Tuesday 21 November 2017

Painful conditions of the feet and hands

Ingrown toe nails can occur in anyone but are most common in teenagers and older people.
Ingrown toe nails can occur in anyone but are most common in teenagers and older people.

Nina Byrnes

Advice from our GP on the best way to care for ingrown toenails and on how to identify hand-foot-and-mouth disease symptoms.

Q. My daughter has an ingrown toenail. We have been trying to help it grow normally at home but it gets sore and red often. What's the best way to care for these?

Dr Nina replies: Ingrown toenails can be painful and uncomfortable. They occur when the edge of the nail grows downwards into the skin surrounding it. The nail curls and pierces the skin which may become infected, red and sore.

Ingrown toenails can occur in anyone, but are most common in teenagers and older people. Teenager's feet tend to sweat more, so the skin may swell and become moist and soft causing it to split, allowing an ingrown toenail to occur. In older people nails may become thickened and hard, making them more difficult to cut and causing pressure on the surrounding skin. The big toe is most commonly affected.

If you have an ingrown toenail, you may notice redness or inflammation along the side of the nail. There may be pain, especially if there is pressure on this area of the foot. Ingrown toenails can become infected.

This is especially uncomfortable. An infected toe may ooze pus or bleed. In more severe cases of ingrown toenails the skin along the side of the nail may be obviously overgrown, covering the side of the nail.

The main cause of ingrown toenails is incorrect nail care. Toenails should be cut straight across with a slight dip in the middle. Trying to follow the curve of the toe or cutting nails too short make ingrown toenails more likely. Wearing tight-fitting shoes or socks also puts pressure on the skin, pushing it into the nails or it may cause the toenail to curve inwards.

It is important to wash and dry your feet frequently and change socks daily. Those whose feet sweat a lot should consider changing socks more than once daily. Wear cotton socks, allowing the skin to breathe. Wearing sandals is even better. This removes pressure from the toe and allows the skin to stay dry and cool.

Poor foot hygiene can cause skin to become moist and boggy and the nail may pierce it more easily. Infections such as athlete's foot are also more likely with poor hygiene, and this causes moist boggy skin too. Trauma or damage to the nail having naturally very curved nails also makes ingrowing toenails more likely. Treatment depends on the severity of the nail infection or damage. If the nail is mildly ingrown, bathing it daily and applying some cotton wool or dental floss under the part that is in-growing may help lift the nail and allow it to grow out of the skin. Wearing open-toed shoes and applying an antibiotic cream or taking simple painkillers may provide relief. In more severe cases part of the toenail may have to be removed.

If the toenail recurrently grows inward, both the nail and nail bed can be removed, therefore preventing that part of the nail regrowing. This proceure is done under local anaesthetic. It can be done in a GP surgery or is also done as a day case in hospitals. Podiatrists and chiropodists can also treat ingrowing nails.

Ingrown toenails may be prevented by paying attention to good foot care. Cut nails straight but not too short. Keep feet clean and dry. Don't pick at nails. Wear appropriate shoes that protect the toes and allow them space and air.

Q. My son attends a crèche a few days a week. There have been some cases of hand-foot-and-mouth disease in his class. Is this contagious? Will he be very sick if he gets it and how will I recognise the signs?

Dr Nina replies: Hand-foot-and-mouth is a viral illness that usually occurs in children under the age of 10, and most commonly occurs in those under the age of five. It causes small blisters to occur in the mouth and on the hands and feet. They can also be found on the buttocks, elbows and knees.

The illness usually starts with a general feeling of being unwell. This is followed by a fever which may last a few days. A sore throat often occurs followed by the appearance of spots in the mouth that develop into ulcers.

In about 75pc of cases spots then develop on the skin. These may look a bit like chickenpox, but they don’t cover the whole body and are usually found on the soles of the feet, palms of the hands and around the bottom area. They can also be seen on the elbows and knees. Unlike chickenpox, these spots are not itchy and in some cases may be tender.

Hand-foot-and-mouth is spread by contact, either through sneezing or coughing, close personal contact, or contact with contaminated objects or surfaces. Infections often spread quickly through crèches and childcare settings. It takes about three to five days from the time a person is infected for symptoms to appear. Illness usually lasts less than a week.

There is no treatment for hand-foot-and-mouth. Like any viral illness, the best treatment involves keeping the person cool and comfortable through medicine, tepid baths and loose cotton clothing. Eating soft or cool foods like yoghurt and ice cream can soothe the mouth blisters. The infection is normally mild and doesn’t require extended periods of absence from school or crèche.

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