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.
January 9, 2023
There can be a range of discolouration in your toes. The most common is a pinkish/red hue - a sign of red toes.
Red toes may result from cold temperatures, toe injury, infection, or potential medical conditions. Red toe onset may be immediate, or red toe onset may be progressive. The redness often resolves itself, but it may sometimes present symptoms of underlying medical conditions.
Learn more about red toes and potential risks in our article below!
Why are my toes red and itchy?
Several causes result in redness in your toes. Red toes result from inflammation, injury, temperature, skin irritation, and infection. Varying degrees of redness may indicate the severity of damage to the toes. In some cases, redness may subside independently, while others may require medical attention.
What medical conditions cause red toes?
There are a variety of medical conditions that induce red toes. Red toe causes range from skin conditions to musculoskeletal damage to infection. Below, we've categorized medical conditions that cause red toes by severity. Note that all medical conditions can have varying degrees of severity, so use this list as a reference, not a diagnosis.
Lower severity
Low-severity medical conditions that cause red toes are short-term causes and often subside independently. Proper attention and care are required to prevent additional damage. However, low-severity medical conditions that cause red toes are more surface-level and less cause for concern.
Blisters
A blister is a small fluid-filled bubble that forms just under the outer layer of the skin. The fluid (usually a serum, rarely blood) is a natural cushion to protect the tissue underneath from friction and irritation. Fortunately, blisters often heal on their own once the source of friction is eliminated. As tempting as it may be, avoid popping the blister and allow it to heal naturally.
Frostnip
Frostnip is a mild, non-severe cold injury to the skin and tissue. As such, frostnip doesn't cause permanent damage. You can treat frostnip with basic first aid. Above all else, you should try to escape the cold as quickly as possible. Possible complications include infection and temporary nerve damage, which are rare if caught at the frostnip stage.
Stubbed toe
A stubbed toe occurs any time you jam your toe against another object. A stubbed toe is a trauma injury. The injury results from a one-time accident. Depending on the severity, damage to the toe may cause swelling and inflammation, muscle injury, and even bone fractures.
Contact dermatitis
Contact dermatitis is a red, itchy rash triggered by an allergic reaction. The skin's response to an irritant causes inflammation, followed by a rash. Contact dermatitis isn't contagious nor life-threatening, but it can be very uncomfortable. Soaps, plants, detergents, or jewelry have the potential to cause an allergic reaction.
One can treat and prevent contact dermatitis by identifying and removing environmental allergens. A doctor can also prescribe topical medications to help treat flare-ups.
Athlete's foot
Fungal skin infections are a common culprit of red toes. Athlete's foot is one such common fungal skin. Athlete's foot is a prevalent cause of the redness. The toe fungus is not life-threatening, but it is contagious and may spread elsewhere on your body or even to other people. It can also cause foot pain and difficulty walking if left untreated.
Nail infection
Paronychia is an infection of your nail folds typically caused by bacteria or a fungus and can cause toe pain and swelling, which causes redness and the appearance of red toes.
Ingrown toenail
An ingrown toenail is a nail condition that targets the toes, mainly the big toe. As the name applies, it occurs when the sides or edges of the toenail grow into the skin. As the nail pierces the skin, it can cause bleeding, redness and pain. If left untreated, the ingrown toenail can get infected.
Moderate severity
Moderate-severity causes of red toes are more severe and may be longer-lasting. Symptoms and recovery time may vary, and pain and discomfort may be more intense and significant. You may require medical assistance to determine the diagnosis and treatment method(s).
Gout
Gout is a form of inflammatory arthritis caused by heightened uric acid in the blood. Elevated uric acid levels lead to the formation of crystal deposits in the joint. The joint then becomes red, hot, swollen, and painful. The initial attack of this condition is usually sudden, with symptoms lasting for about a week. The most common joint it affects is the joint that connects your big toe to the rest of the foot. If left untreated, gout attacks may reoccur, increase in severity and lead to enduring joint damage.
Frostbite (superficial)
Superficial frostbite is a stage more severe than frostnip. Cold temperatures damage the skin and the underlying tissues in your toes. Blisters form 24-36 hours after rewarming, and you may experience pain and discomfort for several days.
