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Fellows Podiatry Blog

In-growing toenails

By November 1, 2022December 6th, 2022No Comments

What is an In-growing toenail?

An ingrowing toenail (onycocryptosis) is where a section of nail or a spike is pushing/piercing into the skin either at the side or the end of the toe.  It can cause a lot of pain and discomfort making walking uncomfortable and wearing footwear problematic.  A common complaint is the weight of the duvet causing pain when it rests on the toe in bed.

A nail spike pierces the skin and acts like a foreign body and the tissue becomes swollen, red, painful and can become infected.

Causes.

  • Poor nail cutting or nail picking can be the cause of an in growing nail, leaving a nail spike or a jagged edge.
  • Involuted nails can be hereditary, caused by trauma, resulting in a thickened nail plate and nail bed and some medications or treatments can cause involuted nails.
  • Bunions can cause rotation and deviation of the joint which can make the nail edge press on the ground, forcing the nail to curve and dig in.
  • Tight footwear, causes pressure on the side of the nails, pushing the nail edges into the skin.
  • Sweaty feet make the skin softer and easier for a nail to pierce the skin.

Treatment.

The offending piece of nail or a section of nail needs to be removed for the skin/tissue to recover and heal.

If the nail is not removed, then the problem is likely to persist.

If the problem is caught early and the nail spike is accessible at the top edge of the nail, it can often be removed easily using the correct instruments, quickly and with little discomfort.  If the in-growing nail has been a problem for some period of time, the tissue reacts and forms hypergranulation tissue which can engulf the section of nail, making it tricky to see the nail edge as well as it being very sensitive to touch.

Salt water can help keep the toe clean and can ease the pressure if there’s inflammation or infection.  Topical antiseptics and help localised, minor inflammation as well as topical antibiotic such as Fucidin. (prescription only medicine)

Oral antibiotics are sometimes needed if the infection and inflammation is not settling, or redness start to track further up the toe.  Please seek medical advice if this is the case.

Packing can be carefully put into the sulci, between the nail and the skin which can add some protection.  It can also allow space for the nail to grow forward and push the skin/tissue out of the way.

Local anaesthetic can be used to numb the toe which requires two injections.  Freeze sprays and numbing gels aren’t that effective in my experience.  Once the anaesthetic is administered, there is no pain, and it is easier to get to the offending spike.

Nail surgery is an option where there is a reoccurrence of an in-growing nail, or the nail is becoming difficult to manage and is causing pain/discomfort.  Blog post to follow on nail surgery and recovery.

Nail cutting and management.

I advise to cut the nails straight with a slightly rounded corner, without cutting down the side of the nail.  Cutting a nail straight across can leave sharp corners and a nail naturally has a slight curvature, therefore following the free edge of the nail in most cases is perfectly safe.  Nail cutting can become more complex when a nail is involuted and has a very curved or ‘n’ shaped appearance. (Looking at it from the top end.) Very involuted nails can almost curl around so much and the edges meet together forming a circle, pinching the skin together.

If you have difficulty in cutting your nails, have painful nails or just want some advice, please contact me and book a friendly consultation for professional treatment and advice.  Self-treating can often result in problems.

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