I often see chronic spinal cord injury (SCI) patients in my clinic complaining of a sudden increase in spasticity and often the cause can be multifactorial.
As I’ve noted before, it is very important to exclude some of the more common causes of increased spasticity. However, one that is often missed is that of the ingrown toe nail. In an able-bodied individual, an ingrown toe nail is acutely painful and immediately noticeable but in people living with SCI, the pain is not noticed but presents itself with spasticity, and often, too, there is some sepsis and inflammation around the nail.
Because persons living with SCI do not bear weight on their lower limbs, the lack of pressure on the feet and toes makes the nail more likely to curve and begin embedding into the flesh of the big toe. Commonly, this process is aggravated if a care attendant cuts the nail too short (with the nail cut too close to the flesh).
As always, prevention is better than cure. I always advise my SCI patients not to cut the nail too short. If ingrown nails recur, there are two solutions.
Temporary relief can be obtained by completely removing the offending nail. This will allow treatment of the locally inflamed or infected toe to be easily managed with simple cleaning and the application of an antibiotic cream. The nail will, however, grow again and then it is important to keep it trimmed as noted above.
A more permanent solution would to have surgery: either a wedge resection is done – this involves removal of a segment of nail and by chemical means or cryotherapy destroying this small section of the nail growth plate – or removing the whole nail with total ablation of the nail growth plate so that the entire nail does not grow again.
If you are having problems with ingrown nails, speak to your doctor for advice.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: firstname.lastname@example.org