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What solution is there for someone with a distorted nail plate? I have a very self conscious lady patient who is unwilling to display her toes because the medial side of both hallux nails are sloping inwards (away from the medial side) as a result of maybe genetics, maybe many years of fungal nail infection which is currently under control but the curvature of the nail is such that it has pinched a large part of the tissue under the nail plate and a large part of the nail is not attached. Is it possible to flatten the nail by thinning it and removing the edge?

I would very much appreciate your advice.

 

Hi

Can you upload photographs please?

Bill Liggins

 

I hope you can see this photo.

 

Conservative treatment with nail brace.
Check ancient thread

 

Nail brace would not be possible because the edges of the nail are too deep and the patient has a very low pain threshold. She would not be able to tolerate the brace. I did consider it. Is there any other solution to the problem?

 

I would bet on hypertrophy of the base of the distal phalanx, with the result that the nail curves to follow the bone. Personally, I would simply carry out a bilateral medial PNA taking minimal nail and allow the left hallux nail to grow out. However, I'd only take such action as a result of the pathology, certainly not for cosmesis.

All the best

Bill Liggins

 

Thank you for that. I will see how the nail grows out. She might ask for an artificial nail on the left hallux for the summer.

 

Do not lose hope .
If you can not insert wire, if you can adhere and Buttons pull with rubber band.

 

I have just seen the photo. Where do you buy the "buttons" from? I see that the centre part of the nail is removed while the edges are being pulled out. Have you had success with this method?

 

Much success.
The buttons are also used by dentists for orthodontics.
It's where I buy .

 

Are there any co-morbidities? looks a little like an auto-immune problem. *just sayin

 

There are no comorbidities unless you mean a long standing fungal nail infection which is getting cured now with terbinafine.

 

I would await the outcome of the terbinafine (oral?) In my experience nail deformity improves once the fungal infection improves. Looking at your photos though I do wonder if a PNA would help if deformity continues after terbinafine. I have not used bracing myself, but always looked to underlying aetiology.

 

Re: Distorted nail plate B/S Spange Nail brace system

I have found a solution to my problem thanks to Jose Antonio Teatino. It is a nail brace system by B/S Spange. A plastic strip which is glued on the top of the nail. I actually remember learning about it.

My problem is that I am not sure which version to buy the classic or the quick. Has anyone had experience using either of these systems?

 

BS is a good system.
Use different fiber types to treat nail tile.

 

This same lady had an appointment with the Podiatry Clinic of the NHS and she was offered total or partial nail avulsion. She is considering this over the summer. She was advised that partial nail avulsion would not solve the problem of her thickened nail and if she has total nail avulsion she could have artificial nails created in a nail bar.
Do you think this is a sensible option? I think she is desperate for a second opinion. Do you think that the raised nailbed is the result of fungal nail infection?

 

The most sensible would be the final elimination of the nail plate.
You can always use polypropylene artificial nails stuck with adhesive putty when wearing open shoes.