What are Ingrown Toenails?

Ingrown toenails are a relatively common complaint that we see as podiatrists. To best explain how and why they occur and what is the treatment options for them, lets have a look at them from the small scale (cellular) process and then look at the larger environmental causes.

 

Ingrown toenails

 

 

What Do Nails Do?

From an evolutionary perspective nails played a key role in digging and fighting – essentially protecting our fingers and toes from trauma and injury. Nowadays nails are somewhat less important. They assist in fine dexterity like pick out splinters; they provide extra sensory (pressure) feedback when walking; for some people they are seen as an extra accessory which can be beautified with nail polish and nail art!

 

What Causes Ingrown Toenails?

There are a number of causes of ingrown toenails. Some which you can change such as; external or environmental causes, others unfortunately you can’t change such as the structure of your nail, toe or foot. Let’s look at these in more detail. Generally, painful ingrown toenails often occur on the big toenails but they can occur in any toenail.

 

High heels and poor fitting shoes leading to ingrown toenails

 

Common Causes for Ingrown Toenails

  • Incorrect cutting technique particularly in people with curly or thick toenails. Sometimes ingrown toenails occur due to toenails being too long as well.
  • Tight fitting footwear
    • Shoes that are too small
    • Shoes with a pointed toe box
    • Football boots
    • Steal cap or composite toe work boots
  • Flat feet (rolling inwards when walking) Rolling inwards when walking causes the toenail to be pushed into the skin.
  • Some types of medications
    • Roaccutaine
    • Methotrexate
  • Sports such as Soccer, AFL or Rugby which involve lots of kicking activities are commonly associated with ingrown toenails. The combination of kicking the ball (repeat trauma) on the corner of the toe coupled with tight boots can regularly cause ingrown toenails.
  • Phase of life
    • Adolescents (particularly in boys) can create the perfect environment in which ingrown toenails can develop. The onset of puberty can lead in increase in perspiration (sweaty feet). Sweaty feet makes the skin fragile and prone to becoming irritated if the nail presses into it. Sometime this can be coupled with other factors like fast growing feet (spending time in shoes too small for a short period) and playing kicking sports or just kicking around a football at lunchtime can sometimes be enough to start the process of irritation and pain.
    • Elderly people will sometimes see their nails thicken and become more brittle
  • Nail specific causes
    • Fungal nail
    • Wide nail plates
    • Curly or involution nails

 

How Are Ingrown Toenails Treated?

Treatment for ingrown nails can be split into 2 categories; conservative care and surgical intervention.

Conservative Care

This type of treatment can usually be performed in a standard appointment. It is often to involve the clipping of the nail and trying to remove the section of toenail that is causing pressing on the skin. Sometimes there can be a build up of  hard skin down the side of the nail which can also be easily removed.

The idea behind this type of treatment is that pressured from the nail or the extra hard skin is being reduced, this will often significantly reduce pain. If there is infection present then treatment may also involve draining or clearing away pus and removing any unhealthy skin.

While these types of appointments provide pain relief this may only be a short term fix. If the ingrown nail continues to be problematic a more permanent solution maybe recommended such as nail surgery, bracing or packing. Generally, nail surgery is the most common intervention used for a permanent solution to ingrown toenails.

 

Podiatrist caring for feet

 

Surgical Intervention

Surgery will provide a more permanent solution to ingrown toenails. It is usually a straightforward procedure that can be performed by most podiatrists. It involves numbing the toe with local anaesthetic so that minimal discomfort is experienced. Then the section of nail that is ingrowing is cut away right to the nail root which sits beneath the cuticle.

Once this section is removed, a substance called phenol (similar to an acid) is used to kill the cells which stops ingrown section of toenail growing back. This means that the ingrown section that has been cut away should no longer cause discomfort at the area. Your toe will be bandaged up and it may be recommended that you take some paracetamol to help with any pain you experience that night as the local anaesthetic wears off.

After the surgery it is recommended 2 days of rest. By staying off your feet for this time it will allow the initial stages of healing to occur and reduce the inflammation. On day 3, your podiatrist will see you for a post operative appointment where your bandages will be removed and the toe will be cleaned and redressed with less bulky dressing.

After this you may be able to return to loose fitting shoes and be able to do more weightbearing activities. Generally, a final review of the toenail is performed 1 week after the redressing appointment with toe most likely to be healed. Depending on the type of nail surgery, age, medical conditions and amount of weightbearing activity performed, it takes about 2-5 weeks for the toenail to heal.

 

Complications:

It is also important to note that there can be some complications with nail surgery mainly that there is a risk of infection and nail deformities but these complications are generally a low chance of occurring and can be managed through medications or re-doing the nail surgery.

Serious complications from nail surgeries are extremely rare as podiatrists will perform a through pre-surgical assessment to determine the potential risk of complications.

 

Summary:

In summary, podiatrist have multiple interventions in treating ingrown toenails. Depending on how severe ingrown toenails are as well as other considerations such as general health, allergies, walking pattern and footwear,  podiatrist’s determine the most appropriate treatment option for an individual’s ingrown toenails. So if you have any concerns regarding ingrown toenails or feet and legs, call in to your local podiatrist.    

 

References:

https://www.health.harvard.edu/newsletter_article/foot-health-what-to-do-about-an-ingrown-toenail

https://kidshealth.org/en/teens/ingrown.html

https://orthoinfo.aaos.org/en/diseases–conditions/ingrown-toenail

https://www.medicalnewstoday.com/articles/326019

About Prashneel Kumar

Prashneel graduated from Charles Sturt University in Albury with a degree in Podiatric Medicine. Prashneel grew up in the Albury/Wodonga region and moved to Canberra to gain further experience in all aspects of podiatry with a special interest in sports medicine, complex lower limb biomechanical conditions, repetitive strain injuries and the role of orthotic therapy in lower limb mechanics. He enjoys working with clients to improve their overall function and achieve their desired goals. Outside of work, Prash is an avid sports fan with a particular interest in rugby league and soccer. Prashneel loves any form of physical activity particularly running and in his spare time you will usually find him spending it with his family and friends. Prashneel also enjoys listening to music as well as watching movies.