Ingrown Toenails

What is an ingrown toenail? 

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the flesh at the side of the toe. They begin with pain, inflamed skin, and swelling. If left for too long, the skin may be pierced by the nail, causing a break in the skin in which bacteria can enter which leads to an infection. If the pain increases, the toe is swollen and hot; Or you notice redness (erythema) or pus - the toenail has become infected. 

So what causes an ingrown toenail? 

There is no one cause - but there are a number of factors to consider when it comes to ingrown toenails. 

If we say funky, smelly feet - which age group comes to mind? 

If you thought teenagers, you’d be right! Teenage feet are often the unlucky sufferers of ingrown toenails. The sudden growth spurts and body changes that teens and adolescents experience mean that they may outgrow their footwear quickly. They may also have been muddling along with their own self-care, not quite getting it right which only worsens over time. Continuing to wear ill fitting shoes, having poor hygiene or nails that have been trimmed incorrectly, can all contribute to teens with problematic toe nails!

Incorrect Nail trimming

We have all accidentally been a bit gung ho with the clippers and cut our nails a little bit too short at times. When nails are cut too short, it can encourage the skin at the side of the nail to fold over the front when standing and walking. Be sure to cut straight across the nail, to avoid this! Your podiatrist can assist with advising the best technique to do this at home.

Nail trauma

You may have noticed an ingrown nail developing after experiencing trauma to the nail. Occasionally, stubbing or jamming your toe, dropping something on it or participating in activities that put repeated pressure on your toes (like running, soccer or ballet in shoes too short) can cause ingrown toenails to develop. 

Family History, genetics and other health conditions

Characteristics that increase a person's risk of developing an ingrown toenail can be passed down. Some nail shapes or nails that are naturally curved, pinched or involuted are inherited and are predisposed to becoming ingrown. Naturally involuted nails, (where the nail grows with a curl along its length and corners) are prone to pinching the skin as the nail grows longer. It is Important to keep these short but not so short that the skin wraps over the front of the nail plate which can then lead to an actual ingrown nail. So if you have noticed that Mum, Dad or even Uncle Bob have been prone to ingrown toenails - it could be family history and genetics playing a part. Having certain medical conditions, particularly those that affect arterial circulation can increase the risk of ingrown toenails.

Footwear

If your shoes are a little too snug or have a pointed or shallow toe - your toes may become crowded, putting pressure on the nails and . Slip-on style shoes, where your foot can't help but slide forwards, will often lead to your toes being pushed up against the end of your shoe all day. What do they all have in common? The building pressure on your big toe can often lead to an ingrown toenail. 

Pedicures

You may have treated yourself to a pedicure at a nail salon. However, if the service was a little too rushed or the technician was a little heavy handed, you could end up with broken skin at your nail edge. The combination of broken skin and a foot bath that hasn't been adequately sterilised, can let in a whole hoard of unwanted bacteria having a little party in your nail sulcus.

Treatment/Prevention

Treatments of Ingrown nails can be broken down into Conservative/Non Surgical or Surgical.

Conservative treatment:

This is where a podiatrist can assist you with your at-home nail care. Our pods can reduce the nail thickness and tame any problem areas by carefully removing any spicules of nail that may be digging or growing into the skin. Filing down the edge of the nail and showing you how to keep the nail clean at home, may be all that is needed. 

For one-off cases after some kind of trauma to the nail, one consultation is often all you will need. For those unlucky enough to have repeat ingrown nails, appointments will need to be made regularly to keep the nails under control if this is your preferred method of treatment.  For many people getting a professional opinion is a really good place to start.

If the ingrown toenail is not too painful, we may be able to treat and fix the problem with a standard Podiatrist consult. However, if the problem is left untreated, the situation can become far worse. Remember to keep the foot clean and dry. Wear comfortable shoes with adequate room for the toes. Consider wearing supportive open toe shoes or sandals until the condition clears up. Apply betadine into the nail sulcus (the groove on the side where the nail plate slides forward)

Prevention:

As always, it's worth noting that prevention is easier than a cure! And thankfully, Ingrown toenail prevention is a lot easier than you would imagine.

