Ingrowing Toe Nails

Definition

 Ingrowing toe nails occur when the side of the toenail begins to grow into the skin of the toe. The big toe is most commonly affected, but it is possible to occur in the other toes aswell.  This may then cause pain and discomfort, particularly when pressure is applied to the toe, which will limit and have an effect on daily activities for example, walking. 

Causes

There are many reasons why ingrowing toe nails occur and they are not necessarily due to poor nail cutting technique.

  • Injury to the toe- For example, Stubbing your  toe.
  • Tight fitting hosiery or shoes- This causes excessive pressure on the toes.
  • Gait- The way you walk can affect your toes. If your foot rolls inward too much (pronates) this can cause excessive pressure on your toes, leading to deformity of nail shape.
  • Foot deformities- Bunions and hammer toes can also cause ingrowing nails.
  • Sweaty Feet- Moisture in the skin can make the skin weaker and therefore easily penetrated by nail.
  • Brittle Nails- As the nails break off the spikes remaining can easily pierce the skin.
  • Fungal Nail infection
  • Poor nail cutting technique- Cutting the nails too short or digging down the sides of the nail can lead to the nail piercing the skin.

Symptoms

You may feel anything from mild discomfort to extreme pain. Symptoms will vary between all individuals and may include:


  • Slight discomfort when pressure is applied to the nail
  • Pain on touch, particularly when the foot is in a shoe, or when under the bed sheets at night.
  • The toe maybe red, shiny and swollen.
  • There may be overgrowth of skin around the nail.
  • Infection may be present- you may see pus or discharge coming from the nail.
  • Bleeding may occur

It is also important to identify if you do have an ingrowing toe nail. It could also just be a curved nail (or involuted nail). These nails can be just as painful but the nail has not pierced the skin. It maybe that debris (dry skin) or a corn has formed down the side of the nail. This can be easily treated by a Podiatrist  who can clear down the side of the nail and relive your symptoms.

Treatment

If you think you may have an ingrowing nail here are some tips of how you can self care at home:

  • Salt foot baths may help relieve some discomfort.
  • Wear comfortable fitting shoes.
  • Correct nail cutting technique:

  1. Cut the nails straight across (it is best to use nail nippers than nail clippers as the edge is smaller and not as curved)

 2. Don't cut the nails too short.

 3. Keep the corner edge visible so it is above the skin and therefore not able to dig in the skin.

  • Good foot hygiene - Keeping feet clean and change socks regularly

When to see a Podiatrist

If left untreated an ingrowing nail may become infected, so if unsure it is best to get a Podiatrists opinion.

Patients with poor or weakened immune system, or diabetes should also get checked out as you are more susceptible to infection.

Treatment from a Podiatrist can vary, an ingrowing toe nail does not necessarily mean you will need nail surgery so it is best to seek advice if needed. Podiatrists can:

* Remove the nail spike or piece of nail digging into the skin.
* Debride or remove any corns/hard skin lying underneath the nail to clear the nail edge
* If the nail is too painful to touch the piece of nail can be removed using a local anaesthetic so that you will not feel any pain as the nail spike is removed.
* If infection is present antibiotics maybe prescribed. The infection will not fully go until the nail spike has been removed.
* If the ingrowing nail is persistent and frequently returns it may then be a good idea to undergo nail surgery. This involves removal of either the side or all your nail under local anaesthetic. A chemical called Phenol is used and placed on the nail bed to stop the nail permanently growing back. It is worth discussing these options in more detail with your Podiatrist.