Nail picking and biting

Nail picking and biting

Nail picking and biting disorders are known clinically as onychotillomania and onychophagia.

Biting of the nail includes the nail plate, soft tissues of the nail bed and the cuticle. Picking can include manipulation and picking of the same nail areas as biting.

Picking and biting at uneven nails isn’t normally a cause for concern, but constantly picking at your nails could indicate underlying stress or an anxiety disorder.

Why do we pick and bite our nails?

We may pick and bite our nails out of habit unknowingly or it may when we are stressed or nervous. 

It is common in children (45% of teens) and these behaviors can extend to adulthood (20-30%). 

Podiatrists the toenail experts 

Nail picking and biting of toenails can lead to painful, infected and ingrown nails. This can be mild where someone has “had a go” at cutting an ingrown nail out or it can be severe with continual picking or biting of the nails. 

Sore toe nails are a very common thing for podiatrists to see and treat, we are able to manage most nail conditions of the feet and often can advise on the hands. 

Physical problems

Physical problems from long term picking and biting include:

Chronic nail picking and biting

You may be at risk of other types of body-focused repetitive behaviors if you picking and biting is chronic, such as:

  • cheek biting
  • hair pulling (trichotillomania)
  • skin picking disorder (excoriation)
  • teeth clenching or grinding (bruxism)

Nail biting and other disorders

Onychophagia is associated with a variety of psychiatric disorders, including:

  • Obsessive–compulsive disorder (OCD)
  • Attentional deficit hyperactivity disorder (ADHD)
  • Oppositional defiant disorder (ODD)
  • Separation anxiety disorder
  • Tourette syndrome.

Treatment for nail picking and biting

Treatment depends on the severity of the disorder. No treatment may be necessary if mild as children can often outgrow the habit.

Things to try:

  • Busy hands – Keeping your hands busy by squeezing a soft ball or putting on gloves
  • Identify triggers – try to avoid triggers of when & where you most commonly pick your skin
  • Resist – try to resist for longer each time you feel the urge to pick
  • Caring – when you get the urge to pick your skin, care for ir by applying moisturiser
  • Telling other people – they can help you recognise when you’re picking
  • Clean – keep your skin clean to avoid infection
  • Minimise temptation – keeping the nails short & neatly trimmed, manicured, or covered
  • Bitter-tasting compounds – the use is controversial and not very effective.

Long term help:

  • Behaviour modification treatment can be effective.
  • Any underlying mental health problem or psychiatric disorder should also be managed.


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Hot and cold therapy

hot and cold therapy

Hot and cold therapy is a popular initial home treatment for soft tissue injuries as the risks are relatively low, with minimal costs.

It can be confusing to know which to use and when, we hope this helps. Should you need further help please go to our solutions for more information.

Cold TherapyHot Therapy
Why use itWith sprains, strains or bruises there is bleeding into underlying tissue which causes pain and swelling. 
If you use ice immediately after an injury it will help to limit the body’s response to your injury. 
This should reduce bleeding into the tissues to reduce or prevent swelling (inflammation) and reduce muscle pain and spasm.
By using heat it causes your blood vessels to open wide (dilate) which delivers more blood to the area. This increase in blood helps with the healing of your damaged tissues.
Heat can soothe and relieve pain and spasms causing lessstiffness.
When to use itUsing ice immediately after the injury. When an injury is over 2 days old.
Do not use heat on a new injury as it may make the problem worse. 
What to use hot and cold therapy onIce can be used on recent injuries, hot and swollen joints, and to ease the pain of the lower back and long-term problems such as arthritis.

Ice gives a longer-lasting effect on the circulation and the pain relieving properties are deeper than heat. 
Heat can be useful on joints which are stiff & painful and muscles which feel tight & cramped.

Heat can also be used on new lower back strains due to the cause from muscle spasm not tissue damage. In this immediate case heat is often more helpful than ice. 
Examples of hot and cold therapy treatments• Reusable gel ice packs
• Coolant sprays
• Make your own ice pack *
• Frozen peas
• Ice massage 
• Wheat/rice bag
• Heat pad
• Deep heat cream
• Hot water bottle **
• A bath, hot tubs, sauna
How to use hot and cold therapyPlace the cool therapy and hold it in place firmly with your hands or a bandage.If your injury is recent and has happened in the last 24 to 48 hours, using ice treatment every 2 hours (when awake) elevate (raise) the limb above the level of your heart.

