Plicatured Nail Trims

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I have a client who has asked me to trim the corners of her plicatured large toenails. I advised her this would not be advisable, as it would likely become problematic with such a trim. The nail plate is grown down into the skin tissue. What is a good explanation to give a client in such a situation? And what is the best way to address increasing degrees of plicatured nails? ~~ Thanks if anyone can give feedback.

 

Hi pedicurist,
I do not know what you mean by "plicatured nails". If you could explain what you mean by this then someone may be able to help you.

regards

CF

 

I believe Pedicurist is referring to involuted nails

 

Plicatured nails are involuted nails that in profile resemble a half-closed staple (plicatured = folded, as a fan). Ingrowing is the direct result of cutting the plate too short or cutting out the sides.

These nails need to be left a little longer than would normally be the case - the plate should fully occupy the entire nail groove to its distal extent on each side after trimming and filing.

It may be necessary to cut the centre of the plate lower than the sides, thus creating a 'negative curve' of the free edge.

Every effort should be made to grow out the nail full width and maintain the nail without any trespass into the groove.

The entire nail plate should sit on the pulp, and no part of the nail plate should be expected to grow through the pulp. To this end, all involuted nails of whatever profile should be cut straight across at the free edge or inverted as described. The entire edge will then always reside within sight, above the pulp.

 

All,
I was asking the OP to explain what they meant by plicatured nails.

The advice given may well be excellent if that is what in fact these nails are. But as we have no further information or pictures perhaps it would be adviseable to wait until the OP clarifies the situation?

I think it is important to gather all the facts before offering advice, especially as we do not know the OPs scope of practice.

regards

CF

 

CF

'Plicatured' nails is a term that should be known to all of us - wherever trained. This is the term used in the text books and is obviously correctly used and well understood by Pedicurist and patient.........and most readers.

 

CF, just because you didn't understand the term 'plicatured' nails, doesn't necessarily follow that no one else, nor indeed the OP, understands it.

Furthermore, as the only advice that JP is offering, is that involuted (or plicatured) nails should not be trimmed down the sides, nor trimmed too short. I hardly think JP has suggested anything invasive, merely cautionary advice. Although we assume that individuals will not act outside their scope of practice - particularly if they have posted on the Arena for advice - perhaps it would be safer if we all issued a disclaimer as a footnote to all our postings...

 

FG & JP,
You both misread my post, please look at it again.

Before advice is given it is important to make sure that everyone is talking the same language

I said I didn't know what the OP meant by "plicatured nails." That's why I asked them to elucidate. Both of you jumped in and made assumptions before there was further clarification.

I see patients on a daily basis who c/o "ingrowing toenails". o/e they rarely have ingrowing toe nails, what they do have is any one of a number of nail conditions that causes them pain.

As I said before, without a picture we do not know exactly what we are dealing with here.

In addition we do not know what country the OP is from or what their scope of practice is. If this person is from UK and is trained as a pedicurist/beautician then pathogenic nails will be outside their remit.


CF

 

Probably best to keep personal agenda away from the thread, so that any advice Pedicurist has requested isnt lost in the melee'

 

CF

I missed no point, and nor did I miss the fact that you did not understand the term.

I regret that I do not know the extent of your remit. Nor can anyone be certain that you understand the term 'nail'. Since this is a professional forum I think we might take some issues for granted and apply a little common sense - with a dose of acceptance that we cannot know everything.

 

FG,
There is no "personal agenda" in my posts.

If anyone is to advise this poster responsibly and accurately then it is important we have all the facts.

The OP asks

unless we know to what degree they are plicatured (or (even if they are plicatured at all) then it would be foolish to advise.

If we do not know this posters scope of practice then it would be irresponsible to suggest they attempt any procedure that goes beyond that.

from your post above you make some quite sweeping assumptions - I prefer to ascertain the facts first.

CF

 

CF

You do as you prefer - most of us grow out of our pedantry in the first year or so.

Even lowly pedicurists treat nails, even plicated ones, with total sucess. What is most important is not to treat to the level of your training , as you imply, but rather to treat correctly. The issue is a technical matter, a matter of management, not a matter of level of training.

I would further point out, because no doubt you are already considering the possibility of ablation and phenolisation, that many people live their entire lifespan with plicated nails.
Just as one bout of chest infection need not necessarily lead to loss of a lung, then phenolisation of a plicated nail is not appropriate for a first episode of discomfort as a result of plication. Removal of the nail for plicature can be likened to extracton of a tooth for a small surface defect - over the top and absolutely unnecessary.

You need to understand that all levels of workers have competence, and all are capable of treating nails. By all means acertain the facts. Others have already understood the clinical aspects of the original poster's request.

'I learned long ago something about wrestling with cats. They hiss and spit and wave their claws about, but they will never rule the world, despite their imagined 'superiority''

 

Pedicurist

In my experience plicatured nails can occur through injury, intermittent trauma, illness and occasionally they may be inherited. Treatment depends very much upon cause, the symptoms they are causing, the degree of abnormality, patient health status and cosmesis.

In my opinion it is very difficult to provide a "one size fits all" treatment to these kinds of nails without an appropriate assessment.

It would be most helpful if you could include photos of this particular case, cause of the nail curvature and express your thoughts on the expectations of this particular patient/client including the medical history. From this information then perhaps a suggestion can be made as to the best explanation for treatment or no treatment as may be the case in this individuals situation.

I too am unsure what you mean by "And what is the best way to address increasing degrees of plicatured nails"

Do you mean on one individual ie the nail is getting worse or the different kinds of plicatured nails you encounter?

Treatment of nail pathologies is a complex and intriguing subject as you have no doubt discovered.

GB

 

Thank you for all the replies regarding my post inquiring about plicatured nail trimming. I am from the State of Washington, U.S.A. Attached is a photograph of this nail condition, which does match Johnpod's term 'involuted' nail, the half-closed staple. I appreciate the description you gave, JP, of how the plate should fully occupy the entire nail groove to its distal extent on each side after trimming and filing. This is exactly what I had supposed would be the procedure to follow ~ no trespass into the groove. Extensive research online of nail condition care offered very poor sources that did not allow me any instruction such as you have offered. Thank you very much. The second half of my question is; are there any instances where the degree of imbedding in a single case becomes an issue: how deep can this nail fold intrude into the skin tissue before there is trouble? I appreciate your comment, JP, that :"...all levels of workers have competence," which is the very reason I felt comfortable joining a forum of podiatrists when I am a pedicurist; where better to get such a credible array of guidance? Pedicurist's request wasn't lost in the melee ~~ Thank you again.

 

Hi Pedi, I'm pleased you found my reply helpful....regrettably there will always be 'static noise' on a forum such as this.

Yes, the condition can predispose to a full-blown onychocryptosis and this may, according to the individual circumstance of the case, require referral to a podiatrist for phenolic ablation. However, I repeat that each case is individual. Much of our skill is to match the appropriate treatment to the individual case - a process known as 'discretion' and a skill not sufficiently recognised and certainly not much practised by many of my so-called colleagues. Many simple onychocryptotic nails can be successfully treated by wedge section without anaesthesia and may not need phenolic ablation of the germinal matrix.

This is a matter for your professional judgement. You will know when the time to refer onward arrives - when you cannot contain the condition yourself, when the patient loses faith in you, or you lose faith in your own abilities.

A pleasure to make your acquaintance - have a good day!