Nail trimming technique:

When trimming your toenails, make sure to trim them straight across, ensuring that the edges are not cut within the grooves on the side (the sulcus). Rather, trim straight across with a gentle curve that matches the contour of the front of your toe. Avoid trimming the toenail too short. Rather, Leave the nail long enough so that the corners lie loosely against the skin at the sides. We recommend avoiding the cheap folding nail clippers and opting instead for nail scissors or the clippers that resemble a pair of pliers. Take your time while cutting, making only small cuts as you work along, so as not to cut off a large section in one maneuver. 

Footwear Advice:

Taking care to wear proper fitting shoes, socks and/or tights goes a long way in avoiding ingrown toenails. Phil or Ed can give guidance and advice regarding choosing the the appropriate footwear.

• The right footwear begins with finding the right fit and style for your foot. Shoes that are too tight put pressure on the toe nails and can compress them, affecting the distribution of weight. In the reverse, shoes that are too loose cause the foot to slide around which can cause the toenails to rub against the inside of the shoe or each other. This friction can irritate the skin around the toenails and make it more likely for the nails to grow into the skin. Ensuring roughly a thumb-width space between your toe and the end of the shoe is a good guide.

• Choose shoes with a wide toe box, allowing your toes to spread out naturally. A rounded or square toe box can be a good start, so that your toes have the space that they need. Ideally, narrow or pointed toe shoes should be avoided. The right shoes should be comfortable and not too tight.

• Look for Shoes with a soft, flexible upper. Shoes with stiff, rigid uppers can put pressure on your toes. Look for shoes with soft, flexible uppers that allow your feet to move naturally. Leather and mesh are good options as a starting point.

• Avoid High Heels if possible. High heels force your toes into the front of the shoe due to the unnatural positioning of the foot. This puts pressure on your toenails and causes them to grow into the skin. If you must wear heels, look for shoes with a lower heel height and a wider toe box.

• Consider Orthotics for help in preventing recurrent ingrown nails. While orthotics are typically designed to support your feet and improve your foot alignment, they can also help prevent ingrown toenails by reducing pressure on your toes through the way that foot alignment is adjusted. They can also help reduce the need to hyperextend your big toe when swinging your leg - a common cause of that annoying hole in the toe box of yourshoe.

• If you are working in hazardous conditions, ensure that you wear steel-toe boots (these too need to be the correct fit and size) 

But what if it gets worse or keeps coming back? 

If the toenail has excessive inflammation, swelling, pain and discharge present, the toenail is most likely infected. Make a booking for an appointment with your podiatrist and they may advise that it is time to go down the surgical route. 

Surgical Treatment:

Sometimes ingrown toenails can become stubborn and chronic. If the treatment of an ingrown toenail is left too long, or not taken care of correctly at home - you will need professional treatment from a podiatrist to avoid the infection worsening or spreading.

The ingrown toenail can be permanently corrected with a procedure called a Partial Nail Avulsion (PNA, avulsion meaning removal) or a Total Nail Avulsion (TNA) and chemical matrixectomy, which involves surgically removing either part or the entire toenail and using a chemical (Phenol) to inhibit the nail matrix from regrowing. If your toenail is continuously struggling with an infection, removal of the entire nail may have to be advised. This is however for worst-case scenarios.

Despite being called a ‘surgery’. It's not as scary as it sounds. We can perform the whole procedure while you sit in the chair. Your podiatrist will first numb the toe with a local anesthetic. The affected portion of the nail is then carefully removed. There are no stitches. It is a simple procedure with very little pain afterwards. So long as you follow the aftercare provided by your pod, most people can resume regular activities in the following days! The biggest inconvenience is the need to keep the wound dry for a week after having the procedure. 

For advice or treatment - We’re here to help!

If you have had a bad experience before and are a bit nervous about going forward, we understand. We are always here to talk you through any questions you might have. Nail surgery in particular can seem scary - but Phil and Ed promise to be extra gentle, we are here to help after all! If you don't want to take our word for it, have a read of some of our reviews on Google. Your toes will be in good hands! Our pods can help you find the best option for your nails and your lifestyle. 

Birdwood Podiatry provides treatment for in-grown toenails right here at our clinic in Springwood. Depending on the severity of the situation, a treatment plan will then be outlined with you to achieve the best outcome. Even surgical treatment is conveniently done here in our rooms at our Springwood Clinic. 

If you suspect you may be suffering from an ingrown toenail, don't wait for it to get worse; make an appointment to see Phil or Ed today!