Sunday, 5 February 2017

#ClinicSpeak & #ThinkHand: who know what onychogryphosis means?

How important is to for you to be able to cut your own toenails? #ClinicSpeak #ThinkHand #MSBlog

One of patients with advanced MS who I saw a few week's ago had been having increasing difficulty with mobilising and has had to take to wearing slippers to shuffle between their wheelchair and their bed or toilet. When I got them onto the examination couch and had a look at their feet it was quite clear they had onychogryphosis; in plain English overgrown and neglected toe nails. I had to refer this patient to their local podiatry service and hopefully they will be able to have a regular appointments to have the toenails cut and their feet looked at an maintained in a good condition. I anticipate that when I next see this patient that their walking will be a lot better. 

Poor foot hygiene is a marker of neglect and is associated with disability. 

Image is from NHS choices.

One of  the hand and arm functions that came up as being important to you as part of our #ThinkHand campaign is being able to cut your own toenails. To maintain this function you need good hand function, preserved co-ordination and joint position sensation, reasonable eye sight and enough flexibility to reach your toenails. As I write this post I wonder how much neurological function you need to lose before you are unable to cut your own toe nails? I would be interested to how well the loss of ability to cut your own toenails correlates with your performance on the 9-HPT and EDSS? If you are willing we could do a survey via the blog to answer this question. Who knows we may get a small community publication out of the survey. 


12 comments:

  1. Something slightly related to this, it makes me think it could be useful for neurologists when examinating patients feet they request socks off. I know some neuros do this already but some don't.

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  2. Prof G do you have any instructions for making a DIY 9HPT? I would like to give it a go.

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    1. RE: "DIY 9-HPT"

      Please see previous posts:

      http://multiple-sclerosis-research.blogspot.com/2016/09/measurementspeak-thinkhand-making-your.html

      http://multiple-sclerosis-research.blogspot.com/2016/11/thinkhand-somebody-laughed-at-me-when-i.html

      Delete
  3. I was horrified to see the cost of 9-hole peg test on Amazon. It is outrageous.

    https://www.amazon.com/Rolyan-9-Hole-Peg-Test-Kit/dp/B007G4S7XA/ref=sr_1_1_a_it?ie=UTF8&qid=1486308885&sr=8-1&keywords=9+hole+peg+test

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    1. RE: "I was horrified to see the cost of 9-hole peg test on Amazon."

      WE agree, which is why we designed an environmentally-friendly and cheaper cardboard version. As we don't have the infrastructure to deliver these internationally we have started selling them online via a third party vendor (http://www.clinicspeak.com/9-hole-peg-test/).

      Delete
  4. I faced this challenge this morning. I think the survey needs another category - Yes - without help but with difficulty. This task is always a bit of a struggle but sometimes more than others. On a good day I can manage it but I do worry about inflicting an injury. On a bad day I don't seek help but just leave it to another day, it's seldom urgent.

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  5. Add limited flexibility to the mix due to AS and cutting toe nails turns into a convoluted yoga pose.

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  6. Do pwMS find the electronic nail care systems and long handed nail scissors help with toenail care?

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  7. Laurence said
    "Ah, ah, I laughed when I received my pair of long handed nail scissor and soon cried with didpair!"

    As we try not to include links in posts here is his blog post

    Toe spreaders and foot care

    I have left you rather a long time sat on the loo. I am sorry about this. I hope that you managed to get dressed. Forgive me, I have been rather busy...
    There is something very important that I must write about today. I have written about podiatry before. It is very important to get a regular podiatry appointment: if your mobility is reduced in the lower limbs you may get into difficulties at some stage when you fancy cutting your toe nails.

    My first idea was not the brightest..I had been told that social care did not permit the care assistant to cut toe nails. Even if I was not a diabetic. My eye sight was not good, my ataxia in my arms was not helpful so I bought an extra large long handled pair of scissors. What a waste! I could not use these.

    I could not find any qualified and wheelchair accessible podiatrist (/poʊˈdaɪətrɪst/ poh-dye-eh-trist). I could not go anywhere near one if I had known one

    I found myself trapped by the system. I did not know a friendly supporting person that would have simplified this for me. I hear that in some part of the country they talk about a "care navigator".

    I bought a pack of emery files. I had a first toe nail infection before I got referred to the podiatrist. As you will understand it I got a bit obsessed in trying to avoid the infection that remained a threat. There where moments of poor staffing in my area for the toe clipping service with barely any explanation.

    I had difficulties getting the staff sent to me by the commissioned care company sent by the social services of **** and North East ****** to help me file my toe nails at home when I felt pain.

    I will cut short this painful story after six toe nail infections to the same bit of the same toe...oh and some
    abuse from a care worker. I got myself in the not very frequent toe nail clipping clinic available in my community.

    I got in the rhythm filing at home and clipping. When one day I remarked to the podiatrist that my MS was definitely affecting my toes. I was always twitching and having toes flexing upwards. At the same time I was still using an NHS wheelchair with no foot rests... I explained each time that it was easier for me to approach the loo to empty my catheter leg bag. My commode was always on the loo, just in case.

    The very good idea was to buy following a podiatrist's appointment a pair of gel looped toe spreaders. It reduced some of the spasms. I have not needed botulinum toxin injections perfomed by a neurologist and a radiologistsince. Any spasms are due to forgetting the spreaders or placing them wrongly.

    These bought spreaders were too wide and my second toe turned black although I did not feel pain. This went on for a couple of years.

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    1. Part II

      I worried about this and mentioned it to the podiatrist. I was lucky, it was very easy to shape a couple of LR looking at bespoke toe spreaders.

      spreaders that would fit me.
      They are part of my routine. They get rinsed at night and drip dry until the next day. They are individual, lightweight and very important to my well being. They are not interchangeable. They have helped feel less spasms in my right leg. I feel that my leg is less contracted. I am able to use foot rest indoors on my wheelchair now. The Wheelchair Service finally got it that I needed to remove these. I can lift them now, they are light. They have also a heal strap. I got this after pestering and contacting the company that sold it to the NHS. I know I will be able to remove and replace my feet on my foot rest easily. It has become very "normal". I even followed some advice regarding the angle of my knee to have a good posture. I have less fatigue and no cramps on the right leg.

      So, I think that podiatry care should be automatically included in any care plan for a person with many symptoms of Multiple Sclerosis. Why did it take me so long to get to this result? How many people have the same problem? Why did I have six toe nail infections in two years?

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  8. Toe nail infections seem fairly common in pwMS. Apparently vapour rub helps clear the infection if applied to toe daily.

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  9. Hasn't this been featured post for long enough now? Getting a little weary of the picture, just saying ;-)

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