What is an ingrown toenail?
An ingrowing toenail when the nail plate itself curves down towards the soft tissue on the side of the toe. This position of the nail causes the nail plate to press on the skin and sometimes the nail can pierce the skin and the soft tissue. This can cause pain and soreness that can feel sharp and throbbing. An ingrowing toenail is at high risk for becoming infected and these conditions should be identified and treated promptly.
How do toenails become ingrown?
There are many reasons that a person gets an ingrowing nail.
The anatomy of the foot and the toe are a large factor. A wide nail plate, a naturally curved nail plate, an enlargement of soft tissue at the nail borders, or an abnormality in the shape of the bone beneath the nail plate can all contribute to a patient getting an ingrown toenail.
Poor cutting technique at home or in a nail salon
Poor shoe choices including ill-fitting shoes that are too short or too narrow
Trauma to the nail can change the trajectory of nail growth or cause alteration to the structure of the nail plate itself
Fungus can cause nails to become thick, brittle, weak, and generally abnormal which can each lead to an ingrowing nail.
Biomechanical problems are a major and frequently overlooked cause of ingrowing nails. Bunions and abnormal angles of toes and bones are a major factor when it comes to how the toe takes the pressure and if the nail will sustain abnormal forces that can lead to an ingrowing nail. Limited or complete loss of range of motion at the big toe joint can also cause abnormal pressures resulting in an incurvated nail. More general structural foot problems like flat feet, excess, pronation and collapsing arches are all significant factors that can determine if one is prone to ingrowing nails.
How can I treat an ingrown toenail?
The internet is crowded with suggested home remedies for ingrowing nails but the fact is that most of these ideas can make a situation worse.
Fist contact a podiatrist and left them to evaluate the toe to determine the proper course of treatment.
One your doctor evaluates you and the ingrowing toenail they will determine which of the treatment options are right for you. Your doctor may recommend a clip out of the offending portion of the nail plate, temporary removal of the incurvated portion of the nail plate, or permanent removal of the part of the nail that is causing the issue. If an infection is present the infected tissue and fluid can be removed and drained at this time. Your doctor will discuss these options and recommend the proper treatment for you as an individual.
The vast majority of these treatments are quickly performed in the office and allow you to leave in normal shoes able to perform the normal activity. Any restrictions on activity will be based on specific treatments. Caring for the site after is easy and usually requires a basic band-aid dressing for a few days. If your toe was infected your doctor may advised you to apply antibiotic ointment on the site and or prescribe you a course of oral antibiotics.
How can I prevent getting an ingrown toenail?
Ensure proper cutting techniques. Cut the nails straight across, not down the sides. Don't allow the nail salon to cut too short or too deeply and do not allow any technique that causes pain or damage to the soft tissue around the nail.
Wear shoes that fit appropriately. If your shoes come to a point or are too narrow or short then they may need to be donated in exchange for something that appropriately accommodates your foot type.
Address underlying issues.
If you have fungal nails treat them. Your doctor can discuss with you the options of debridement, topical medication, oral medication, and laser therapy.
If you have a structural abnormality like pronation, flat feet, or bunions, be sure to manage them with the appropriate treatment. Your doctor can advised you on the best course of action, whether it be conservative splinting and shoe modification, surgical correction, or simply a custom made orthotic to optimize your foot structure and mechanics.
The take-home point here is that if you have pain in the toe get it looked at. Don't try to self treat it. At Advanced Podiatry, we are happy to discuss your issue, how it came about, how to treat it, and how to make sure you are walking pain-free as soon as possible. If you need anything or have any questions please give us a call. Our 10 doctors are all available to discuss your issue and we can even do the appointment virtually or over the phone to get things started!
Stay safe, be well.