Saturday, May 23, 2009

Ingrown toenails: the myth of cutting toenails straight

by James Channing Shaw, MD

Twenty-five years of practice in dermatology has taught me that ingrown toenails have little or nothing to do with whether nails are cut straight across or with a curve. What you mostly read is 'cut toenails straight or you'll get ingrown nails'. The message comes from supposed experts such as podiatrists and doctors. Every child on the face of the earth grows up thinking this. And why not? They hear it from grown-ups who must know everything. Grown-ups, after all, are supposed to know stuff.

Once again, I am here to dispel another myth: the myth of the straight-cut toenail. There is no evidence to support the notion that cutting nails with a curve causes ingrown nails, or that cutting straight prevents them. Those who preach straight-cut are merely perpetuating unsubtantiated traditional beliefs. Studies have not been done and closer examination of the rationale exposes its faults.

In every case I've seen, and there have been many, patients have always done exactly as they were told: they cut their toenails straight across and still developed ingrown toenails. Ingrown nails are more about an individual's own anatomy, plus, in some cases, trauma from shoes.

The photograph below shows a typical ingrown toenail. The nail is straight-cut, but the ingrown nail goes nearly to the cuticle. The manner in which the nail was cut couldn’t have influenced the ingrown nail close to the cuticle.



What, then, is an ingrown nail? Most importantly, it appears NOT to be an infection in the true sense, i.e. caused by bacteria. Most cases of ingrown nail don't respond at all to antibiotics. Instead, an ingrown nail results when the tissues at the side of the nail get irritated, inflamed, and swollen, leading to redness, pain, and tissue breakdown with oozing and pus. There is one exception: if you cut too close and injure the skin, you can introduce real infection, but it behaves differently: more rapid in onset, more painful, and responds to antibiotics.

It is thought that the sides of the nail must play a role in ingrown nails, that the edge 'digs' into surrounding tissue, either naturally or from shoe pressure. We know this because the problem goes away when the lateral sides of the nail or excess nail fold skin are permanently removed by surgery. Whether from the nail itself, or excessive surrounding skin, the individual's reaction to microscopic trauma is probably a key factor.

What makes NO sense is the belief that cutting the nail influences how a nail grows. If that were the case, we might expect to see it happen with finger nails, but we don’t: fingernails and toenails grow out regardless of how they are cut. Nails grow by sliding horizontally outward from the cuticle area. Whether you cut straight or curved, the nail still slides toward the tip in the way it is genetically programmed to do. The white part that gets clipped away has already separated from its base (the nail bed), and even if you cut too close, it cannot influence how the nail grows.

The big question is whether we have ANY control over preventing ingrown toenails. My suspicion is that we do not. Reasonable hygiene (but not too aggressive) is as much as we can recommend. Plenty of toe space in shoes also seems wise (but not proven). All definitive treatments, however, involve surgery, although many devices and practices to flatten out the nail have been tried with mixed results.

It would be good if someone did a scientific study of curved cut versus straight cut, but since this is a non life-threatening condition, it’s not likely to happen. In the meantime, if you would like some contour with your pedicure, give it a try. If you have never had ingrown nails, the odds are in your favor. Go easy at first. A little rounding of the edges of the big toenail won't hurt you.

Thursday, May 7, 2009

Robertson Davies Quotations: Literary Riffs, or...Scripture for Secularists

The world is so full of published quotations telling us how to successfully conduct our lives that it is a wonder we haven’t all reached a perpetual state of contentedness and wisdom. Judging from the current state of world affairs, I can only surmise that perhaps some people are reading the wrong quotations.

The following quotations, from The Quotable Robertson Davies, are my favorites, the ones I keep returning to. The book contains over 800 from the Canadian novelist and playwright Robertson Davies.

I had a revelation of sorts while compiling Davies's quotes for the book. I have always been annoyed by fundamentalist thinking and behavior. Reborn Christians were the worst: they were endlessly reciting scripture! While extracting passages from Davies’s books, more and more quotations were at the tip of my tongue during conversation. A Davies quote seemed to be apropos to almost any subject being discussed. After collecting more than half of the quotations in the book, it suddenly struck me that I was doing exactly what I disliked about scripture-quoting Christians. I was quoting Davies by chapter and verse! Davies had become my secular scripture! Alone in my study, I blushed with embarrassment when I made this discovery, and have since become more discreet with the use of the quotes.

Nevertheless, here are 25 of my favorites.

Quietness is a great beautifier. –Tempest-Tost

No man should ever assume that he will be able to get the immediate and undivided attention of a woman who has children. -Leaven of Malice

Music is like wine; the less people know about it, the sweeter they like it. – A Mixture of Frailties

One of the secrets of life is that one must give up caring too much about anything. – A Mixture of Frailties

I, as a skeptic, am committed to non-belief in everything, including my most cherished philosophical ideas. –The Rebel Angels

Too much orthodoxy can lead to trouble; a decent measure of come-and-go is more enduring. –The Rebel Angels

Nobody gets through life without a broken heart. -What’s Bred in the Bone

A happy childhood has spoiled many a promising life. -What’s Bred in the Bone

Nature and nurture are inextricable; only scientists and psychologists could think otherwise. -What’s Bred in the Bone

Genius is the only true aristocracy. –The Lyre of Orpheus

Canada…. the Home of Modified Rapture. –The Lyre of Orpheus

Who really knows his father, or his mother? In our personal dramas they play older, supporting roles, and we are always center stage, in the limelight. – Murther & Walking Spirits

In my experience snobbery sometimes means no more than a rejection of what is truly inferior. – The Cunning Man

Shakespeare in printed form should be kept from children; if they cannot meet him in the theatre, better not meet him at all. One might just as well ask children to read the symphonies of Beethoven. – The Cunning Man

Don’t miss a chance to acquire an ancestor. – The Cunning Man

Longing is some of the best of loving. – The Cunning Man

A doctor’s treatment is always a reflection of himself, to some degree. – The Cunning Man

If we were all robbed of our wrong convictions, how empty our lives would be. – The Diary of Samuel Marchbanks

Children never forgive their elders for their ignorance. It is obviously a grown-up’s business to know. – The Table Talk of Samuel Marchbanks

My dullness is so complete and all-embracing that it constitutes a kind of mystical experience – the merging of the Null with the Void. – The Table Talk of Samuel Marchbanks

It takes two to make charm. . – Hunting Stuart

The good life is lived not widely, but deeply. It is not doing things, but understanding what you do that brings real excitement and lasting pleasure. – One-half of Robertson Davies

If one regards oneself as a skeptic, it is a good plan to have occasional doubts about one’s skepticism too. – One-half of Robertson Davies

Everybody can share in grief, and grief can be feigned; but laughter can only be shared by those who are of like mind. –A Voice From the Attic

Don’t be surprised if you find that nobody wants you except in your professional capacity. – One-half of Robertson Davies