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Ingrowing & Painful toenails

Ingrowing & Painful toenails

Ingrowing toenails are commonly seen in clinic. They can be extremely painful when wearing shoes and walking.They can present in a variety of ways and the tissues around the nail can become inflamed and infected.

Ingrowing toenails can occur on any toe, but it it is the big toe (Hallux) which is most commonly affected.

The medical term used for  an ingrowing toenail is Onychocryptosis.

Ingrowing toenails can affect all ages, however teenagers are particularly affected, which often related to increased sweating.

There are various stages of ingrowing toenails in the early stage the tissues around the nail become inflamed and sore. As they progress the nail can penetrate the skin, and create a portal for infection to get in.

 

Causes of Ingrowing Toenails

Wearing shoes that are too narrow or short can put increased pressure onto the toes creating an ingrowing toenail.

A recent Study highlighted  63-72% of the population are wearing shoes that do not accommodate the foot in length or width.

Ladies wearing high narrow shoes or football players who like to have their boots fitting snugly.

Dropping heavy items, having your toe trodden and repetitive injuries such as kicking balls can lead to pressure on the nail and cause it to become inflamed and ingrowing.

Cutting your nails too short or down the sides of the nail can cause injury and lead to an ingrowing nail.

Picking nails is often a habit like biting your nails, this can lead to tearing and irregular nail shape and damage to the surrounding skin and tissue.

We inherit the shape of our feet including the shape of our nails.  As result nail plates can present as being wider or increased curvature, which can predispose to problems with the toenail pressing into the skin.

Top Tips for Treatment at Home

Clinic Treatments

The painful toenail is assessed to identify the best possible treatment option.

If the ingrown toenail is minor, a simple conservative nail trimming may be sufficient. In most scenarios, a minor ingrown toenail surgery is required. This is the most effective treatment option and is highly likely to provide a permanent solution to ingrown toenails.

Ingrowing toenails can be prevented and treated if caught in the early stages.  Treatment may include removing a small wedge of the nail and placing a piece of packing at the edge of the nail plate, to act as a buffer.

Changing footwear to a wider and longer shoe can also help.

If conservative treatments are unsuccessful nail surgery may be indicated.

Nail Surgery

 

Partial nail avulsion (PNA) with phenolisation of the nail matrix

This is completed under a local anaesthetic, which involves two injections at the base of the toe.

A wedge or wedges of the nail are removed from the offending side of the toenail.

A chemical called phenol is applied to where the nail has been removed to stop the in-growing toenail from reoccurring.

A dressing is applied which need to be left on for 24-28hours.

The procedure takes approximately 10-15minutes, however, allow for up to 1hour for preparation and postoperative monitoring.

After Surgery:

There maybe some mild pain and discomfort following the procedure for which it is advised you take some painkillers prior to the anaesthetic wearing off.

It is important for you to go home and elevate your for and rest for 48hours after the procedure.

Please bring a pair of wider fitting shoes or sandals as the initial dressing maybe bulky.

You will be shown how to look after your toe, healing takes approximately 4-6weeks, for this duration is important to keep a dressing on your toe, it is quite normal for the surgery site to discharge whilst healing is occurring.

Considerations for Nail Surgery:

Every effort is made to reduce these, however,  risks and complications include:

Infection (2-4%).
Recurrence and re-growth of the offending nail 5-8% and up to 10% undergoing total nail removal.
Delayed healing.
A thickened nail plate.
A change and altered nail shape, every effort is made to provide a cosmetic appearance, sometimes due to a large involuted plate or chronic infection, a large section needs to be removed.

To find a Podiatrist in your area, here is a link for the College of Podiatry

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