An ingrown toenail (onychocryptosis) occurs when a section of the nail penetrates the skin, often resulting in the toe becoming inflamed, painful and infected. Most ingrown toenails affect the big toe but the smaller toes can also be affected. The condition may vary in severity from slight discomfort with swelling at the tip of the toe to the entire side of the nail becoming acutely painful often discharging fluid, particularly if infection is present, and the development of enlarged flesh surrounding the nail (granulation tissue).
Some nails press into the skin without piercing the tissue and this is known as an involuted rather than ingrown nail. This can also be painful as a corn/callus is commonly found down the side of the nail as a reaction to the nail pressure.
What causes an ingrown toenail
The following are the main factors involved in the cause of ingrown toenails :-
- The main risk factor is the shape of the nail. Some people have the first toenail that is more curved from side to side rather than being flat, making them more likely to become ingrown. The shape of our nails can be inherited but is also affected by pressure, either from the way we stand and walk, to the type of footwear we choose.
- Poor nail cutting can influence how the remaining nail continues to grow. Cutting toe nails very short or at an angle down the side of the nail may result in the new nail growing in. Trimming too far down the sides or tearing rather than cutting nails is a common cause of an ingrown toenail.
- Footwear with a narrow or shallow toe box is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk of an ingrown nail.
- Previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail
- Ingrown toenails are often a symptom of a foot that is unstable. Pressure at the front of the foot is often due to the back of the foot not held in a level position to the ground and this may need to be looked into as part of the treatment.
- Those with swollen feet or a ‘chubby’ or fleshy toe are more likely to have an ingrown nail.
- Excessive perspiration of the feet can often be a contributory factor, particularly if one or more of the above are also present. Those with sweaty feet may find the skin has less resistance to pressure and can be pierced more easily.
Home care of ingrown toenails
The most important factor in preventing ingrown toenails is cutting the nail straight across to allow the corners to protrude, so that they do not penetrate the skin. However, this can be difficult if the nail is very curved down the side. In this case DO NOT ‘dig’ down the sides – seek professional help for this (see below).
It is a myth that a V should be cut in the end of the nail to treat an ingrown toenail. The idea is that if you cut a V in the nail, the edge of the nail will grow together as the nail grows out. This does not happen – the shape of the nail is determined by the growing area at the base of the toe, not the end.
Those with a tendency to ingrown toenails should avoid wearing shoes and socks that are too tight.
Keep feet clean to prevent the ingrown nail from becoming infected.
Those with poor circulation or diabetes should not do any self management of ingrown toenails but see a Podiatrist.
Treatment of ingrown toenails
Regular conservative treatment by a Podiatrist can often be needed to prevent the ingrown nail becoming a problem. Reshaping the nail and correct nail cutting can encourage it to grow in a straight fashion away from the sides.
It may be possible to remove the spike of an ingrown nail painlessly without the use of a local anaesthetic, particularly if it is only growing in at the tip of the toe. However if the nail is ingrown towards the base of the nail, a local anaesthetic is normally advised so that treatment can be performed with the minimum of distress for the patient. Antibiotics are often necessary if the surrounding tissue is infected. However, the cause of the infection (the ingrown nail) is still there, and this will still need to be removed.
Surgical treatment of the ingrown toenail:
If the ingrown nail is severe or does not respond to conservative care, then minor surgical intervention is a good option. Minor surgery is a relatively simple procedure and is very successful for permanent relief.
The most common procedure is the removal of a section of nail of the ingrown nail (Partial Nail Avulsion). The main benefit of this procedure is that it not only leaves the nail pain free but also in a cosmetically acceptable state as the majority of the nail remains in tact. Occasionally the nail is so ingrown from both sides or is grossly thickened and in these cases, it may be necessary to remove the entire nail (Total Nail Avulsion). After a nail or part of the nail is removed, it will grow back as the growing cells at the base of the nail are still there. To prevent regrowth, usually an acid is used to destroy the growing cells and stop this painful condition happening again.
After the surgery you will need to keep your foot elevated for a few hours and rest is advisable. The following day, you can return to work or school. It is advisable not to take part in vigorous activities, such as running for 2 weeks after the surgery.