INGROWN TOENAILS

Ingrowing toenails

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An ingrowing toenail is where a piece of nail pierces the flesh of the toe. 

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What causes it?

• Not cutting your toenails properly

• Posture (the way you stand) and gait (the way you walk) 

• Foot deformity’s such as a bunion, hammer toes or excessive pronation of the feet (when your foot rolls inward excessively). 

• Nails that splay or curl out instead of growing straight 

• Tight footwear, hosiery and socks 

• Fungal infection 

• Medication, for example isotretinoin.

 

How do I know I have it?

The most common symptom is pain followed by inflammation in the surrounding nail area.

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However, not everyone identifies an ingrowing toenail correctly. Sometimes, they have a curly nail which has a lot of debris (dirt or fluff) underneath it or a corn or callus down the side of the nail, which can be just as painful. However, if it’s a corn, you tend to experience a throbbing pain as opposed to the sharp pain you get with an ingrowing toenail. If this is the case, your podiatrist will remove the debris, and, if necessary, thin the nail.

 

When should I see a podiatrist? 

You should see a podiatrist urgently if you have symptoms of infection, and also have diabetes, poor circulation or a reduced immune system. You should also visit a podiatrist if you experience any persistent pain in your toe from the ingrowing nail or have a condition that affects the nerves and/or feeling in your foot.

 

What are the treatments?

Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge.

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How a podiatrist will treat you will depend largely on the severity of your condition:

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For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be gently removed and the toe covered with an antiseptic dressing

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For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail

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For involuted nails, part of the nail that is curling into the flesh is gently removed and then the edges of the nail are filed

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If infection or hypergranulation (jelly red blood filled overgrowth of tissue) is present then you will need a prescription for antibiotics from your GP, as well as having the offending spike removed. (Podiatrists cannot prescribe in New Zealand)

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For those particularly prone to ingrowing toenails a partial nail avulsion (PNA) may be recommended along with finding a more permanent solution to the underlying condition. This procedure is done under a local anaesthetic where part of the nail is removed (including the root), leaving a permanently narrower nail. In some cases a total nail avulsion (TNA) may be performed, where the entire nail plate and root are removed. In either case, the chemical phenol is used to cauterise the nail and prevent it regrowing. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings

 

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.