Ingrown Toenails

What is it?

Ingrown toenail is a painful condition characterised by the nail digging in to the surrounding skin, leading to inflammation and possible infection of the toe. Whilst this is a very uncomfortable condition no matter who you are, it is a serious condition for people with circulation problems, diabetes or diseases causing immune suppression. There are generally two types of ingrown toenails – those where a spike of nail is penetrating the flesh and those where the nail has curled over a period of time into the skin at the edges.

  • Onychocryptosisis the type of ingrown toenail where there is a spike of nail is piercing the flesh. This is often an acute (sudden onset) problem due to nail trauma, poor nail cutting or picking at the nails where a spike is left which later grows into the skin. Often this type of ingrown toenail is complicated by infection taking advantage of the warm, moist environment. Whilst antibiotics if often prescribed, this is often not enough and the spike of nail needs to be removed by a Podiatrist.
  • Involuted Toe Nailis the type of ingrown toenail where the nail has curled over a period of time into the skin at the edges. This is generally a chronic (long term) change in the nail profile that leads to ingrown toenail. It often occurs secondary to pressure which could be due to poor fitting shoes, a poor foot structure or a combination of both.

Complications of ingrown toenail can include the development of granulation tissue, infection, cellulitis, ulceration and gangrene.

4 Life Podiatry

It is important to seek treatment of an ingrown toe nail as soon as possible. Within a short period of time a simple nail spike can cause the adjacent tissue to become infected and make the treatment considerably more complex (and expensive) to treat. The treatment of ingrown toe nail can be divided into two general categories; conservative and surgery.

Conservative Treatment includes seeing a Podiatrist for removal of the nail spike, nail edge and/or dry and callused skin around the nail. The podiatrist can cut the nail to “train” it to grown in a way that will prevent further ingrown toenails. Sometimes poor foot biomechanics can cause ingrown toenails by causing increased pressure on the area and this can be alleviated with the use of orthotics. Footwear designed for your foot type will also be recommended.

Surgical Treatment is required for more advanced or recurring ingrown toenails. This is a procedure performed at our clinic (very regularly) where the Podiatrist will remove the offending piece of nail, and the application of a chemical to ensure it does not grow back. This provides a permanent solution to the ingrown nail. The surgery is typically completed within 30minutes and the process includes:

  • A local anaesthetic is applied to ensure the following surgery is pain free
  • Nail edge is gently lifted
  • The offending section of the nail is cut down the to the nail bed under the skin
  • The ingrown nail edge is removed
  • A chemical is applied to the nail bed to stop the nail from growing back again

Due to the application of the local anaesthetic this procedure is generally not painful. Whilst the patient can walk out of the clinic it can take up to 6-weeks to make a full recovery from this procedure.

Prevention & Home Management Strategies

It is important to seek treatment of an ingrown toenail as soon as possible to prevent infection and progression of the problem which often results in the need for surgery. Some tips for the prevention of ingrown toenail include:

  • Salt Water Baths can be used whilst awaiting an appointment to help the infected nail. Boil water and add 1Tbsp of salt for each litre of water. Allow the water to cool to lukewarm and soak the foot for 10mins. Allow your foot to thoroughly dry prior to wearing any enclosed shoes. Please note that this treatment will not cure ingrown toenail or infection and treatment should be sought as soon as possible.
  • Wearing shoes that are well fitting and do not put pressure on to the toe nails. Pointy shoes, and shoes made of synthetic materials are usually not ideal when experiencing an ingrown toe nail.
  • Cutting the nail straight across and gently rounding off the edges can help prevent the nail from digging in at the sides.
  • Seeking Antibiotic treatment from a GP will help to eliminate the infection while awaiting treatment. Whilst this won’t cure the ingrown toenail it will improve the situation temporarily before you see the Podiatrist.