Higher severity
More serious medical conditions that cause red toes may be chronic or permanent. These conditions can be irreversible and limit the motor function of your toes. Surgery may be a last-resort treatment option in severe cases.
Rheumatoid Arthritis
Rheumatoid arthritis ("RA") is an auto-immune disease that causes chronic joint inflammation. RA causes periodic flare-ups of joint pain, stiffness and swelling, eventually making movement difficult. Although there is no cure, you can manage the condition with proactive and diligent treatment focusing on your overall health and well-being.
Diabetes
Diabetes can cause a chain reaction in your body that hinders circulation to the feet and toes. People with diabetes may experience two conditions that cause red toes: peripheral vascular disease and nerve damage (diabetic neuropathy). Nerve damage and reduced circulation can cause an itchy or numbing pain in the toes. Diabetes can also hinder the body's ability to fight less severe conditions due to reduced immune response and blood circulation.
Frostbite (deep)
Deep frostbite is the most severe form of cold damage to the skin. Your skin or tissue may turn red and black and die altogether. You may sometimes lose muscle function and require surgery to remove part of the toe.
Bunions
A bunion is a foot condition of the first metatarsophalangeal joint. Bunions occur when the big toe misaligns. The shift in bone structure causes what appears to be a bony outgrowth. The outgrowth is simply the angling of your toes. The damage to the joint causes pain and redness, and the increased volume of your toes can make wearing shoes uncomfortable. Without proper footwear or orthotics, you can further aggravate your bunions.
Bunions are irreversible and have no "cure" other than surgery. However, physical therapy and accommodations, like orthotics and proper footwear, improve quality of life.
How can I prevent my toes from turning red?
Treatment and prevention for red toes depend on the severity of the underlying medical condition. Generally, low-severity medical or skin conditions are treated simply through rest and recovery. For low-severity conditions, the goal should be to focus on "How do I prevent this from getting worse?"; whereas for high-severity needs, much of the damage has been done and is irreversible. For more severe red toe conditions, the focus is more geared towards improving quality of life and implementing tools to improve mobility, like custom foot orthotics or orthopedic footwear.
We've created a treatment guideline below:
Low severity. Low-grade medical or skin red toe conditions are treatable, often at home. Treatment methods include topical creams or prescription medication, rest, recovery, taping, or changing footwear. Further prevention should focus on recognizing signs and symptoms of red toes early and following proper foot hygiene.
Moderate severity. Moderate severity medical or skin red toe conditions are a mix of prevention and treatment. A proper diagnosis is often required, followed by a treatment plan. Rest and recovery may be part of the treatment plan, but the recovery may be longer (weeks, not days). Like low-severity causes, prevention should focus on recognizing signs and symptoms of red toes early and following proper foot hygiene.
Higher severity. Severe medical or skin red toe conditions are often irreversible and have no cure. Treatment methods focus on improving motor function, mobility, and well-being through orthopedic tools and physical therapy.
November 17, 2022
A self-performed nail trim may seem like a simple task. However, many people make plenty of mistakes when trimming their nails.
Failing to follow the correct technique can lead to a wide array of painful toenail problems, like ingrown toenails (P.S. you should never try to cut your own ingrown toenails), cracked toenails, and even infections like toenail fungus.
In the world of podiatry and chiropody, a trim nail is serious business. There are guidelines to follow to protect your toenail health, and foot specialists also recommend specific tools of the trade. The good news is you can learn to trim your toenails properly from home.
Let's look at common toenail trimming errors (and useful tips) and then learn how to cut your toenails like a pro!
Toenail Trimming: Common Errors and Helpful Tips
Don't trim your toenails when they are wet. Everyday Health notes you should trim them while dry for a smoother cut.
Don't clip your toenails too short. This almost guarantees ingrown toenails, as the skin can overlap the toenail.
Use the right toenail clippers and avoid using unusual objects for toenail trimming, like standard scissors.
Curving the edges of your toenails may look aesthetically pleasing, but experts suggest not doing this. It will put you at risk of ingrown toenails, so trim your toenails straight across instead.
