Do-it-yourself Podiatry


      In the beginning podiatrists were chiropodists.  Then chiropractors came along; now foot specialists are called podiatrists.  One of their most important chores is cutting stubborn, thick, horny nails of the elderly.  Many nurses in long term care facilities have informally learned how to operate a Dremel, a high speed rotating tool to which tiny grinding wheels can be attached.


       Normally nails get thicker and tougher with age.  This is especially true of toe nails.  Because we wear shoes most of our waking hours, toe nails stay warm and moist.  This fosters growth of fungi—the same ones that cause athletes foot.  This fungus occasionally infects finger nails and can be treated successfully by taking antifungal medications for the entire time a nail is developing and growing out—in the case of our big toe nails a few months more than a year; so fungus infection of toe nails is seldom worth treating.  Over the years such nails become thicker and more sharply curved—almost tubular in the case of some big toe nails.  They are not only hard to cut, but the tubular shape fosters ingrown toe nails at the hidden corners.


       The Dremel type tool is not only convenient for grinding off the growing tip of the nail but can also grind off the entire top surface weakening the nail so that it is not so sharply curved preventing ingrown toe nails much more simply than surgery.  The surgeon makes the nail much narrower by removing both edges including the root of both edges—tricky surgery in an area of poor blood supply and slow healing.


       If you, or someone in your inner circle, is handy with tools, let them practice on your hard, thick, curved, almost unclipable nails (before they get ingrown).  Or if your nails only require grinding off the tips instead of cutting, you can probably be your own podiatrist.  Note which way the Dremel spins, so if it grabs and jumps, you can orient it so it jumps into midair.  Don’t hang out a shingle advertising your skill; the podiatry licensing board might get after you.   


John A. Frantz, MD

September 30, 2011