Dr. Tariq Jagnarine
Family Medicine, Endocrinology
Ingrown toenails occur when the edges or corners of the nails grow into the skin next to the nail. The big toe is most likely to get an ingrown toenail. Ingrown toenails are treatable at home. However, they can cause complications that might require medical treatment. The risk of complications is higher if a person has diabetes or other conditions that cause poor circulation.
CAUSES
Ingrown toenails occur in both men and women. According to the National Health Services (NHS), ingrown toenails may be more common in people with sweaty feet, such as teenagers. Older people may also be at higher risk because toenails thicken with age. Many things can cause an ingrown toenail, including:
• Cutting toenails incorrectly (Cut straight across, since angling the sides of the nail can encourage the nail to grow into the skin.)
• Irregular, curved toenails
• Footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for the feet
• Toenail injury, including stubbing the toe, dropping something heavy on the foot, or kicking a ball repeatedly
• Poor posture
• Improper foot hygiene, such as not keeping the feet clean or dry
• Genetic predisposition
Using the feet extensively during athletic activities can make them especially prone to getting ingrown toenails. Activities in which it repeatedly kicks an object or put pressure on the feet for long periods of time can cause toenail damage and increase the risk of ingrown toenails. These activities include Dancing, Football, and Kickboxing
SYMPTOMS OF INGROWN TOENAILS
Ingrown toenails can be painful, and they usually worsen in stages. Early-stage symptoms include:
• Skin next to the nail becomes tender, swollen, or hard
• Pain when pressure is placed on the toe
• Fluid building up around the toe
If the toe becomes infected, symptoms may include:
• Red, swollen skin
• Pain
• Bleeding
• Oozing pus
• Overgrowth of skin around the toe
Treat the ingrown toenail as soon as possible to avoid worsening symptoms.
DIAGNOSIS
The doctor will most likely be able to diagnose the toe with a physical exam. If the toe seems infected, it might need an X-ray to show how deep the nail has grown into the skin. An X-ray can also reveal if the ingrown nail was caused by injury.
TREATMENT
Ingrown toenails that aren’t infected can normally be treated at home. However, if the toenail has pierced the skin, or there is any sign of infection, seek medical treatment. Signs of infection include: Warmth, Pus redness, and swelling
• Home treatment
To treat the ingrown toenail at home, try:
• Soaking the feet in warm water for about 15 to 20 minutes three to four times per day (At other times, the shoes and feet should be kept dry.)
• Pushing the skin away from the toenail edge with a cotton ball soaked in olive oil
• Using over-the-counter medicines, like acetaminophen (Tylenol), for the pain
• Applying a topical antibiotic, such as polymyxin and neomycin (both present in Neosporin) or a steroid cream, to prevent infection
• Try home treatments for a few days to a few weeks. If the pain worsens or there is difficulty walking or performing other activities because of the nail, see the doctor.
If the toenail does not respond to home treatments or an infection occurs, it may need surgery. In cases of infection, stop all home treatments and see the doctor.
Surgical treatment
There are different types of surgical treatments for ingrown toenails. Partial nail removal only involves removing the piece of nail that is digging into the skin. The doctor numbs the toe and then narrows the toenail. According to the NHS, partial nail removal is 98 percent effective for preventing future ingrown toenails.
During a partial nail removal, the sides of the nail are cut away so that the edges are completely straight. A piece of cotton is placed under the remaining portion of the nail to keep the ingrown toenail from recurring. The doctor may also treat the toe with a compound called phenol, which keeps the nail from growing back.
Total nail removal may be used if the ingrown nail is caused by thickening. The doctor will give it a local pain injection and then remove the entire nail in a procedure called a matrixectomy.
The toenail will likely grow back a few months after a partial nail removal surgery. If the entire nail is removed down to the base (the nail matrix under the skin), a toenail can take over a year to grow back.
COMPLICATIONS OF INGROWN TOENAILS
If left untreated, an ingrown toenail infection can cause an infection in the bone of the toe. A toenail infection can also lead to foot ulcers, or open sores, and a loss of blood flow to the infected area. Tissue decay and tissue death at the site of infection are possible.
A foot infection can be more serious if a person is diabetic. Even a small cut, scrape, or ingrown toenail may quickly become infected, due to the lack of blood flow and nerve sensitivity.
If there is a genetic predisposition to ingrown toenails, they may keep coming back, or appear on multiple toes at once. The quality of life may be affected by pain, infections, and other painful foot issues that require multiple treatments or surgeries. In this case, the doctor may recommend a partial or full matrixectomy to remove the toenails that are causing chronic pain.
PREVENTING INGROWN TOENAILS
• Ingrown toenails can be prevented by making several lifestyle changes:
• Trim the toenails straight across, and make sure that the edges do not curve in.
• Avoid cutting toenails too short.
• Wear proper-fitting shoes, socks, and tights.
• Wear steel-toe boots if working in hazardous conditions.
• If the toenails are abnormally curved or thick, surgery may be necessary to prevent ingrown nails.
