regular medical pedicures with your chiropodist. Source: istock. While Fungal Toenail usually looks thick and yellowish brown, there can aslo be black spots caused by debris build up.
July 17, 2023
Black toenails can be an unsightly but under-discussed topic for some individuals. The condition can stem from an injury, an underlying health issue, or ill-fitting shoes. A black toenail is likely a bruise under the nail, called a subungual hematoma. Seeing a black toenail at first glance can be alarming and uncomfortable, especially for first-timers. Fortunately, the discolouration and potential pain associated with blackened toenails are generally not a cause for concern. While the condition may not always be serious, understanding its possible causes, prevention methods, and treatment options is crucial for maintaining overall foot health and finding relief. Today, we'll focus on black toenails. In this article, you'll learn more about the common causes, treatment options, and prevention tips for black toenails: Causes of black toenails Causes of black toenails typically fall under three categories: injury, footwear, or an underlying health issue like a fungal infection. Below we dive into the three most likely culprits in more depth. Trauma or injury Stubbing the toe, dropping something heavy on your foot, or repetitive pressure from running or soccer can lead to a black toenail. Repeated pressure or friction to the nail bed can damage the blood vessels under the nail, ultimately creating a black toenail. For instance, marathon runners often get black toenails after running long distances. Ill-fitting footwear Shoes that are too tight or do not provide adequate toe room can cause repeated pressure and friction on the toenail. Whether on the job or wearing the wrong shoes for your partaking activity, ill-fitting footwear can be the culprit for black toenails. Fungal infection Sometimes, a black toenail can result from a fungal infection that affects the nail bed. Rare causes If none of the above apply to you, you shouldn't necessarily rule out rarer causes. In this case, consult a medical professional for a proper diagnosis. Rare causes of black toenails include: Malignant melanoma Chronic ingrown nail Other health problems Treatment for a black toenail Generally, black toenails aren't severe and are more of a sight for sore eyes. If you have a black toenail, you can do the following: Observation and self-care: If the black toenail is painless and there are no signs of infection, you can let the nail heal independently. It will typically take several weeks for the discoloured nail to grow naturally. The discolouration could take 6-8 months to disappear as the nail grows and you trim away the culprit. Rest and elevation: Resting and elevating the foot above heart level can help reduce swelling and promote healing. Ice: Applying ice packs wrapped in a cloth to the affected area can help reduce pain, inflammation, and swelling. Pain relief: Over-the-counter pain medications, such as acetaminophen or ibuprofen, can alleviate pain if necessary. Protective padding: You can use cushioned bandages or moleskin padding to protect the affected toe to prevent further irritation. Professional treatment: Sometimes, a foot specialist may need to drain the blood from under the nail to relieve pressure and facilitate healing. Paint your nails: If aesthetics are a primary concern, you can cover the nail with nail polish to hide the visible signs of a black toenail. Just first make sure you don't have any exposed skin or abrasions, as this can then lead to infection. Prevention tips for black toenails Prevention for black toenails hones in on proper nail care and hygiene and investing in the proper footwear: Invest in your footwear: Ensure that your shoes fit well and provide enough room for your toes to move freely. Avoid tight or narrow shoes that can cause pressure on the toenails. Investing in the proper footwear also means having specific footwear for each purpose - for instance, at work, casually, or while playing a sport. Protect your feet: If you engage in activities that pose a higher risk of a toe injury, such as sports or heavy lifting, consider wearing protective footwear or toe guards. Trim your toenails: Trim your toenails straight and avoid cutting them too short to prevent trauma or ingrown nails. For more tips on how to cut your toenails, read our nail trimming guide. Further, use toenail clippers for your toenails, not fingernail clippers. Maintain good foot hygiene and habits: Keep your feet clean and dry to minimize the risk of fungal infections affecting the nails. Regular inspections: Regularly examine your feet and nails for any signs of damage or discolouration. Promptly address any issues to prevent further complications. If the black toenail is accompanied by severe pain, signs of infection (such as redness, swelling, or discharge), or if it doesn't improve within a few weeks, it's advisable to consult a healthcare professional. They can assess the condition, provide appropriate treatment, and ensure no underlying issues require further attention.
