The condition of nails in a CRPS affected limb forms part of the diagnostic criteria for the condition. Specifically, they are one of the trophic changes to be considered in diagnosing CRPS under the Budapest Criteria. CRPS frequently causes nails to become ridged, brittle and easily damaged and the rate of growth is often affected.
However, despite the clear and obvious changes to nails caused by CRPS, little practical information and guidance is available to sufferers on basic nail care.
Our client, Paul, who suffers CRPS in his lower leg and foot, is a classic case. He says “my toenails are long and brittle and they curl off in different directions. They’re more like claws really; really horrible to look at.”
Paul developed CRPS over two years ago, since when he has been unable to tolerate having his toenails cut. “The thought of cutting them fills me with dread. My nails get to a certain length and then just snap off, usually because I’ve managed to catch a toenail on something, mainly clothes. That’s often after I’ve had a soak in the bath so I suppose they’re a bit softer then. Over the last year I think they’ve all snapped off at least once. When it happens it’s an absolute killer and there’s usually a lot of swearing!”
Can the medical profession help?
CRPS sufferers generally report that those treating them rarely if ever raise the issue of nail care, but is this simply because there is no easy solution?
One client told us that when she raised the problem with her treating pain specialist, he suggested that she consult a podiatrist. However, whilst sympathetic, the podiatrist had little knowledge and experience of CRPS. At the end of day, a podiatrist has available to them a whole range of tools, equipment and techniques for the care and treatment of feet, but this entire armoury is rendered useless if physical contact cannot be tolerated.
Perhaps one of the most dreadful cases we have encountered is one where the clawing of a lady’s fingers resulted in her fingernails beginning to grow into the palm of her hand. Ultimately, surgery under general anaesthetic was required to remove the nails altogether. However, in all but the most extreme cases an anaesthetic, all forms of which come with their own risks, is not a realistic solution.
Is there an answer?
It would be wrong to say that CRPS presents a barrier to nail care for every sufferer. CRPS is variable between sufferers and some people have devised or discovered nail care techniques that can work for them. Some people can just about tolerate occasional clipping, cutting or filing, whilst others nibble at their fingernails, their teeth giving them a greater sense of control over the process than scissors, clippers or files.
If it can be tolerated, it seems that regularly moisturising brittle nails can be helpful in reducing the incidence of cracking and splitting. This in itself can be important in reducing the risk of infection.
From a purely cosmetic perspective, it’s not just the length or shape of the nails that people find embarrassing. Nails on a CRPS affected limb are often discoloured and the lunula – the half-moon shaped white area at the base of the nail – can all but disappear. It’s therefore not unusual to find that people have coloured their nails. In fact, many people coloured their nails orange in November for CRPS awareness.
At the end of the day, nail care is just one of many practical, daily problems encountered by those living with CRPS. There is no easy answer. If you are fortunate, you may have devised your own solution or partial solution to the problem, but for others like Paul, there seems little option other than to let nature take its course.