Pincer Toenails

A pincer nail is a medical condition were the sides of the toenails become curved inwards. The condition is also called in-curved nail, trumpet nail, convoluted nail, omega nail, and transverse over-curvature.  The process can take years to develop, and as the nail progressively becomes more and more curved, the edges of the nail can begin to irritate the toe and often cause an ingrown toenail. The curvature usually increases as you move from the base of the nail out to the tip. A pincer nail can become so curved that when looking at the toe from the tip the two sides of the toenail are almost touching and sometimes even form a tube. The condition is often accompanied by thickening of the nail. This makes the nails very difficult to trim. Patients and podiatrist often tend to round off the nails when they trim them in an effort to reduce pressure on the distal portion of the toe and improve cosmetic appearance of the nail. The nail can also be ground down in the center further improving the facade  of a flat, normal toenail. Unfortunately, this technique often results in the development of a painful ingrown toenail.

Cause

Pincer toenails can be hereditary or acquired. Most commonly the condition is acquired. The cause of pincer toenails is usually a combination of years and years of wearing tight shoes. Tight shoes slowly squeeze the toe from both sides and over time begin to “bend” the nail root or matrix. After many years the nail root becomes permanently curved, and the nail grows into a pincer nail. The condition is more common in females because of the type of shoes they wear. Women tend to wear tighter shoes and pointy-toed shoes that crowd the toes. Additionally, women wear high heel shoes that further cram the toes into an already tight toe-box. Once the nail has become pincered, wearing proper shoes will not undo the damage.

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Years of tight shoes is not, however, the only way to develop a pincer toenail. Other causes include a bone spur under the toenail. This type of spur is called a subungal bone spur or subungual exostosis. The subungual bone spur forces the toenail into the pincer nail by pushing up on the center of the nail.

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Signs and Symptoms

Pincer toenails are sometimes painful and sometimes not. When pain develops it is usually because the edges of the nail are sticking into the skin and causing ingrown toenails.

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Treatment

Pincer toenails can be tricky to treat. Historically, they have been treated by performing an ingrown toenail procedure which involves removing the offending nail borders. The problem with this treatment is that, with a severely pincered nail, the doctor must remove such a large piece of toenail from both sides, that hardly any toenail is left once the procedure is complete. The result is a very narrow nail that most patients find cosmetically unpleasing. To learn more about the KD device and the procedure to attach it to the nail, click here.

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So what’s the answer?

Recently a brand new treatment has been developed called the KD Device, an FDA approved clip that is placed on the toenail and straightens the nail at the root. The advantage of this procedure is that it actually straightens the nail root and does not require removing and destroying any of the nail root or matrix. The procedure is simple and can be performed in the doctor’s office. It involves a small incision on both sides of the toe where the nail root or matrix is freed off the bone and the KD device is placed over the nail to splint the nail in its new corrected position. Stitches are removed at 2 weeks and the clip is left on for approximately 3 weeks. Once the clip is removed the nail is fixed. You can call or request an appointment online today. Let the Doctor’s of Gulf South Foot & Ankle diagnose your foot pain and prescribe the best possible treatment for you!