June 19, 2023
Toenails serve a critical role in the health of our feet. They are are sensory organs that act like a shield, providing a critical layer of protection. The various parts of the toenail comprise toenail anatomy. These parts work together to protect the underlying tissues of the toe and aid in walking and other activities. Toenails may look like a singular unit, they're actually pretty complex. In this blog post, we'll dive into the structure and functions of the different parts of our toenail anatomy, providing a deeper understanding of this often-overlooked aspect of foot health. Nail plate The nail plate is the hard part of the nail and is comprised of a tough protective protein called alpha-keratin. Keratin adds strength and durability to the nail. The nail plate grows out from the nail matrix. It is translucent, and its colour can vary from white to yellowish-brown, depending on the thickness and the presence of underlying tissues. The end of the nail plate is part of the nail you trim away when clipping your toenails. Nail bed The nail bed is the skin under the nail. It nourishes and supports the nail. The nail bed is composed of blood vessels, nerves, and cells called melanocytes, all of which combine to produce the pigment that gives the nail its colour. When the nail bed is damaged, you may notice your toenail appears to change colour. For instance, your nail bed may produce a purple/darkish colour known as a black toenail, which occurs when the nail bed is damaged and pools blood. Nail matrix Did you know it takes roughly 18 months for a toenail to grow its entire length? This is thanks to the nail matrix, which helps dictate toenail growth. The nail matrix is the part of the nail bed that produces new nail cells. It is at the base of the nail plate, just beneath the cuticle. The nail matrix contains specialized cells called keratinocytes, which produce the protein that forms the nail plate. Lunula The lunula is the crescent-shaped white area at the base of the nail plate. It's the actively-growing component of the nail. The lunula is sometimes called the "half-moon" of the nail due to its curvature and half-ringed shape. Cuticle The cuticle is the thin skin layer covering the nail plate's base. It protects new nails from bacteria when they grow from the root, and also helps to keep the nail plate hydrated. Nail folds The nail folds are the skin folds surrounding the sides and base of the nail plate. They help to anchor the nail plate in place and provide support and protection to the surrounding tissues. Nail folds direct the nail growth in the correct direction and shape. When the nail folds are damaged, you may experience horizontal grooves across the nail, known as Beau's lines. Nail groove The nail groove separates the nail plate and the nail fold. It helps to direct water and debris away from the nail bed.
February 6, 2023
Age is just a number, but age starts to catch up with us at a certain point. As much as we want aging to slow, getting older comes with its fair share of aches and pains. Few people age the same; it is a complex process. Environment, genetics, exercise, and many other factors mould who we become as we enter our elderly years. This also applies our feet. As we age, our feet become more susceptible to various conditions such as arthritis, plantar fasciitis, bunions, foot injuries and chronic pain. Our latest blog is all about common foot conditions in the elderly and how to treat them. What happens to our feet as we age? Did you know that when you turn 70, you'll be 25,550 days old? That helps put the body's remarkable ability to withstand constant wear and tear into perspective. Beyond just a number, there are also physiological changes that occur as we age. Your feet may get bigger. Your feet may widen. Muscles, tendons, and ligaments also wear down, putting you at greater risk of certain foot conditions. You may notice you experience foot pain and other problems more often. Any number of the following may happen: Weakness Frailty Exhaustion Gait alteration Balance difficulties Increased swaying while walking Decreased walking Walking speed As we age, it's essential to check how you feel regularly. A bonus would be to have your feet checked regularly. Our team of expert foot specialists can help you manage acute and chronic conditions that affect the toes, feet, and ankles. Most common foot conditions in the elderly Foot conditions amongst the elderly may include bone injuries, toenail damage, foot deformities, and muscle and tendon damage. It's important to note that most of these conditions are not specific to the elderly, but age contributes to increased risk. Below we break down the following common foot conditions in the elderly and how to treat them: Bunions Osteoarthritis Fat Pad Atrophy Thickened or Discoloured Toenails Gout Plantar Fasciitis Stress Fractures 1. Bunions What are bunions? A bunion is a deformity of the first metatarsophalangeal joint ("MTP" joint for short). The first MTP is the joint of the big toe. (Essentially, the big toe's "knuckle.) Damage to this joint can cause bone misalignment over time. Eventually, the bone