Ingrown Toenails

It can be painful when you get an ingrown toenail. You feel pain when the slightest touch occurs on the toenail, such as a bedsheet.

This condition is prevalent and affects all ages, from babies to the elderly; no one is immune.

Teenage boys and teens are at a prime age for this condition. The main reasons why are:

  • excessive sweating
  • poor hygiene
  • sports
  • poor nail cutting
  • a thin nail and
  • rapid nail growth.

The skin becomes damp and macerated, and with increased sport and rapid growth, the nail works its way into the skin. Mid to the lower portion of the side of the nail, and usually both sides of the nail.

What exactly is an ingrown toenail? It is where the nail is excessive, natural, or mechanically altered to cause pain resonating from the sulci (side skin of the nail)…a lot of words 🙂

I have split this condition up into two sections. Pseudo and True.

Most patients believe they have an ingrown nail because of poor nail cutting, but that is not always true, and usually, re-education is needed to reassure the patient and explain that this could be a reoccurring problem.

Many clinicians do not state this, leading to the patients believing the clinician caused the problem or failed to fix their problem. Pseudo nails are not ingrown toenails, but they fall into that category.

The main culprits are involuted and wide nails. Sometimes you find that a nail is just too wide for the toe. As the nail grows, it jostles for the position through the toe, and any mild amounts of trauma can cause a problem.

Unfortunately, this type of nail is hard to maintain because you will note that the actual redness and pain radiates from the middle part of the sulci (sides of the toe- where the nail meets the skin) down to the eponychium (base of the nail).

Cause of Ingrown Toenails

1. Involuted nail

involuted nail ingrown toenail
Here is an involuted nail (sometimes called a pincer nail. The picture is quite severe). However, the nail is hard to cut and could be uncomfortable, but notice that the skin hasn’t been broken.

2. Wide nail

ingrown toenail wide nail
If some patients have venous problems or are pretty significant, that also causes swelling; overlapping the skin causes an ingrown toenail. This is where you have a regular nail, but because the toe itself grows and overlaps, the area to which the nail grows reduces, causing ingrown toenails. This is very similar to nails too wide for the toe itself.

Some people also think that there is too much skin- in this case, the sulci skin is removed without touching the nail. Too wide nail? Too much skin? I prefer the too wide-nail idea.

3. Poor Nail Cutting/ Trauma

Then you have the traditional toenail that has been cut poorly, and a small spike of the nail is left, as seen in the picture.

By looking at this nail, you can easily see that a spike is present…if you go up from the purple cross, you can see very slight whiter skin around the scab- which means that a tip is pushing up under the skin.

Signs of an Ingrown Toenail

1. A lump on the side of the nail. This is where the war is going on. The body is fighting off bacteria and nails that are present. However, it can not attack the nail, so as the nail grows, it presses more into the skin, causing more swelling…and the cycle continues.

2. It can be painful to the touch, especially if there is a spike. You are pressing the tip into the skin, which causes pain.

3. Bleeding can be more prominent because of the very vascular nature of the bump on the side of the nail.

4. Smell. The area, after some time, can start to smell. This is because dead blood, white cells, and bacteria are building up. Usually, antibiotics take care of the infection, but they will not take care of the nail. We have seen patients on antibiotics for some weeks with the Doctor’s failure to refer on to get the nail sorted out.

5. It sticks to socks…because of the discharge and fluid that is being released. When you rip off your socks, you irritate the area even more.

Treatment for Ingrown Toenails

Treatment for Ingrown Toenails depends upon two things.

1. Where the problem is and,

2. How long they have had the problem.

For a problem like this, I would go and see a Podiatrist/ Chiropodist.

Many home treatments fail to do anything and can even worsen the problem.

I am active in the Yahoo Answers Community. Here is someone who posted a question and did a search online for help:

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Swollen big toe-ingrown/hangnail? So last week sometimes i clipped a piece of flesh/nail from the corner my big toe (right foot if it matters). i noticed a little stinging for a few days but it wasn’t until yesterday that it actually began to swell and turn dark around the cuticle. I goggle and self diagnosed a ingrown /hangnail, so i did the epsom salt soak then doused with peroxide and applied some triple antibiotic ointment. My problem now is that since i’ve done all that this evening, its actually gotten a bit more painful and swollen a little more. there is no pus draining its just the pain and discoloration. should i continue the epsom salt until at least weekend or just suck it up and go to the doctor now?

