Ingrown Toenails

Ingrown Toenails can be painful. We can help.

When a toenail is ingrown, it can often curve and grow into the skin that is usually at the nail borders (the sides of the nail). In certain cases the nail can also grow into the skin at the end on the toe ( the Hyponychium). This can happen after the nail has received trauma, like a nasty stubbing or dropping something upon it.

It is 8 times more likely for males to suffer from in-grown nails in comparison to females. Male adolescents are at the highest risk of suffering from this condition.

Ingrown Toenail

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odour. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

Causes of ingrown toenails include:

  • Heredity
    In many people, the tendency for ingrown toenails is inherited.

  • Trauma
    Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.

  • Improper trimming
    The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.

  • Improperly sized footwear
    Ingrown toenails can result from wearing socks and shoes that are tight or short.

  • Nail Conditions
    Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

While a in-grown nail may appear a simple disorder, a physical examination of the affected toe it vital to enable Mr Edwards to visualise the exact cause.

Sometime an X-ray is required if an underlying bony cause is suspected. This could include the presence of a Sub-Ungual Exostosis, a bony cartilaginous benign growth, underneath the nail plate, that distorts the nail plate, pinching the soft-tissue underneath the nail plate and on top of the distal phalanx, producing acute pain upon gentle compression.

After examining the toe, Mr Edwards will select the treatment best suited for you. If an infection is present, an oral antibiotic may be required.

Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.

If you don’t have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom’s salt may be recommended by your doctor), and gently massage the side of the nail fold to help reduce the inflammation.

Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it’s time to seek professional help.

Sometimes a minor surgical procedure to remove the offending portion of ingrown nail is performed. This helps to ease the pain and resolve the infection at the toe. After applying a local anaesthetic, Mr Edwards removes part of the effected nail’s side border. This procedure is called a partial nail avulsion or PNA for short. Following this nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day.

Some nails may become ingrown again a the removal  (or Matrixectomy) of the nail root is required.

A Matrixectomy is the process of excising or destroying the effected germinal matrix of the nail. The germinal matrix is the area of the toenail in which the toenail grows from. The matrix is located directly underneath the cuticle.

When a partial Matrixectomy is performed, this means that only a portion (usually the sides) of the matrix is removed. The Frost and Winograd procedures are examples.

Frost Procedure: 
The Frost Procedure includes partial removal of the toenail by splitting the toenail longitudinally. An inverted “L” or hockey stick shaped incision is made in order to gain access to the nail matrix. The skin is flapped over to expose the nail matrix and removed. This procedure is indicated for ingrown toenails without a large overgrown nail lip.

Winograd Procedure:
The Winograd procedure includes partial removal of the toenail along with partial removal of the adjacent toenail lip or skin. When the skin along the side of the nail is very thickened and “bubbly” and significantly overlapping the toenail, it may have to be removed in order for the toenail to achieve a better result. The following picture depicts the Winograd procedure.

Many cases of ingrown toenails may be prevented by:

  • Proper trimming. Cut toenails in a fairly straight line, and don’t cut them too short. You should be able to get your fingernail under the sides and end of the nail.
  • Well-fitted shoes and socks. Don’t wear shoes that are short or tight in the toe area. Avoid shoes that are loose, because they too cause pressure on the toes, especially when running or walking briskly.

 

What you should know about home treatement

  • Don't cut a notch in the nail. Contrary to what some people believe, this does not reduce the tendency for the nail to curve downward.
  • Don't repeatedly trim nail borders. Repeatedly trimming does not change the way the nail grows, and can make the condition worse.
  • Over-the-counter medications are ineffective. Topical medications may mask the pain, but they don't correct the underlying problem.

For further advice or to make an appointment, please contact one of our professional team, our numbers and contact details are listed on the Contact page.