shifts and protrudes at the base of the big toe. Bunions affect approximately one quarter to one third of adults, and women experience the foot condition more often than men. As we age, bunions worsen. Although there is no "cure" for a progressive foot deformity, you can lessen the effects and pain associated with bunions through several habitual changes. How can I treat bunions? You can choose either invasive treatment or non-invasive bunion treatment. In most cases, you can manage bunions with non-invasive treatments, though surgery is the only way to remove the bump altogether. Footwear modification: Avoid tight shoes that squeeze the toes and ditch your high heels. You may also find that orthopedic shoes that stretch or come in wide widths effectively accommodate your bunion in your footwear. Shoe stretching is also an effective method for changing the structure of your current footwear. Anti-inflammatories: Specific medication like NSAIDs or ibuprofen reduces joint inflammation and relieves pain. Splints/aligners: Medical-grade bunion splints and bunion aligners help stabilize the joint. You can choose from medical-grade plastics or a toe sleeve based on your preferred rigidity. Taping: A specialist tapes the joint to keep the big toe in place, prevent further misalignment, and manage pain and inflammation. Supportive insoles or custom orthotics: Supporting your arches and correcting poor biomechanics can reduce pressure and strain on the first MTP joint. Bunion exercises: Basic exercises to strengthen foot muscles can better support and stabilize the joint, thus decreasing pain over time. The treatments you see above are all available at Feet First Clinic. 2. Osteoarthritis What is osteoarthritis? Osteoarthritis is not only the most common variant of arthritis; it is also one of the most common foot conditions in the elderly. Osteoarthritis is the "wear-and-tear" arthritis that causes degeneration of the cartilage in our joints. Reduced cartilage in our joints causes pain and can lead to other foot conditions like bone spurs. Your toes are most susceptible to osteoarthritis. Age plays a significant role in developing osteoarthritis. Wear and tear of our joints accumulate over time. Also, post-menopausal women risk developing osteoarthritis through osteoporosis (low bone density). How can I treat osteoarthritis? Osteoarthritis is a degenerative condition, meaning what's done cannot reverse. The cartilage in your joints doesn't re-grow, so treatment aims to slow the effects of osteoarthritis and reduce pain. Effective treatment includes a combination of the following: Active rehabilitation: Physiotherapy, massage, and exercise all help reduce the effects of osteoarthritis by promoting solid muscles. Stronger and more balanced muscles and feet reduce the strain on affected areas where you may have osteoarthritis. Medication: Anti-inflammatories can help control inflammation. Proper footwear: Specialized shoes can accommodate deformities of osteoarthritis (like bunions or hallux rigidus). The right shoes or boots can support your feet, provide balance, and offer cushion. Custom orthotics: Orthotics can be customized to add or reduce your reliance on certain parts of your feet. Controlling the impact on affected joints can help prevent further joint damage by distributing the impact and weight elsewhere. Limit awkward movements: If you find your joints are sore after a particular activity, consider reducing, modifying, or stopping the activity. For instance, if lunges hurt your foot, consider finding a replacement exercise. Surgery: If the joint is damaged extensively, a doctor may recommend surgery. Surgery and removing part of a bony outgrowth can be effective if the sheer volume of bone buildup is the culprit. If you experience osteoarthritis and are looking for orthotics, a gait analysis, or proper footwear, visit Feet First Clinic for solutions. 3. Fat pad atrophy What is fat pad atrophy? The heel fat pad is a cushion to absorb shock and distribute plantar force on impact. As we age, the heel fat pad gets atrophies and gets thinner. This can put you at a greater risk of heel injuries and other foot conditions. The increased pressure on the heel can cause you to overcompensate with other parts of your body, and weight distribution becomes unevenly distributed. How can I treat fat pad atrophy? You should reduce the pressure on your heel if you suffer from fat pad atrophy. Custom orthotics are effective as the personalized insoles provide padding and support and help distribute weight across the complex network of foot muscles. Be sure to also wear shoes with lots of padding and cushioning, like the ASICS Gel-Nimbus. 