Ingrown Toenail

Ingrown Toenail

An ingrown toenail is one that pierces the flesh of the toe. It can often be a splinter of nail digging into the flesh, and can be extremely painful. In more severe cases, it can become infected, producing pus and bleeding. Ingrown toenails most commonly affect the large toenail, but can affect the other toes too. A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn’t a true ingrown toenail, but can also be very painful and inflamed.

Who gets ingrown toenails?

  • Active, sporty people are particularly prone as they usually get hot sweaty feet
  • Younger people are often quite likely to get them where they pick their nails
  • Those wearing of support hose that squeezes the toes
  • People wearing shoes with tight toe boxes
  • People cutting their toenails too low.

What causes the problem?

There are many genetic factors that can make you prone to ingrown toenails, such as your posture (the way you stand), your gait (the way you walk), a foot deformity such as a bunion, hammer toes or excessive pronation (inrolling) of the feet, and inherited problems causing your nails to naturally be wide and fan shaped, or curl in instead of growing straight, encouraging your nail to grow into the flesh. Tight footwear and socks can also push your toe flesh onto the nail so that it pierces the skin and, if you sweat excessively, or don’t rotate your footwear, this makes the skin moist and weak, so that it is pierced by the nail. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nails that are sticking out, you’re more likely to get an ingrowing toenail. However, one of the most common causes is cutting your nails incorrectly.

What is the treatment for an ingrown toenail?

It depends on the severity of your condition. For the most basic ingrown toenail, your local podiatrist (also known as a chiropodist) will carefully remove the offending spike of nail. If your toe is too painful to touch, your podiatrist may use a local anaesthetic to numb the toe, before removing the offending portion of nail. If you have involuted nails, your podiatrist may remove the bit that’s curling into the flesh and file the edges of the nail to relieve discomfort and advise on preventing this happening again. If you have bleeding or discharge from the toe, or even excessive healing flesh (hypergranulation tissue) around the nail, you may need antibiotics to beat the infection, after having the offending spike removed.

If you are particularly prone to ingrown toenails from underlying problems such as poor gait, your podiatrist may recommend correction of the underlying cause as well as a more permanent solution to treating the nail problem. Partial nail avulsion’s (PNA) are done under a local anaesthetic where a small section of the offending nail edge is removed including the growing area at the base of the nail, so the nail becomes slightly narrower. A chemical is used to prevent the nail regrowing along the offending edge. This procedure was developed by podiatrists and is shown to be over 97% successful. You will, however, have to go back to your podiatrist for re-dressings post operatively. After surgery, the overall appearance of the nail looks normal – to the extent that some people even forget which nail they’ve had done!

High risk patients

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt any form of self/treatment by trying to remove the ingrowing spike of nail yourself; refer to your podiatrist as soon as you can.