Ingrown Toe Nails

More people are complaining about their ingrown toe nails as winter comes and closed shoes are being worn more.

The most common cause of  an ingrown toe nail is poor self-treatment, but  there are numerous other factors, divided into intrinsic and extrinsic.

Common intrinsic(internal) factors are the basic shape of the nail – especially at the edges – we all have different curvatures and angles and some nails have increased curvature  on one side only.

Another factor is the structure and function of the foot (the biomechanics). If a flexible foot rolls or flattens excessively toes can rub against each other, causing pressure. Other factors can be sweaty feet and thin skin, caused by age, medication or circulation.

However, it is the extrinsic factors that really produce the problems – poor self-cutting and shoe pressure top the list. (Sometimes even health care professionals and therapists can cause ingrowns!),  tight socks and injuries can also be added to this list.

In the clinic, the appearance of  ingrown toe nails varies from a small pink swelling, to an inflamed growth or ‘proud flesh’, like a small cherry, lying over the nail plate. The pain seems to depend on the individual’s pain threshold more than the condition itself.

The offending nail can be just a small ‘shoulder’, pressing into the sulcus or a sharp spike of nail which penetrates the skin. The skin tries to heal itself when a spike penetrates it and that process leads to the formation of ‘proud flesh’ or hypergranulation tissue. Of course if the toe becomes infected then pus is also present.

Treatment for ingrown toenails varies with the cause and duration. The simplest treatment is correctly cutting out the offending portion of nail. In the more painful and complicated cases this is done under a local anaesthetic.

The permanent solution under local involves an operative procedure where the complete side of the nail including the matrix, is cut out and the matrix space is destroyed with a strong caustic. After about a month the side where the nail was looks normal – the cavity heals completely. This is a procedure that podiatrists do very well as an outpatient procedure.

Obviously avoiding  ingrown nails is the best, but nobody should suffer with them when skilled podiatric care is available.