Article 2 – ingrown nail series
An ingrown toenail occurs where a piece of nail pierces the flesh of the toe. It can be painful on use, in shoes and when in bed with the covers on it. It affects around 10,000 people per year in the UK, of which 20% of GP foot appointments are due in ingrown toenails.
Who gets ingrown toenails?
It is seen in every age group but is common amongst adolescents with a higher incidence in males. Adolescents are common due to incorrect nail cutting, picking, sports such as football and ill fitting shoes (feet grow faster than shoes replaced). Adults get changes in foot shape due to arthritis or nail condition such as fungal infections, and some are long term sufferers, not realising that nail surgery can correct the condition.
Ingrown toenails are thought to be caused most commonly by trauma and poor nail cutting technique but ill-fitting footwear, excessive sweating, poor hygiene, biomechanical factors and obesity can all contribute. Systemic disease, the aging process and congenital malformation are also causative factors.
What can go wrong?
The first toe is the most common site, but lesser toes can also be affected. The condition ranges from mild, which can be treated conservatively, to progressively more painful stages which need surgical measures to resolve.
It often presents with pain on the side or the top of the nail. Bacterial infections are common, especially if the nail is ingrown for a while.
If the nail remains grown into the skin, it means there is an open wound, even if you cannot see it. The body will attempt to close this hole by producing more tissue, this can build up next to the hole and become painful. It is known as hypergranulation tissue. This process makes the ingrown nail worse as the toe becomes enlarged and struggles to sit comfortably in a shoe.
This will impede walking and the ability to wear certain footwear affecting daily working and social life.
What can I do to help my ingrown toenails?
Regular toenail care
- Cut your nails regularly
- It is best to cut after a bath or shower as it will make them softer
- Use nail nippers not scissors
- Cut straight across, leaving the corner of the nail visible if possible
- Wash your feet daily, and change your socks daily
- Wear well fitted footwear
- Have children measured regularly
- Avoid footwear made by man-made materials (synthetics)
- Choose socks and shoes of natural fibre
- Be cautious when cutting if you have long term conditions such as diabetes, are taking steroids or are on anticoagulants
- Do NOT remove spikes of nails yourself – seek a podiatrist
- If you have a PAINFUL toenail – seek a podiatrist
- Are concerned or worried – seek a podiatrist
- In the case of any symptoms of a bacterial infection – seek a podiatrist
When the toenail is painful
Things that will help before you see the podiatrist:
- Bathe your toes – relieves discomfort and helps to clean the toes
- Use warm water – not HOT or COLD
- Dissolve a spoon of salt into boiling water then add cool water
- Soak for 2-3 minutes
- Leave to dry before adding a dressing
- Apply a sterile dressing – this will help to keep out dirt and minimise infection
- Wear footwear that will accommodate your toe with a dressing
- Avoid high impact sport whilst the toe is very painful (squash or climbing)
- Avoid adding creams to the toenails as bacteria may grow in it.
- Remove all nail varnish, the body treats it as a foreign object and may react worse.
- We advocate the use of clinisept+ LINK
- Order a nail care pack from us
For any patients that have foot care issues that do not resolve themselves naturally or through routine foot care within two weeks, it is recommended that you seek the help of a podiatrist
Will antibiotics get rid of my ingrown toenail?
Antibiotics will help with the bacterial infection from the ingrown nail, it will help reduce inflammation and may reduce your pain. These are symptoms, the nail unless removed will remain in the toe and will continue to cause you pain. You must treat the cause as well as the symptom. Antibiotics on their own will not get rid of your ingrown toenail.
What treatment is available for ingrown toenails?
Podiatrists treat ingrown toenails daily. The severity of the ingrown toenail would be assessed and treatment options offered accordingly.
These may include a small removal of offending nail (nail resection) or nail spike (nail spicule).
This treatment may not require anaesthetic and advice about long term treatment would be given including cutting and footwear.
Should the toenail be at a more severe stage that requires long term nail removal this will be advised. Long term includes the use of a chemical to prevent it growing back. The podiatrist will suggest this if they feel the nail is beyond regular management. The surgery known as Nail Avulsion is often a side (partial) removal of the nail and if required a total nail removal. This would be with local anaesthetic. It has a success rate of 97% in the UK when actioned by a podiatrist.
As podiatrists we are able to manage infected toes with antibiotics and administer all foot anaesthetics within our clinics. If you think you have an ingrown toenail please contact us we can help you at Zest Podiatry & Physio, alternatively you can book online.