Treatments and Common Causes of Ingrown Toenails

Ingrown toenails are frequently the cause of pain in both adults and children, but what exactly is the cause of them? Oftentimes, ingrown toenails are caused by a combination of factors. These factors can range from the technique you use to cut your nails, to genetics, to footwear and more! As the causes of ingrown nails are varied, the treatments are varied too – this allows us to target each causative factor to the best of our ability.  Treatments may include regular podiatry treatment and safe cutting techniques at home, to nail surgery called partial nail avulsion where we permanently remove the ingrown section of nail and many more options in between.

What Causes ingrown toenails

  • Incorrect cutting of your toenails
  • If you cut your toenails too short or curl/ taper your toenails inwards this encourages and causes the toenail to grow into the skin of your toe resulting in the nail to lay under the skin and cause increased pressure and callus build up.
  • Naturally involuted (rounded/curved nail bed) or wide toe nail
  • Unfortunately genetics can play a role in the development of ingrown toe nails and the main common reason is that your toenail naturally curve in towards the skin or have a very wide nail plate. This can cause the nail to become Ingrown and if left untreated can become 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.
  • 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 a spike of nail, a nail spike, 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 on the nail. This results in the nail 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?

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, redness and swelling. 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 exudate (yellow/white or green discharge), increased swelling, painful throbbing, hypergranulation tissue (overlying red bump like appearance) and even a bad smell!

What Happens if an Ingrown Toenail is left untreated

An untreated Ingrown toenail is often not a pretty sight.

If an ingrown toenail is left untreated it may progressively increase in pain and discomfort. The area may become infected causing the toe to swell, become hot, throb and even exude pus. Additional tissue, called hypergranulation tissue, may grow as your body’s response to try to remove the ingrown portion of nail.

In some cases the ingrown nail may self resolve, however, you may begin to get ingrowns more regularly following this. The original ingrown nail and it’s inflammatory response may have resulted in scar tissue formation causing more pressure between the skin and the nail.

How can you avoid ingrown toenails

To avoid ingrown nails we need to minimise the causative factors of ingrown nails.

  • Cutting Technique: we advise to cut/ trim your toenails straight across without curving the edges. It is also important to make sure you’re not cutting your nails too short or leaving them too long.  If unable to cut your own toenails to come in for regular maintenance of your toenails.
  • Picking, tearing and biting: we advised not to pick, tear or bite toenails, always cut straight along the nail, do not curve or bend edges.
  • Tight footwear: Shoes should have about 1 finger width of extra length in the front of your shoes to prevent pressure on the tips of your nails. The shoes should also be wide enough so your toes are not squished together and are free to wiggle.

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 manage an ingrown toenail and treat ingrown toenails.

HOME TREATMENT:

There is a lot of information on the internet regarding how to best treat an ingrown toenail or an infected nail at home and prevent ingrown toenails.

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 2 tablespoons of salt for about 5-10 minutes daily decreases your risk of infection
  • Betadine dressing – Applying an antiseptic such as Betadine will help to reduce the risk of the area becoming infected/ more infected. Apply Betadine to the affected area along with a bandaid to protect it from infection daily.
  • 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.

Additionally, 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 you DO NOT DO this.  These treatments should only be performed by a trained podiatrist, if attempted at home you are at high risk of developing an infection.

Conservative Podiatry Treatment:

Once your Ingrown toenail has been assessed a management plan will be developed by your podiatrist on how to treat and manage your ingrown toenail in accordance to your goals.

Our first ideal option is to always go for a more conservative approach to treating an Ingrown toenail.

After 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 a portion of the nail. 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. If needed your ingrown nail will be reviewed regularly.

Surgical Podiatry Treatment – Nail Surgery:

If conservative management is not successful or if you are after a more long term solution 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).

A PNA involves removing a slither of nail from the side of the nail to relieve the pressure between the nail and the skin. The resultant nail will be approximately 3-7mm narrower following a partial nail removal. A TNA on the other hand involves removing the entire nail leaving no nail present following the procedure.

This is a small procedure that is done in the treatment room where a section of the nail (PNA) or the entire nail (TNA) is removed under local anaesthetic. This can be done with or without chemical 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.

At Home care following Nail Surgery:

After having a PNA or TNA for your 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. Keeping 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. If further signs of infection develop we may refer you to your doctor or GP to apply antibiotic therapy.

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