Ingrowing & Painful Toenails
Ingrowing toenails are commonly seen in our clinic. They can be extremely painful when wearing shoes, walking and doing sport.
They can present in a variety of ways and the tissues around the nail can become inflamed and infected.
Overview of Ingrowing Toenails
Ingrowing toenails can occur on any toe, the big toe (Hallux) nail 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.
Common Causes of Ingrowing Toenails
Footwear is a significant cause of ingrowing toenails. Wearing shoes that are poor fitting which are narrow or too short increases the pressure onto the toes, creating irritation and pressure leading to the nail becoming ingrown.
A recent study highlighted 63-72% of the population wear shoes that do not accommodate the foot in length, width, or depth.
This typical with ladies wearing high narrow shoes or football players who like to have their boots fitting snugly within the toebox.
Our toenails provide a very important protective function from trauma.
Dropping a heavy item, or having your toe trodden on and repetitive injuries such as kicking balls leads to damage to the nail and surrounding soft tissues. In turn, this leads to the nail becoming inflamed and ingrowing.
Poor Nail Care
Cutting your nails too short or down the sides of the nail causes injury to the soft tissues around the nail and leads to an ingrowing nail. As does ripping or tearing your nails.
In older people with reduced eyesight and flexibility are prone to ingrowing nails is as they have a reduced ability to care for their nails and feet.
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 a result nail plates can present being wider or with an increased curve, which can predispose to problems with the toenail pressing into the skin.
Based on foot type, a higher incidence of ingrowing nails is found in people in which the big toe is shorter than the second toe. Also, in people in which the first and second toes are equal in length.
Underlying Health Issues
Other risk factors that may increase the likelihood of ingrowing toenails are diabetes and obesity; as well as cardiac, renal, and thyroid disorders with associated lower limb oedema/ swelling.
In adolescence, the feet perspire more often, causing the nail and skin to become soft. This results in nails that easily split, allowing a part of the nail to pierce the soft skin. In older people ingrowing nails are more often caused by a reduced ability to care for their nails.
Top Tips for Ingrowing Toenails
Keep the area Clean.
Keep the area Clean. This can be done by soaking the area with warm water with a teaspoon of salt for 10minutes every day.
Apply a dry clean dressing if the toe is weeping, avoid sticky plasters that make the skin wet and soggy.
Good Fitting Shoes
Wear comfortable shoes to allow space for the toe, and avoiding pressure, considering length, width and depth of the toe box.
Cutting a 'V'
This is an untrue myth that cutting a ‘V’ in the middle of the nail stops the nail growing from the corners and rectifies the nail shape. Unfortunately, this does not work!
Cutting down the side of the nail
Avoid cutting down the side of the nail as this can cause more trauma to the soft tissues and let to a bacterial infection.
Get in Contact
Ingrowing toenails are often best treated as early as possible.
Progression of an Ingrowing toenail
At first, an ingrown toenail can feel hard and swollen. If the nail grows into the skin, or the skin grows over the nail edge, bacteria can enter. The nail may become infected.
Signs of infection!
- Liquid or pus coming out of the toe.
- Redness or darkening of the area.
- Toe feeling warm or hot.
How are Ingrowing Toenails Treated?
The painful nail is assessed to identify the best possible treatment option.
If the ingrown toenail is low grade or in its early stages, cutting the nail and clearing the painful and offending edge and packing the edge to act as a buffer is often all is required. This is completed with or without local anaesthesia.
This is followed by wearing a shoe with enough space in the toe box and cleansing the toe in saltwater.
Longer-term advice is provided on how to prevent or manage the toe will be given.
For the recurring or long-term ingrowing toenails a small procedure whereby a wedge of the nail is removed from the offending side and application of a chemical to prevent the nail regrowing from the offending area. This is referred to as a partial nail avulsion.
This is completed under local anesthesia and can be completed within the clinic setting.
This is the most effective treatment option and is highly likely to provide a permanent solution to ingrown toenails.
for further details on nail surgery please see the link.
- The management of ingrowing toenails
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- DeLauro NM, DeLauro TM. Onychocryptosis. Clinics in Podiatric Medicine and Surgery 2004;21(4):617‐30.
- Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. American Journal of Epidemiology 2004;159(5):491‐8.
- Gunal I, Kosay C, Veziroglu A, Balkan Y, Ilhan F. Relationship between onychocryptosis and foot type and treatment with toe spacer. A preliminary investigation. Journal of the American Podiatric Medical Association 2003;93(1):33‐6.
- Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrowing toenails?. Archives of Family Medicine 2000;9:930‐2.
- Westert GP, Schellevis FG, de Bakker DH, Groenewegen PP, Bensing JM, Vander ZJ. Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. European Journal of Public Health 2005;15:59‐65.
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