Ingrown Toe Nails by David Webby

 

Ingrown toe nails are a common nail problem, that can affect people of all ages. 

It is an often a painful condition in which the nail digs into or grows into one or both sides of the nail groove or sulci.

 

Technically an ingrown toe nail occurs when a spicule of the nail penetrates the skin, which results in an infection. But often the nail doesn't penetrate the skin but causes a build up of callus or a corn down the groove of the nail. This condition can be exacerbated by poor nail cutting or tight footwear. 

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Causes:

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1. Poor nail cutting. Cutting down into the corners leaving a spicule or sharp edge. Sometimes if one cuts the nail too short, or peels / picks the nail, it can leave a rough edge which can irritate the skin after a few days or weeks.

2. Bad-fitting shoes. Shoes that are too short can cause pressure at the end of the toes, particularly the 1st toe. Shoes that are too narrow can cause the toes to bunch squeezing them together, resulting in one toe to curl and dig into the skin of the neighbouring toe. 

3. Trauma to the nail where the nail is forced into the skin. Or damage to the toenail can cause the nail to grow irregularly and press into the flesh. Sometimes this occurs after one has dropped a heavy object on the foot, or kicked it accidently. Bush walkers or Runners can also get truma to their nails from their foot slidng forward in their shoes causing bleeding at the base of their nails, thus black toe nails.

4. Genetic predisposition, ie inherited from your parents. This can result in highly incurvated nails, abnormally shaped nail beds, nail deformities caused by diseases, and a susceptibility to nail problems that can cause a tendency for nails to ingrow.

5. Circulation. Very poor circulation can result in thick incurvated or distorted nails, which is common in the elderly.

 

What can you do?

 

Ingrown nails can be avoided by cutting nails straight across; nails should not be cut along a curve, nor should they be cut too short. In both cases, the important thing to avoid is cutting the nail shorter than the flesh around it.

 

Pressure on the toe nail from footwear, whether the shoe is too short or tightness across the forefoot. If your foot slides forward in your shoe, this can be corrected by changing your lacing or buying a bigger shoe.

 

How can we help?

 

Podiatrists treat the problem by first trying to address the cause and then deciding on the options available. 

This may involve cutting out the afflicting spicule or painful edge of the nail and retraining the nail to grow forward of the nail grove,(sulci). 
Some people benefit from regular nail care to reduce nail discomfort, particularly those with corns under the nails. 

A lot of the time ingrown toenails come from shoe pressure, i.e. short shoes. So it is important to assess people's footwear to help resolve ongoing problems. 

 

 

Ingrown toe nail surgery can be a very successful option if required. 

When conservative care fails to give sufficient relief, surgical removal of the nail edge is considered.

 

It sounds painful but it isn’t. Here at Daniel Lewis Podiatry we use very fine needles which allow a gentle approach with minimal discomfort. Once the toe is numb then the procedure is painless. One may have minimal or no discomfort that night, which the Podiatrist recommends Panadol in case.

 

The procedure is very simple It involves removing a small portion of the nail.

The growth plate of the nail is then sterilized using a chemical to destroy that portion of the nail and prevent it growing back.

 

The nail operation takes approximately 1 hour, after which your toe is dressed with a antimicrobial dressing. A list of instructions to take care of the nail is given after the first review to ensure the patient helps in the healing process. We will inspect the toe after the first week, or It is expected that the area will completely heal within 4 to 6 weeks after the operation. The skin forms a new border with existing nail, which gives a great result and no further issues with ingrown toe nails. Problem resolved.

 

Sometimes it is difficult to assess and treat the condition yourself, so if you are having any problems with your toe nails, come see us for advice and treatment.