Clip your toenails every six to eight weeks. Don't wait longer, or it will be more difficult. Athletes may want to clip more frequently.
Maintain a toenail length of 1 to 2 mm, no shorter. Toenail growth can be quite slow sometimes.
If you don't have the right tools, enough time, or simply the confidence to focus on a nail trim, try a medical pedicure instead. It includes the right nail trimming procedure and concludes with a relaxing (and beneficial) moisturizing session, thorough cleaning, and more. Before the nail trim, a chiropodist also examines your feet for other foot conditions.
Try OnyFix if you're already burdened with ingrown toenails. This non-invasive, pain-free procedure ensures your toenails grow in the right direction.
How a Foot Specialist Cuts Toenails
Start with a clean, dry base. A clean base keeps your tools from slipping and eliminates debris so you can see the toenails clearly. Cut your toenails after a shower or bath and ensure they're dry, using a towel to soak up any excess water.
Use sharp nail clippers or nickel-plated pedicure scissors. Remember, toenails are thick, so flimsy tools will just cause mistakes.
Clip nails straight across. There should be no curving of the edges or cutting the nails down too far. A straight cut keeps the nail growing in the right direction.
Trim once more if needed. If the first trim doesn't look quite right, trim straight across one more time. Cut along the straight line of the initial cut to clean up the edges.
Use a nail file. This tool is necessary for properly smoothing the edges of the nails. After the trimming, there will likely be some jagged edges, sharp corners, and "spikes."
October 31, 2022
In Ontario, there are two terms for a foot specialist: a chiropodist and a podiatrist.
Many prospective patients ask themselves if there is a difference between the two occupations. They assume there must be since there wouldn't be two words for one specialty, right?
But the truth is, there are very few differences between chiropodists and podiatrists. Even if you research the definition of both professions, you can be left feeling just as confused as when you started. You'll often find that the internet tells you that they are healthcare professionals who tend to the feet, so what gives?!
Despite your confusion, there are some reasons medical experts split foot care experts into two categories. Let's explore why the healthcare world doesn't simply settle on one term!
Podiatry and Chiropody: Key Differences
Now that we have a clear understanding of each profession, the question remains; why does the medical industry insist on preserving two terms for foot specialists?
The terms are not interchangeable, despite how similar they are. Let's look at why.
Education
It takes longer to become a podiatrist. According to the Ontario Podiatric Medical Association, podiatrists must complete a Doctor of Podiatric Medicine (D.P.M.) degree. This is a four-year post-baccalaureate program. On the other hand, chiropodists complete a post-secondary diploma in chiropody. Furthermore, both often have additional education in a science-related field from an accredited university.
Terminology and Word Choice
Even though they don't go to a traditional medical school, you can use the term "foot doctor" to describe a podiatrist, as podiatrists obtain their D.P.M. You should not use this term to describe a chiropodist, although "foot care expert" and "foot specialist" certainly qualify.
Diagnoses Communication
Podiatrists can "communicate a diagnosis" to their patients, which stems from Ontario law granting them one of the six primary care professions in the province. This does not mean that a chiropodist cannot participate in effective communication with their patient.
Specialties
With their background in sports medicine, a podiatrist may be a better fit for someone experiencing a foot/ankle fracture or sprain. They're also the only foot specialists able to perform surgeries on the forefoot bones. One may be able to argue that a podiatrist is better suited for a severe condition requiring surgical intervention. For example, surgery for severe heel spurs or bunions.
However, a chiropodist can also address foot conditions and may be a better fit for establishing follow-up visits, ongoing care, foot care treatments, and giving advice on managing your foot health.
For more information about the things a chiropodist can and cannot do, visit our FAQ.
Availability
As of May 2022, there are over 600 chiropodists and only 60 podiatrists in Ontario. With limited access to podiatry, it's important to reiterate that those suffering from foot issues can explore chiropody and don't have to wait for a podiatrist to become available. Of course, the exception is if you require bone surgery.
In addition, unlike a podiatrist, you do not need a referral to see a chiropodist (although your private extended benefits may require one for coverage).
Coverage
Podiatrists can bill OHIP. Chiropodists cannot bill to OHIP, but they can bill companies that offer extended healthcare coverage, like Manulife and Sunlife.
