Ingrowing toenails

An in-growing toenail is a toe nail that pierces the flesh of the toe. It can feel as if you have a splinter, or other foreign object embedded in it and can be extremely painful. In more severe cases, it can cause bleeding and pus. In-growing toenails most commonly affect the big toenail, but can affect the other toes too. A nail that is curling (involuted or convoluted) into the flesh, but does not pierce the flesh, is not classified as in-growing, but can also be red, inflamed and very painful.

Active, sporty people are particularly prone to them, because they sweat more. Younger people are also susceptible as they tend to pick their nails more, compared to older people who may not reach their toes. Women often develop them as a result of cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.

Is it serious?

If left untreated, the infection can spread to the rest of the toe. The quicker you treat it, the less painful the treatment.

What causes it?

The primary causes are genetic factors that make you prone to in-growing toenails. Nails may naturally splay or curl out instead of growing straight, resulting in the nail growing into the flesh. Additional factors include, posture (the way you stand), your gait (the way you walk), excessive pronation of the feet (when your foot rolls in), foot conditions, such as bunions or hammer toes. Tight footwear, hosiery and socks can also push your toe flesh onto the nail so that it rubs, becomes inflamed and painful. With excessive sweating, the skin is likely to soften, so that the nail could piece it more easily. Brittle nails may break, leaving sharp edges or points that are more likely to ingrow. However, one of the most common causes is not cutting your toenails properly, either going too deep, and cutting the flesh, or not deep enough and leaving a point.

What can I do?

Learn to cut your nails properly. Nail scissors have a curved cutting edge and can cut the flesh. Many find nail trimmers awkward and they are prone to slip. It is best to use nail nippers, as they have a smaller cutting blade and a longer handle. Cut your nails straight across. When possible, do not cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Cutting nails after a bath or shower when they are soft, may be easier.

Good hygiene can go a long way to preventing in-growing toenails. Avoid wet skin by alternating footwear and hosiery, so that each pair has a chance to thoroughly dry out. Avoid man-made materials and choose socks and shoes of natural fibre. In the summer, wear open-toed sandals where possible.

If you have booked an appointment with a podiatrist, relieve the discomfort in the meantime by bathing your foot in warm salty water for no longer than five minutes. Gently and carefully massage the area. This can prevents infection and reduce inflammation. Apply a clean sterile dressing, particularly if there is any discharge, then rest your foot as much as possible.

If you have diabetes, are taking steroids or are on anti-coagulants, do not attempt to cut your nails or remove the in-growing nail yourself.

What can a podiatrist do ?

It depends on the severity of the condition. Typically, the Podiatrist will remove the in-growing section of nail. If there is bleeding or discharge from an infection, it may require antibiotics as well as having the offending spike removed..

If the toe is too painful to treat, or the patient is particularly prone to reoccurring in-growing toenails, the Podiatrist may recommend a more permanent solution, such as partial nail avulsion (PNA), or total nail avulsion (TNA). Under local anaesthetic, the in-growing section is removed. The chemical phenol cauterises the wound and prevents that part of the nail re-growing. A number of dressing appointments would be necessary.

After surgery, the overall appearance of the nail looks normal.