What are ingrown nails?
Ingrown toenails is the most common treated condition in children and teens that podiatrists at AllCare Foot & Ankle treat. This problem is most commonly seen in the big toe, but with improper cutting can occur in small toes. The term "ingrown toenail" is often used to describe a number of problems that lead to pain and discomfort around the nails despite the fact that in many cases, the nail does not actually "grow" in to the skin around it.
What causes pain around the nails?
- Improper cutting. A True ingrown toenail (onychocryptosis) is where a small nail spike pierces the skin leading to pain and infection. This normally occurs at the tip of the nail along the sides when a spike in the nail is left from improper nail cutting techniques or trauma. Watch our video for proper cutting of nails.
- Tight fitting shoes. Poorly fiiting shoes restrict room for nail growth and can cause micro trauma which can lead to ingrown nails.
- Incurvated nails. Sometimes nail edges curve into the skin either due to trauma, changes in the bone under the nail or a congenital disorder.
- "Chubby toes". People with chubby toes will find the skin at the sides of the toe, is more likely to be traumatized or pierced by the nail as it grows.
- Arch height can lead abnormal propulsion when walking causing the weight of the body to "roll over the side of the big toe instead of propelling straight over the top. Due to repetitive compression on toes an ingrown nail can result.
- Poor skin hydration/dry skin around sides of the nail can lead to extra pressure and cause pain and even infection.
- Genetic. Sometimes the shape of the nails that we have inherited from our parents can put us at a higher risk of developing ingrown toenails such as wider nail plates, "chubby toes", or nails that curl around.
- Trauma. Either an acute injury near the nail or anything that causes the nail to be damaged repetitively (such as playing soccer) can also cause an ingrown nail. Common traumas include: once off occurrences such as dropping a brick on your toe; or continual micro trauma such as lots of little knocks from activities such as running, sports or wearing pointy toed shoes
Ingrown toe nail
Involuted Toe Nail
How are ingrown toenails treated
Ingrown toenails can be treated two ways. Conservatively with care from a podiatrist, a change of cutting techniques, salt water soaks, shower etc. When bad enough a nail surgery is the only option to get quick, lasting relief. Nail surgery can either be permanent or temporary depending on the situation or your preference and can be discussed with your New Jersey Podiatrist. When surgery is required we perform nail surgery in our office typically the same day to remove the side of the nail that digs in to remove the pressure from the area to allow it to heal. If you are concerned about what is done during this removal watch our video.
Treatment without surgery may include:
- Toenail Salt Water soaks will not cure ingrown toenails, they are often recommended as the first step for newly infected nails before antibiotics can be obtained. It is suggested to soak your foot in a salt water foot bath ( 1 tbs spoon of salt in a liter of luke warm) for 10 mins and follow by dressing with antibiotic liquid or ointment and a fabric bandage until you can be see by a podiatrist.
- Remove pressure from area. This can achieved by wearing less pointy shoes or using paddings to deflect pressure away from the area of pain such as toe spacers.
- Antibiotics. Antibiotics are important if your nail is infected. However, antibiotics rarely solve the problem alone. Whist the toe may often seem to improve while on the antibiotics, the infection often returns once the course is finished, especially if there is a nail spike piercing the flesh.
If ingrown toenails are a recurring problem, it is generally recommend that a podiatrist performs an in office procedure whereby the offending piece of nail is removed either on a permanent or temporary basis.
The most widely used procedure involves a simple nail wedge resection and matrixectomy with phenol. This is an "in office" procedure done under local anesthesia. After the ingrown nail is removed, the growth plate (matrix) is destroyed using the repeated application of phenol, a chemical designed to stop the nail growing back. After the local is applied, it is often a fairly pain free experience with most people reporting little to no pain after the procedure and being able to go back to work the next day.
b) cutting of nail
c) removal of ingrown nail edge
d) application of phenol chemical
to stop nail growing back again