———–

The problem comes in the fact that peroxide, Epsom salts, and ointments will do more damage. They will make the area very wet and make the nail dig in further and get infection into moist tissue.

For most patients, conservative treatment methods for ingrown toenails are needed from a clinic. If the problem occurs from the tip to a quarter of the way down the sulci, then small nippers should quickly remove the offending nail with minimal discomfort to the patient. The clinician would then use a Blacks file to smooth the edge of any rough edges. It is a relatively painless 5-minute procedure.

If you have had one ingrown toenail, which is the one you are treating, then Nail Surgery is not advised, mainly because it is overkill- there is no need unless the nail is too bad to work on conservatively.

Usually, once the spike has been taken out, the toe will reduce itself to its original size, and the inflammatory reaction will reduce. Just like taking a splinter out of your skin, the site heals itself up without a problem once it has been done.

How to Cut an Ingrown Toenail

Treatment Options

1. Trimming & Soaking

  • At the first sign of an ingrown nail, soak the nails in warm water and Epsom salts (about 1/2 cup to a gallon of water) for 15 minutes twice a day.
  • After the nail has softened, trim the edge of the nail. (Do NOT trim down the sides of the nail, this will make the problems worse).

2. Wedge Resection

  • A wedge resection involves a trip to see a podiatrist.
  • A section of the nail is removed without an anesthetic.
  • For some types of ingrown nails, this will work well. But, there is a higher chance that the ingrown nail will return.

3. Antibiotics

  • Although antibiotics will treat the infection, they will not treat the problem.
  • They may be necessary for some instances of severe infection.
  • Antibiotics are commonly used to eliminate the infection before a definitive procedure.

4. Nail removal – temporary

  • A partial nail avulsion is the removal of part of the nail.
  • This procedure involves an injection of an anesthetic to numb the toe.
  • The nail is removed on one or both sides.
  • The nail always grows back in, but the idea is to allow the surrounding skin area to heal and inflammation to decrease before the nail grows back in.
  • This is a suitable procedure for 1st time ingrown nails, ingrown nails which started after an episode of trauma or a certain pair of shoes.
  • There is a high recurrence rate with chronic ingrown nails with this procedure.

5. permanent Nail Removal

  • This is called a matricectomy or matrix for short.
  • In most cases, only the side of the nail is removed, not the entire nail.
  • A chemical is used to kill the nail root, called the matrix.
  • This procedure involves an injection of an anesthetic to numb the toe.
  • About 5-10 % of the time, the nail will regrow.
  • This treatment is best for those with chronic ingrown nail problems and those with deformities of the nail bed.
  • As diagnosed by a physician, those individuals with poor circulation should not have this procedure done.

Related: Best toe protectors

Severe Ingrown Toenails

This is where it gets slightly gray.

The best, simplest, and most accessible treatment for severe or reoccurring ingrown toenails is the use of minor surgery. Now many clinicians have different methods and ways of doing this simple procedure; unfortunately, they can mess it up for everybody.

What we do is the following:

1. Assess the patient, making sure that they know what is happening, want it done, and discuss other treatment options.

2. Inject the toe with a local anesthetic, this does sting a bit, but then the whole toe goes numb. You will be able to feel tugging, but no pain is done right.

3. We test the toe- make sure you can not feel anything. If you can, we might wait longer (it takes 10 mins to kick in) or give you more- into an area where you can’t feel.

4. We then begin and, using specialized nail clippers, we clip the offending part of the nail away. If it is for the sides of the nail, we take both sides out, forces push over, and will cause an ingrown nail on the other side; if not also done, it looks better. If removal of the whole nail, we remove the nail.

5. Any nail removal comes with it the matrix- where the nail grows from. Any left behind will start the whole process again.

6. We then apply Phenol to the area where the matrix comes from. This stops the nail from growing back 97% of the time. We would not use Phenol in certain circumstances if we want the nail to grow back.

7. We dress the area and make sure the patient is OK, and then we see them back the next day and then every week after that, giving instructions on how to take care of the toe.

In all of this, the patient has not had their skin cut, can walk in and out of the clinic, and the procedure itself took 8 minutes. The body takes 4-6 weeks to heal the toe. It’s because of the Phenol that it takes so long, but you walk out pain-free 😉

If you go to the hospital, sometimes they surgically cut the matrix away, which increases healing time, and many times the nail grows back because they haven’t got all of it.

It depends upon the site of the ingrown toenails if there is an infection, and how long you have had it to decide what needs to be done.