What do podiatrists do with thick toenails? Your Expert Treatment Guide

According to the American Podiatric Medical Association, fungal infections, a common cause of thick toenails, affect a significant portion of the adult population. Addressing this issue professionally is crucial for managing pain and preventing complications. So, what do podiatrists do with thick toenails?

Quick Summary

Podiatrists first diagnose the cause of thick toenails, such as fungus, injury, or underlying disease. They then provide safe and effective in-office treatments, which can include professional nail trimming, debridement to reduce thickness, targeted medications, or permanent removal in severe cases.

Key Points

• Professional Diagnosis: Podiatrists accurately identify the cause of thick toenails, which can range from fungal infections and trauma to underlying diseases like psoriasis or diabetes.

• Safe Debridement: Expert podiatrists use sterile instruments to painlessly thin and trim thick toenails, providing immediate relief and improved nail health.

• Targeted Medication: For fungal infections, podiatrists can prescribe highly effective oral or topical antifungal medications, often more potent than over-the-counter options.

• Advanced Treatments: Laser therapy offers a non-invasive solution for persistent fungal infections, and nail surgery is an option for chronic, painful nails that don't respond to other therapies.

• Comprehensive Care: Beyond treatment, a podiatrist provides guidance on proper at-home care and preventative measures to maintain long-term foot and nail health.

Why Toenails Become Thick

To understand professional treatment, it is important to know the potential causes behind the condition. Thick toenails, medically known as onychauxis or onychogryphosis, can develop for several reasons, and identifying the root cause is the first step a podiatrist takes.

• Fungal Infection (Onychomycosis): This is the most frequent cause, where fungus invades the nail, causing it to become thick, discolored, and brittle.
• Repeated Trauma: Microtrauma from tight or ill-fitting shoes, or a single major injury, can damage the nail bed and lead to thickening. This is common in athletes or those who wear footwear that puts consistent pressure on the toes.
• Aging: As people age, reduced blood circulation and years of minor trauma can lead to thicker nails. Nails also grow more slowly with age, which can contribute to the issue.
• Systemic Diseases: Certain health conditions, such as psoriasis or diabetes, can cause or worsen nail thickening. Diabetes is particularly concerning as thick nails can lead to foot complications.
• Neglect: Poor foot hygiene over time, especially in seniors, can lead to severely overgrown and thick, curved nails (onychogryphosis or "ram's horn" nails).

How a Podiatrist Diagnoses Thick Toenails

During an initial consultation, a podiatrist will conduct a thorough examination of the feet and toenails. They may ask about your medical history, symptoms, and footwear habits. To accurately diagnose the cause, they may perform one or more of the following:

1. Visual Inspection: An experienced podiatrist can often identify the probable cause, such as fungal or traumatic nails, by sight alone.
2. Nail Clipping for Lab Analysis: A sample of the nail or debris from under the nail can be sent to a lab to confirm or rule out a fungal infection.
3. Physical Assessment: The podiatrist will check for signs of other conditions, like psoriasis or peripheral artery disease, which can affect nail health.

Professional Treatment Options for Thick Toenails

Once the cause is identified, the podiatrist can recommend a tailored treatment plan. These professional methods are far more effective and safer than at-home attempts, especially for those with health conditions like diabetes.

Nail Debridement

This is one of the most common procedures for thick toenails. Debridement involves using specialized, sterile instruments to reduce the thickness of the nail plate. This is often a painless process that provides immediate relief from pain and pressure caused by the thickened nail.

• Benefits: Reduces pressure and discomfort, allows footwear to fit more comfortably, and can improve the nail's appearance.
• Procedure: The podiatrist uses a variety of tools, including nail clippers, files, and burrs, to safely thin and trim the nail.

Topical and Oral Medications

For fungal infections, medication is often a critical part of the treatment.

• Oral Antifungals: Pills like terbinafine or fluconazole are often the most effective treatment for fungal infections because they work systemically to clear the fungus from the nail bed. These require a prescription and are taken under a doctor's supervision.
• Topical Antifungals: Medicated nail lacquers or creams can be applied directly to the nail. These are less effective for severe infections but can be used for mild cases or in combination with oral medications to improve results.

Laser Therapy

For stubborn fungal infections, laser therapy is a non-invasive option. The laser emits a concentrated beam of light that passes through the nail plate to target the fungal organisms in the nail bed without damaging surrounding tissue.

• Benefits: Painless procedure with no known side effects and no need for anesthesia.
• Duration: Several sessions may be needed to achieve optimal results.

Nail Surgery

In rare and severe cases, or when a nail is chronically painful, a podiatrist may recommend temporary or permanent nail removal.

