Tips and Toes

By Karen Minard #64779, RN

Whether or not we are in our RVs or in our stick homes, we are busy, busy, busy, and we can be hard on our hands and nails. These growths at the ends of our most distant appendages aren’t there just for looks, even though some of them we see are rather attractive when well-kept and maybe even painted.

The nails are a complex plate that are made up of several parts and have multiple uses besides the protection for our fingers and toes. Let’s see—they are great back scratchers, wonderful for helping pick up something that is being obstinate, stress reliever when we nibble on them and fun to polish and so on.

Let me give a quick little anatomy lesson on the “parts” of the nails, which is the same for both the fingers and toes. The edge that you see beyond the end of the finger is called the free edge. The center area is called the nail plate and the area under it is rich in blood vessels. The area that looks like a half moon is called the lunula, and the part that we nibble on is called the cuticle. The part that is under the skin near where the nail is visible is called the nail matrix. Nails grow from the matrix and are made up of the tough protein called keratin, which is also part of what makes up our hair.

My main goal with this article is to tell you about some of the unusual things we may experience with our nails; however, first let’s look at healthy nails. Most importantly, to have healthy nails we must keep the hands and feet clean and exfoliated of dry scaly skin where bacteria love to hide. Remember, foot odor is caused from bacteria on the feet, and bacteria especially love to live under the nails and around dry split skin and cuticles and between the toes. Using grainy scrubs for the hands is much more gentle than a pumice you might use on the feet. The best time to remove dry, scaly skin is during or right after bathing, when the skin is clean and soft from the water. Since RVers need to ration water use, we can soak the hands in a bowl of warm, soapy water or the feet in a basin. If you use lotions, don’t use them between the toes, which can increase sweating and bacteria growth, and be sure your lotion around the heels and the rest of the feet is dry before putting on your socks, for the same reason.

A little time spent keeping the cuticles clean and moist and pushed back will reduce the occurrence of peeling and splitting and the temptation to nibble on them. I don’t think we need to worry about nibbling the cuticles of the toes, do we? However, they also need to be kept soft and pushed back. Keeping all the nails filed when they have a ragged edge will reduce the chance of snagging or tearing the nail. Be sure to clean under the nails with an orange stick or nailbrush, and use the orange stick to push all the cuticles back. The toenails should be cut square across the free edge to reduce the chance of ingrown toenails. Don’t allow them to grow longer than the toe because they can hit the inside end of the shoe and be injured. If you aren’t inclined to spend time doing your own nail care, grab a book and enjoy a very nice experience at a salon for a manicure and a pedicure; this also includes you guys.

Well, now for the troublesome things for the nails that we may have seen or may have experienced ourselves. The most common cause of abnormalities in the shape, color or texture of nails is injury. It can also be from changes in general health, the health of the skin at the nail bed or infection of the nail bed itself. Not all abnormalities need treatment, but others may be a sign of an underlying health problem that may require medical intervention.

The small white marks you may see on one or more nails is due to minor damage from a knock or blow.

Thickening mostly affects the toenails and is caused from neglect, a fungal infection or for no reason at all. Hygiene, trimming and treatment of athlete’s foot may help resolve this condition.

For us older folks, we may notice ridges on the nails that run from the skin to the nail end. This is normal in this age group. When seen in younger people, this could be a sign of rheumatoid arthritis or from the skin condition called psoriasis.

Pinhead-sized pits on the surface of the nail can also be caused from psoriasis or eczema. People with alopecia, a hair disorder where part or all of the hair falls out, may also have pitting of the nails.

Separation of the nail from the nail bed may be from injury; however, people with psoriasis or certain thyroid conditions may experience this problem. Usually the nail falls off, making the nail bed susceptible to infection. If there is infection of the nail bed, the lifted nail will appear green.

Crumbly, yellow nails can be caused from a fungal infection. Smokers may also have discolored fingernails.

People with pulmonary disorders, like cystic fibrosis or tuberculosis or lung cancer, may have what is called clubbing. This is an increased dome-like curvature of the nail and broadening of the fingertips. It may also be a sign of liver disease, congenital heart disease, thyroid disease or Crohn’s disease.

Spoon-shaped nails, nails that look concave, are usually caused by a severe iron deficiency.

Paronychia, a bacterial infection that enters the nail skin folds through a cut or break in the skin, can begin suddenly or over several months. There will be swelling and pain, and more than one nail can be affected. People who have jobs where their hands are frequently immersed in water are most susceptible, as well as diabetics.

An ingrown toenail is caused when one or both sides of the nail curve under and cut into the skin. This results in inflammation and sometimes infection. It usually affects only the big toe and is most often caused by ill-fitting shoes, incorrectly cut nails and poor hygiene. After a good cleaning and soaking, while the nail is soft and pliable, trim the nail across and then gently lift out the corner of the nail and clip the side of the nail as straight as possible, reducing the size of the curve cutting into the skin. You can roll a tiny piece of cotton and place it under the corner area while the nail is still soft and pliable to help keep the nail edge out of the skin. If these simple steps don’t help, it is important to see a podiatrist or MD and get the care you need, hopefully before you get an infection, which sometimes requires the whole nail to be removed.

If any of the above conditions that are causing the nail disorder is treatable and receives treatment, the nail will usually begin growing normally when the condition has been corrected. This growth is a slow process taking anywhere from six to nine months for the nail to grow out, and the toenails take even longer. While the re-growth process is taking place, you can improve the appearance of the nails again by providing good hygiene, and manicures and pedicures, whether you do them yourself or give yourself a treat by having it done.

Karen has been in nursing since 1969, with the last eight years as a travel contract RN across the country. Her areas of specialty are emergency room and telemetry. Karen lives full-time in her motorhome. Karen advises that nothing written is meant to diagnose, prescribe or take the place of seeing a physician. Portions of her articles have been previously published or will be published in other informational newsletters and publications.

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