Elevation of the injured area limits swelling as it helps the return of tissue fluids to the body.

Large muscular area:
Such as the thigh, it can be kept on the area for up to 20 minutes.

Small bony area:
Such as the ankle, it should stay on the area for 10 to 15 minutes.

The skin will normally become red and cold.
Place the heat pack over the area to be treated. If heat is applied to the skin it should not be hot; gentle warmth will be enough. 

Heat should be applied for a period of 15 to 30 minutes and can be reapplied every 2 hours.
If the area starts to feel too warm place an extra towel between the heat pack and your skin to reduce the temperature.

** Hot water bottles should never be applied directly to the skin. These should be wrapped in a towel.

When filling the hot water bottle DO NOT overfill or use boiling water
Wheat/rice bags follow the manufacturer’s instructions for heating

Hot & cold therapy warnings

Cold Therapy Hot Therapy
Individual Never put a homemade ice pack directly onto your skin. Always place a damp cloth on your skin then the ice pack *

Remember to check the skin underneath the ice pack every 5 minutes for: 
• whiteness of the skin 
• blueness of the skin 
• blotchy and painful skin 
• excessive numbness

If you get any of these symptoms, remove the ice pack straight away.

Cold therapy should not be used if you have poor circulation.
It is not recommended to lie, sit or sleep on any heat packs, as this will increase the risk of a burn.

A towel can be placed between the heat source and the skin for protection. The skin must be checked at regular intervals.

If you have either heart disease or hypertension, ask your doctor before using heat therapy. If you are pregnant, check with your doctor before using saunas or hot tubs.
General Warning• Only use an hot or cold therapy on areas of normal skin sensation and circulation
• Never place onto an open wound or graze
• For children’s injuries always use under supervision and for reduced times

Contrast Bathing

The use of both hot and cold therapy can be particularly useful for treating pain and swelling.

For use on feet:
1. Fill one deep bowl with warm water (bath temperature) & one with cold water (do not add ice).
2. Put the affected limb in warm water for one minute then remove and place into cold water for one minute.
3. Repeat this for 10 minutes (5 times into WARM water & 5 times into COLD water).
4. Repeat every 2 hours


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Long covid & peripheral neuropathy

peripheral neuropathy

Peripheral neuropathy: Weeks to months after having a covid infection some people are experiencing neurological changes to their feet.

What is peripheral neuropathy?

Peripheral neuropathy is where nerves in the body’s extremities, (hands & feet) become damaged. If damaged, they may not be able to send signals between the central nervous system (the brain & spinal cord) and all other parts of the body.

Are all nerves the same?

We have different types of nerves with their own specific functions:

  1. sensory nerves are responsible for transmitting sensations, such as touch, sight, hearing, taste and pain.
  2. motor nerves control the movement of muscles, such as walking, talking and grasping.
  3. autonomic nerves control organs to regulate activities that people do not control consciously, such as breathing, digestion, and heart and gland functions (automatic functions).

What are the symptoms of peripheral neuropathy?

The symptoms depend on which nerves are affected:

  1. The symptoms of sensory nerve damage can include loss of sense of touch, temperature, and pain or a tingling sensation. 
  2. Damage to the motor nerves can cause muscle weakness and cramps.
  3. Common autonomic nerve symptoms include excess or absence of sweating, heat intolerance, and drop in blood pressure upon standing. Postural orthostatic tachycardia syndrome (also known as POTS) can increase heart rate when standing up and cause such symptoms as lightheadedness (or fainting) or difficulty concentrating.

How can podiatry help you?

As podiatrists we can assist you with peripheral neuropathy by recognising the extent of numbness through testing sensations with special fibres and then providing advice on how to care and manage your feet in the future. 

The following things we test include:

  • Numbness or tingling
  • Diminished or absent temperature sensitivities
  • Reduced sensations to include temperature, sharp and blunt, light touch, and vibration.
  • Altered muscle strength and reduced proprioception leading to imbalance.

If you are concerned and are a new client to Zest Podiatry, please book an initial assessment where we can fully assess your feet.

What else may cause peripheral neuropathy?

Other conditions that cause someone to be at risk of peripheral neuropathy include:



Previous reports have focused on covid toes during the covid viral infection.

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