• Temporary Removal: Removing the infected nail allows topical medications to be applied directly to the nail bed, improving their effectiveness.
• Permanent Removal: For chronically painful or ingrown thick nails that do not respond to other treatments, permanent removal of the nail plate and its growth center can be performed.

Comparison of Professional Treatment Methods

Feature	Debridement	Oral Antifungals	Laser Therapy	Nail Surgery
Best For	Routine maintenance, pain relief	Moderate to severe fungal infections	Persistent fungal infections, cosmetic improvement	Severe, chronic pain, non-responsive nails
Effectiveness	Immediate relief from thickness	Highly effective for many fungal cases	Good, but requires multiple sessions	Permanent solution for the nail
Duration of Treatment	Routine appointments every 6-8 weeks	Several months (e.g., ~3 months for terbinafine)	Multiple sessions over several months	One-time procedure, followed by healing
Side Effects	Minimal, low risk	Potential for liver side effects, drug interactions	Minimal side effects, painless	Possible infection, pain during healing
Cost	Generally affordable, covered by insurance for some conditions	Varies based on prescription and insurance coverage	Higher upfront cost, often not covered by insurance	Varies, can be covered if medically necessary

How to Care for Thick Toenails at Home (with Professional Guidance)

While professional care is essential, you can support your treatment with safe at-home practices. A podiatrist can advise you on these techniques.

1. Soften the Nails: Before trimming, soak your feet in warm water for at least 10 minutes to soften the nails.
2. Use Quality Clippers: Invest in strong, podiatrist-style clippers with straight blades. Never use regular fingernail clippers, as they are not strong enough and can cause splintering.
3. Trim Straight Across: To prevent ingrown toenails, always trim the nail straight across, making several short cuts instead of one long one. Avoid cutting too short.
4. File Rough Edges: Use an emery board to gently file away any sharp edges after trimming.
5. Use a Moisturizer: Applying a thick moisturizer or urea cream can help keep the nails and skin soft. Check with your podiatrist for recommendations.
6. Maintain Hygiene: Keep feet clean and dry. Wear moisture-wicking socks and change them regularly.

For more detailed information on foot health and finding a certified podiatrist, the American Podiatric Medical Association is an excellent resource: www.apma.org.

Prevention is Key

Preventing thick toenails involves consistent, proactive foot care:

• Wear properly fitted shoes with a roomy toe box.
• Keep your feet and toenails clean and dry.
• Wear flip-flops in public showers and locker rooms to prevent fungal infections.
• Disinfect your clippers and other nail tools regularly.
• For diabetics, daily foot checks and regular podiatric visits are essential.

Conclusion

Thick toenails are more than just a cosmetic concern; they can be a sign of an underlying medical issue and lead to significant pain and mobility problems. Podiatrists offer a range of expert solutions, from pain-relieving debridement to targeted medical and laser therapies. Seeking professional diagnosis and treatment is the safest and most effective path to healthy, comfortable feet, especially for seniors and individuals with pre-existing health conditions.

Frequently Asked Questions

Is it painful when a podiatrist treats thick toenails?

Professional treatment by a podiatrist is generally not painful. Procedures like nail debridement are typically painless and provide immediate relief from pressure and discomfort. The use of sterilized tools ensures safety and precision.

How often do you need to see a podiatrist for thick toenails?

The frequency of visits depends on the underlying cause and severity. For ongoing management, especially in seniors or diabetics, routine debridement appointments are often recommended every 6 to 8 weeks to maintain nail health.

Can I treat my thick toenails at home?

While soaking your nails can help, treating severely thick toenails at home is not recommended. Professional assessment is necessary to identify the cause, and podiatrists use sterile, specialized tools to prevent infection and injury, particularly for individuals with circulation problems or diabetes.

What is nail debridement?

Nail debridement is a procedure where a podiatrist uses specialized tools to trim and safely thin excessively thick toenails. This process reduces pressure on the nail bed and surrounding tissue, relieving pain and making it easier to wear shoes.

Are oral antifungal medications safe?

Oral antifungal medications prescribed by a podiatrist are often the most effective treatment for deep-seated fungal infections. The podiatrist will monitor your health with bloodwork to ensure the medication is safe for you and to minimize any potential side effects.

Is thick toenail treatment covered by insurance?

Coverage for thick toenail treatment varies depending on your insurance plan and the underlying cause. Treatment for medically necessary conditions, such as reducing pain or preventing complications in diabetic patients, is often covered. Cosmetic treatments are less likely to be covered.

How can I prevent my toenails from getting thick again?

To prevent recurrence, maintain good foot hygiene, wear properly fitting shoes with a wide toe box, use moisture-wicking socks, and avoid walking barefoot in public areas. Regular check-ups with a podiatrist are also crucial for ongoing foot health.