4. Thickened or Discoloured Toenails What are thick or discoloured toenails? Thick toenails and discoloured toenails are a byproduct of aging and are one of the most common foot conditions in the elderly. As we get older, toenail growth declines. As such, nail cells begin to accumulate at a faster rate than nail growth. The accumulation of onychocytes (nail cells) causes thickened toenails. Alternatively, reduced circulation or acute trauma can cause thickened toenails. Discoloured toenails, on the other hand, indicate damage to the nail or nail bed. Acute trauma to the nail causes discolouration, but so does reduced circulation. At an older age, we're at a greater risk of diabetes and peripheral vascular disease. Both diabetes and peripheral vascular disease cause reduced circulation in our feet and discoloured toenails. How can I treat thick or discoloured toenails? Toenail treatment for thickening and discolouration varies. To properly diagnose your feet and nails, book an appointment with a specialist at Feet First Clinic. Our nail care services involve proper trimming and filing of the toenails, addressing any pain or discomfort, and educating patients on proper hygiene and care. For more information, visit our nail care and treatment page. 5. Gout What is gout? Gout is a form of inflammatory arthritis targeting the foot's joints. You may experience intermittent bouts of severe pain, including inflammation and hypersensitivity. During these episodes, any kind of activity becomes challenging, leaving you less mobile. The prevalence of gout increases in older people. Elderly people are susceptible to gout for a few reasons: Renal function declines with age, there can be dietary changes, you may experience sudden weight gain, and certain medications for age-related conditions have indirect side effects that may lead to gout (i.e.: water pills, blood pressure medication). How can I treat gout? Before any treatment, the first step is to see a family doctor and a rheumatologist. Once diagnosed, you may be prescribed the following treatments, all of which aim to prevent future attacks, reduce pain, and improve quality of life: Change your diet: Ditch food containing excessive purines. Avoid foods like red meat, certain types of seafood like sardines and mussels, alcohol, high fructose beverages, and yeast. Diet also impacts your weight. Maintaining a healthy and consistent diet can help reduce sudden weight gain and keep inflammation at bay. NSAIDs: Non-steroidal anti-inflammatory drugs reduce joint inflammation. Alternatively, corticosteroids are an option if one doesn't react to NSAIDs. Stay or become active: Light-strengthening exercises, relaxing physical activity, and physiotherapy can improve quality of life and mobility in people with gout. Keeping your muscles strong also makes them less susceptible to inflammation build-up, which can trigger gout attacks. Supportive footwear: Proper footwear can help you deal with any pain associated with gout as it reduces the impact on the joints. 6. Plantar fasciitis What is plantar fasciitis? Plantar fasciitis is a condition of the heel. The band of tissue on the underside of the foot gets inflamed and causes pain. Often, plantar fasciitis develops gradually over time. Changes in our body as we age can make this condition more common in the elderly. How can I treat plantar fasciitis? With proper care and treatment, most cases of plantar fasciitis heal with time. A foot specialist can guide you through the healing process and provide options for preventing it from recurring in the future. There are several treatment methods available for plantar fasciitis. Rest: Take a break, and let your heel recover by staying off your feet. Supportive footwear: Wearing supportive footwear with strong arch support and a good heel counter is essential for managing and even preventing plantar fasciitis. Stability shoes are particularly helpful. Check out this article for our top recommended shoes for plantar fasciitis. Rolling: Gently massage your heel using a tennis ball or frozen water bottle under the foot. Rolling helps massage and relieve the plantar fascia and encourages faster recovery. Add stretching and strengthening exercises to your routine. Shockwave therapy: Shockwave therapy delivers sound wave pulses to the injured fascia. This triggers your body's the healing process, making for a natural recovery. Shockwave therapy is extremely effective for cases of plantar fasciitis persisting more than 6 months. Taping: Taping the heel engages other muscles and tendons of the foot, reducing the load on the plantar fascia. Wear a splint: A splint helps keep your foot stable while you sleep. Supportive Insoles or Custom Orthotics: A good supportive insole, like Superfeet Green, is tried, tested and true for helping with plantar fasciitis. If that doesn't work, or if there are biomechanical factors contributing to your plantar fasciitis, you can look into custom orthotics. 7. Stress fractures What are stress fractures? Stress fractures are micro-breaks of bones are another common foot condition in the elderly. When we age, bone growth slows, losing more bone than we generate. Our bone density also reduces. If your bone density drops too much, you develop osteoporosis. Weaker bones put the elderly at greater risk of stress fractures, whether acute, like when you fall or by too much repetition, like walking. How can I treat a stress fracture? The RICE method is critical to treating a stress fracture. Rest, ice, compression, and elevation. Untreated stress fractures can lead to bone shift, permanently altering the foot's biomechanics.
