Providing Podiatry Home Visits in Oxford

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ON NAIL TUFTS AND 'HAEMS'.

 

I have lost count of the number of times a patient says to me when I first meet them, "the last chiropodist cut me".  This is real live skin with verrrry sharp implements and unfortunately accidents do happen.  Yes, some haems (as they are colloquially known) can definitely be avoided, and will be related to your clinicians eyesight and skill. But sometimes the body creates little curve balls to give us chiropodists a bad rep.

A 'nail tuft' is one of those curve balls. It is a vascular dermal protrusion beneath a nail - this means two things a) it will bleed very readily and b) beneath a long nail it may not be evident until the nippers (nail clippers) have already gone through it!

 

In my personal experience, nail tufts tend to be associated with older patients who have allowed their nails to grow very long; often through no fault of their own as they simply cannot get down there! The excess fleshy skin grows up along the underside of the nail plate.  The longer and thicker the nails, the longer and thicker the nail tuft.

 

Another common curve ball is the involuted or ingrown nail.  It may or may not have been causing you pain, but there is definitely a little bit of swelling to the side of the nail and on your chiropodist/podiatrist gently and carefully cutting the nail and removing the offending 'spicule' (sharp piece of nail digging into the skin), a bleed (haem) is caused.  Again, this is through no fault of your clinician.  The nail had already punctured the skin, it just hadn't got to the infected stage yet (the next stage; as once there is an open wound there is room for surface bacteria to colonise the area and cause a local infection, or paronychia).


As a Diabetes Specialist I have been trained to be absolutely paranoid about causing any sort of injury to the foot. I'm not saying that I never cause a little haem, but I am saying it's pretty darn infrequent!

Haems are only a problem if the clinician does not deal with them properly. If a clinician cuts you, they should cleanse the area with saline, preferably swab it with a bit of iodine and dress it with a clean, dry dressing. They should advise you to leave the dressing on for 1 or 2 days and be in touch if there is any problem. I personally call patients where I have had to apply a dressing a couple of days later to ensure everything is OK.

Questions? Please get in touch.

 

 

 

 

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