Can a Chiropodist and Podiatrist Treat the Same Conditions?
Unless you require surgery on the bones in your feet, or you are not covered by extended health insurance and need OHIP coverage, you can see a chiropodist instead of a podiatrist.
It can be difficult to schedule an appointment with a podiatrist, so there's no reason to neglect the expertise, kindness and care a chiropodist can offer you. Plus, they treat the same conditions as podiatrists, which include (but are not limited to):
Skin conditions such as calluses, corns, plantar warts, and cracked heels.
Toenail conditions like ingrown toenails, cracked toenails, and discoloured toenails.
Structural abnormalities that cause foot pain, like Plantar fasciitis, osteoarthritis, Rheumatoid arthritis, gout, and bunions.
Contagious conditions such as fungal toenail and athlete's foot.
Additional conditions like foot odour.
Diabetic foot care, assistance and guidance.
August 8, 2022
With summer finally in full swing, it’s time to get your feet in tip-top shape! Get ready to show off your toes in those sexy new sandals with a medical pedicure. A medical pedicure is a great way to clean up and refresh your toes, just in time to hit the beach. Today we will discuss what happens during a medical pedicure and break down the medical pedicure process, from toenail trimming to callused skin removal.
What is a medical pedicure?
A medical pedicure is a procedure performed by your foot care specialist. During this service, the foot specialist (a chiropodist) will examine your feet and determine the best course of action to get them in pristine condition. Also known as a “medi-pedi”, a medical pedicure deals with issues that go far beyond just the aesthetics of your feet. They tackle medical concerns like ingrown toenails, calluses, corns, cracked heels, and even fungal infections.
Feet First Clinic can help treat and prevent ingrown toenails by properly trimming and cutting your nails.
All medical pedicures are different. Your practitioner will select a foot care regimen catered to your unique needs. While a medi-pedi is still a relaxing experience that will get your feet feeling their best, their main priority is to focus on the health of your feet and prevent further medical issues from occurring.
Why choose a medical pedicure over a regular pedicure?
Unlike a cosmetic pedicure, a medical pedicure is performed by a chiropodist, who specializes in conditions affecting the feet. This makes it an excellent option for people with underlying medical conditions. If you have diabetes, cancer, or autoimmune diseases, a medi-pedi is one of your safest options. There is a minimal risk of infection, and the medical pedicure is performed in a sterile medical setting by a qualified foot specialist. A medical pedicure is not painful.
While a cosmetic pedicure's primary focus is on making your feet look good, a medical pedicure focuses on treating the root cause of your foot issues and preventing more problems in the future. A medical pedicure looks at the condition of both your toenails and the skin of your feet. Treating underlying skin and nail issues affecting your feet allows you to experience improved foot health, which can in turn improve your overall health and make walking will be more comfortable. No nail polish is applied during a medical pedicure.
Plus, during a medical pedicure, you can ensure that you get the highest level of service that has been catered to your unique needs.
What Does the Medical Pedicure Process Look Like?
If it's your first time receiving a medical pedicure, you may be wondering what you can expect from this service. While it may be a different experience from a cosmetic pedicure, we are confident that you will find it just as therapeutic and relaxing.
Prior to your appointment, it is important to ensure that all nail polish is removed.
Step 1: Examination
The first step of a medical pedicure is the examination. Your chiropodist will check for any underlying foot conditions affecting the skin and toenails. They will inspect your feet for cuts and infections. They will also check for any irregularities, like ingrown toenails, toenail discolouration, warts, corns or foot fungus.
Step 2: Nail Care
Next, your chiropodist will trim and file your toenails. This will ensure that they remain at the proper length to prevent ingrown nails and promote healthy, proper nail growth. The chiropodist can address any toenail concerns at this time, like toenail fungus or thickened toenails.
Step 3: Skin Care
The next step involves dealing with dry skin, corns and calluses. Over time, the friction of your feet rubbing on your shoes and the ground can cause skin build-up. This can lead to a bump on the skin, excessively dry skin, and pain when walking. Using specialized tools, your practitioner will gently remove this excess skin, leaving your feet softer and smoother than before. This process is painless. The chiropodist will then apply medical-grade moisturizer to leave your skin soft and smooth.