January 16, 2023
Fact: Your toenails can give you clues about your overall health. That's right, the state of your nails, including toenails, can indicate an underlying health condition. Conversely, healthy nails can be a sign of a healthy lifestyle. The state of our toenails can differ in a lot of ways. Toenails can splinter, thicken, thin, peel, dry out, break, and pit. Toenail pitting is the focus of this article. Below, you'll learn about toenail anatomy, the basics of pitting, signs, treatment methods, and preventative measures to keep your nails in good shape. Toenail anatomy Before we delve into the details of toenails and pitting, we must understand their anatomy and the part it plays for our feet. Toenails are the plate-like covers on our toes. Alpha-keratin, a type of protein, comprises toenails. Alpha-keratin is the same protein building block for hair and the outermost layer of our skin (the epidermis). Generally, the toenail is about 0.5 mm thick and slightly curved. The toenail consists of several distinct components. The toenail includes the nail plate, the cuticle, and the nail folds surrounding the nail's perimeter. The part referred to as the toenail colloquially is the "nail plate." What's toenail pitting? Pitting, by definition, is an indentation. Toenail pitting follows the same logic. Pitting of the nail occurs when tiny dents or "pits" form in the nail plate. Toenail pitting is a type of nail abnormality. Toenail indents can be shallow and only recognizable by touch. Deep toenail pits may be visible due to their concave nature. Within the grooves, some parts of the pitting may be deeper than others, just as there are deeper and shallow parts of a pit. Nail pitting is generally more common for fingernails, but toenails are also affected. What causes toenail pitting? There are several causes for toenail pitting. Toenail pitting reasons range from external trauma to an underlying medical condition. Learn about the various causes of toenail pitting below. Nail psoriasis Psoriasis is a chronic inflammatory disease that can cause toenail pitting. Those with nail psoriasis produce too many skin cells, causing nail irregularities. According to Healthline.com, approximately 80% of those with psoriatic arthritis experience nail irregularities or changes. You may be able to recognize nail psoriasis because of two related symptoms: discolouration and nail bed separation. There are a few groups more likely to develop nail psoriasis. At-risk factors include: People who are over 40 (though psoriasis may occur at any age) Males Genetics Psoriatic arthritis According to a study published in the National Library of Medicine, psoriasis can cause toenail pits "remarkably even in size and depth. Their distribution may be haphazard or sometimes arranged in parallel transverse or short longitudinal lines." Though psoriasis is not curable, you can mask the effects of toenail pitting. You can buff or apply nail polish to hide the indents and improve the aesthetic. Nail eczema Eczema is a condition that causes itchy and red skin. The disease can cause nail thickening or pitting when eczema targets the feet. Habit-tic deformity Habit-tic deformity on the fingernail. The habit-tic deformity is a nail condition similar to toenail pitting with several differences. When you constantly pick at your nails, external trauma can create pits in your nail. The habit-tic deformity is most common on the fingernails, specifically the thumbs, but it can also happen on your toenails. For instance, if you sit cross-legged or have your feet at arm's reach, you may develop a habit of picking at your toenails. The defining features of habit-tic deformity are horizontal ridges across the nail and a slight depression in the middle of the nail plate. The habit-tic deformity is not severe and typically heals if left alone. The condition is known as "washboard nails" because of the horizontal nail ridges. Reiter's syndrome/reactive arthritis Those with reactive arthritis may experience toenail pitting. An infection or bacterial infection elsewhere in the body can cause reactive arthritis, also known as Reiter's syndrome. People with a specific type of gene are more likely to develop the condition, as it's believed to be genetic. How do you fix nail pitting? Toenail pitting fixes vary. In some cases, like psoriasis, there is no cure. Cosmetic procedures are an option to mask the effects. Removing external trauma can help reverse toenail pitting in cases like a habit-tic deformity. Additional treatment options include medication applied to the nail itself. Options include steroids, salicylic acid, calcipotriol, cyanoacrylate adhesive (for the habit-tic deformity) and tazarotene. Is nail pitting serious? In most cases, nail pitting as a symptom isn't severe. Nail pitting is more often a cosmetic issue than a medical issue. However, the underlying conditions that cause toenail pitting can vary in severity.
