What are ingrown toenails?
Ingrown toenails or medically known as onychocryptosis is a common condition that can affect any of your toenails, but most commonly affects your big toe nail and can occur on either side of your nail known as the nail sulci. Ingrown toenails are a very common condition that presents in Podiatry clinics It develops from the toenail growing into the skin incorrectly. Ingrown toenails can cause pain and discomfort and show common signs of infection (pus, redness, swelling, hypergranulation). Whilst you may be tempted to get rid of your Ingrown toenail yourself that is the most common error and can cause more problems or make your Ingrown toenail worse and increases your chance of infection.
What causes ingrown toenails?
- Incorrect cutting of your toenails
- If you cut your toenail to short or curl/ taper your toenails inwards this encourages and causes the toenail to grow inwards into the skin of your toe resulting in the nail to lay under the skin and cause increased pressure allowing callus build up.
- Naturally involuted (rounded/curved nail bed) or wide toe nail
- Unfortunately genetics come into play with IGTN (thanks mum and dad!) and the main common reason is that your toenail naturally like to be round in towards the skin or very wide and this can cause the nail to become Ingrown and if left untreated can be an Infected toenail
- Injury to your toenail:
- If you have had any trauma to your nail whether this is stubbing of the toenail/ toe, someone stepping on your nail, sport injury to the toe this can result in damage to the nail matrix changing the way that your nail grows out permanently and can cause the nail to naturally grow inwards.
- Incorrect cutting of your toenails
- Tearing, picking or biting your toenails
- We tend to find a lot of kids, teenagers and adults tend to tear, pick or bite their nails instead of using proper nail clipper or scissors to cut them this can result in nail spike or splitting of the toenail being left in the edge of the skin and resulting in an Ingrown toenail.
- Tight fitting shoes
- Ingrown toenails may occur due to wearing shoes that are too tight or too short and causing excess pressure place on the nail resulting in it changing direction and digging down into the skin
- Medical issues – diabetes, immunosuppressed, psoriasis or Raynaud’s
- Unfortunately some medical conditions do increase the chance of Ingrown toenail and in particular infected Ingrown toenails
What are the symptoms of ingrown toenails?
Ingrown toenails can look and feel different from person to person depending on the severity of the ingrown toenail.
The initial signs and symptoms of ingrown toenails will be tenderness, pain, swelling and redness. You may notice it will be more painful in shoes and socks compared to barefoot. You will most commonly notice this on the inner or outside of the nails bed, but can sometimes occur at the base of the nail as well.
Ingrown toenails can become infected which in when you will start to notice, pus or purulent (yellow/white or green discharge), increased swelling, throbbing, hypergranulation tissue (overlying red bump like appearance).
How are ingrown toenails diagnosed?
It is always important if you think you may have an Ingrown toenail or an infected toenail that you get it checked by a trained podiatrist.
When checking for an Ingrown toenail or an infected toenail the podiatrist will start by taking a thorough history. This will include what has caused it, family history, previous history and medical history.
After the treating podiatrist has a thorough history they will then have a physical look at the toenail and start evaluating the Ingrown toenail. The podiatrist will be feeling the area to see how deep/location of the ingrown is, visually what can they see (redness, swelling pus), they will also be checking to make sure the area is too warm and checking for tracking of any infection.
The treating podiatrist will then start to inform you of options based on all the information gathered.
What are the treatment options for ingrown toenails?
Any individuals or people who may have an ingrown or infected toenail know exactly how painful it can be. However, there are many ways to solve an ingrown toenail.
There is a lot of information on the internet regarding how to best treat an ingrown toenail or an infected nail at home. One of the most common ‘home treatments’ includes cutting a “V” in the middle of the toenail or digging/pulling out parts of the nail where it is painful. We advise against doing these treatments at home as they should only be performed by a trained podiatrist.
If you are waiting for an appointment or want to try a more conservative approach before seeing with one of our Podiatrists, here are some tips to keep the ingrown toenail from becoming worse:
- Salt water baths – soaking your feet in lukewarm water and a tablespoon of salt for about 5-10 minutes daily decreases your risk of infection
- Betadine dressing -. Applying Betadine is an antiseptic that will help to reduce the area from becoming infected/ more infected. Apply to the affected area along with a bandaid to protect it from infection.
- Wear open-toed shoes or shoes with a wider toe box – this ensures that the ingrown is not pushing on the other toes or against the side of the shoe.
Podiatry Treatment – Conservative management:
Once your Ingrown toenail has been assessed a management plan is developed and your treating podiatrist will discuss this with you in your appointment.
Our first ideal option is to always go for a more conservative approach to treating an Ingrown toenail.
From identifying the cause of the Ingrown toenail and checking for nail spikes you treating podiatrist will use a clippers and a small blade to remove the nail spike. This is a low risk option with minimal pain experienced. After the nail spike/ Ingrown toenail has been removed the podiatrist will check the area through palpation to ensure that the pain has reduced/ is gone. Note there will still be inflammation/ redness present for a few days post treatment. The area is cleansed and dressed appropriately. This may include the area being packed with a small piece of foam underneath the nail to aid in regrowing of the nail properly and then dressed betadine and cutiplast.
Your podiatrist will review your Ingrown toenail one week later to determine if further treatment is needed or a follow up is needed to avoid the recurrence of the painful nail.
Your podiatrist may discuss a more permanent option with you this is known as a Partial Nail Avulsion (PNA) or less commonly but sometime necessary a Total Nail Avulsion (TNA).
This is a small procedure that is done in the treatment room where a section of the nail or the entire nail is removed under local anaesthetic. This can be done with or without cauterization of the nail bed. This procedure can be used to provide long term relief for recurrent ingrown toenails or for a nail that has been damaged and is no longer growing properly. The resultant nail will be approximately 3-7mm narrower following a partial nail removal and no nail will be present following a total nail removal.
After having a PNA or TNA for your Infected or Ingrown toenail your podiatrist will provide you with information regarding the following 72 hours. This will involve only taking Panadol if pain relief is needed, no nurofen or aspirin. Keep your foot elevated as much as possible and wear a wide or open toed shoe. More information will be provided through a handout should you need this procedure.
Complications of ingrown toenails
Complications with ingrown toenails and surgery are rare. Although there are small risks these can be
- medical conditions may increase the possibility of complications
- You may have a reaction or experience side effects from some of the drugs/chemicals (Local anaesthesia or cauterising chemical
- The wound may become infected post operatively and be painful.
- If you have reduced blood supply due to specific medical conditions (eg. diabetes) or smoking, healing may be delayed
- Ingrown toenails may reoccur.
- Change to the appearance of the affected nail
Preventing ingrown toenails
In order to prevent toenail, we advised not to pick, tear or bite toenails, always cut straight along the nail, do not curve or bend edges. If unable to cut your own toenails to come in for regular maintenance of your toenails.
Our Podiatrists are experts in treating ingrowing toe nails. We would love to be part of your journey to rid you of your toe nail issue. You can book in to see a Podiatrist who will be able to effective treatment of an ingrown toe nail and provide you with a structure management plan.
Call 03 9553 0044 or make an appointment HERE for your nail assessment with one of our team!