Step 4: Recommendations
At the end, your chiropodist will make recommendations to maintain your foot health. This can include at-home care, follow-up treatments and ongoing maintenance. If the chiropodist suspects other foot conditions (i.e.: a biomechanical issue that could be causing excessive calluses or ingrown toenails), they may also recommend a foot assessment.
After your medical pedicure is complete, your feet will feel rejuvenated and refreshed. You will be ready to show off your feet in those new, open-toe shoes and can feel confident that all your foot concerns have been adequately addressed.
May 12, 2022
Ingrown toenails can be a real pain, literally. In addition to pain, symptoms can include swelling, redness and irritation. Ignoring ingrown toenails can sometimes lead to an infection, so it’s important to be proactive and get them treated.
While ingrown toenails can be painful, the treatment doesn’t have to be. There are many ways a chiropodist can safely and effectively treat ingrown toenails (click here to learn more about that). In today’s article, we’re highlighting a brand new painless treatment for ingrown toenails at Feet First Clinic, a highly innovative system called Onyfix. Keep reading to learn more!
What is Onyfix?
Onyfix is a completely pain free way to treat an ingrown toenail, which overwhelmingly occurs on the big toe. It involves a composite material applied by the chiropodist across the nail, which acts like a “nail brace” to correct the nails growth.
The Onyfix nail correction system has following components:
Onyfix primer: This is an adhesive agent. It works similar to the way paint primer does, by allowing the composite (the “nail brace”) to adhere to your nail and not fall off after.
Composite material: There are two composite materials – hard and soft. The Onyfix Hard is for larger, adult nails and malformations, while the Onyfix Soft is for thin nails and children's nails. The composite itself is white and has a consistency similar to liquid glue.
A LED light to cure the primer and composite
How It Works
Ideally, toenails should grow vertically from the base toward the tip of your toes and retain their shape. Misshapen and ingrown toenails, however, grow outward and into the skin. Onyfix works by acting as a nail brace that redirects nail growth and helps the nail retain its shape during the growth process.
If you have an ingrown toenail that won't go away, you should first book an appointment with a chiropodist for ingrown toenail treatment. Your foot care expert can then determine when and if they should use Onyfix.
Onyfix is applied in conjunction with a standard ingrown toenail and nail care treatment. This involves filing, smoothing and properly trimming the nail. Once that is completed and the nail is flattened and cleared of all debris, the chiropodist will do the following:
First, the chiropodist will prep the nail by roughening the surface with a ceramic bur (like sanding a surface before priming and painting), and cleaning it with a degreasing agent.
Onyfix primer is then applied with a cotton swab (again, like prepping to paint).
The chiropodist will shine the LED light for 10 seconds to cure the primer to the nail. This helps ensure the composite applied in the next step stays on and works properly.
Once the primer is cured, the chiropodist will apply either the hard or soft composite to the widest point of the nail, creating a white band across the nail. This acts as the “nail brace” (without the wires). The chiropodist may also apply an additional band at the top or corners of the nail.
The LED light is then applied for 30 seconds to cure the composite.
As the composite hardens, it secures the Onyfix to the nail in a fixed position. There is no tension or pain as the product secures itself. Over time, the Onyfix ensures that the toenail grows in a favourable position and retains its proper shape. This treats and prevents further ingrown toenails.
The Onyfix should last for 2-3 months. During that time, your chiropodist will see you for follow-up appointments to assess the nail growth and potentially add additional bands. After 2-3 months they’ll remove the Onyfix and the treatment is complete. The nail will then ideally continue to grow naturally in the correct physiological position.
Benefits of Using Onyfix
Onyfix is a pain-free solution to ingrown toenails. Additionally, it provides the following benefits:
It is a non-invasive treatment for recurrent or chronic ingrown toenails.
It focuses on natural regrowth and reformation of the nail rather than ingrown toenail removal.
It provides results without using invasive force on the toenail. This is particularly beneficial for people with diabetes.
It quickly relieves ingrown toenail pain. This is noticeable shortly after the treatment
You don't have to restrict your activities after treatment.
