Ingrown nails, also called onychocryptosis, are one of the most common conditions we treat at our Shellharbour clinic. If you have ever suffered with one, you will know just how painful they can be!
Below is some information about ingrown toenails including signs and symptoms, associated risk factors and causes, prevention techniques and treatment options.
What is an ingrown toenail?
An ingrown toenail occurs when part of the nail – most commonly the inside or outside edge – grows into the skin surrounding it. This can cause localised irritation, inflammation and discomfort. In more severe cases, the nail can actually penetrate the skin leading to an infected ingrown toenail.
Initially symptoms are mild. You may feel some discomfort in tight fitting shoes or when the blankets are resting on the end of your toe in bed. If left untreated an infection may develop. The toe may become more swollen, red and pus may be present. There may be toenail pain even with the lightest pressure on the nail and life can become pretty miserable!
Ingrown nails can be classified into three stages of increasing severity:
Stage 1 (mild)
- The skin surrounding the nail becomes red and perhaps mildly swollen.
- Direct pressure on the nail will result in toenail pain.
- The toenail may or may not have broken through the skin.
- No pus or drainage.
- Consider seeing a podiatrist if things don’t improve or if the pain is bothering you.
Stage 2 (moderate)
- The toe becomes increasingly red, swollen and painful.
- Wearing shoes that place pressure on the ingrown nail causes pain.
- There may be pus in the fold between the nail and skin.
- Infection has likely developed.
- You should make an appointment with a podiatrist.
Stage 3 (severe)
- Redness, swelling and pain are increased perhaps with redness moving further toward the base of the toenail.
- Hypergranulation tissue (proud flesh or overgrowth) forms at the fold between toenail and skin.
- More severe infection with fever may follow.
- You should have made an appointment with a podiatrist yesterday!
No ingrown toenail blog post would be complete without a few gory photos! Here are some cases we have seen recently at our Shellharbour podiatry clinic:
Risk factors that may increase your chance of an ingrown toenail:
Improper cutting technique
Cutting the nail too short or cutting down the side of the nail unnecessarily
Chemotherapy and some medications
Some chemotherapy medications such as doxorubicine and paclitaxel can cause changes to the nails that increase incidence of ingrown nails. This also goes for some acne medications such as isotretinoin.
Tight or ill-fitting shoes
This can cause compression at the forefoot and toes which push the skin surrounding the nail against the nail itself.
Stubbing or having your toe stood on can cause the nail to penetrate the skin.
This increases the chance that the inside or outside edge of the nail will grow into the skin.
Soccer / football boots
Are often narrow in the toe. This causes compression and crowding, encouraging an ingrown toenail
Thickened nails are more difficult to cut, increasing the chance of an ingrown nail
Fungal toenail infection
Fungal toenail infections can cause the nail to change shape and become thick.
Pregnant women often suffer with swollen feet, particularly in the third trimester. This can cause the skin to come up around the nail and unfortunately lead to ingrown nail problems.
Who is most affected?
Ingrown toenails are common and most people will suffer with one at some stage in their life. Perhaps the most frequent group we see them in is kids and teenagers. Kids feet are always growing which means that shoes may become tight and ill-fitting causing increased pressure at the nail. Children also participate in sports where greater pressure is placed on the toes such as soccer, ballet, netball and football. We find teenagers are also more susceptible due to increased sebum production, an oil that is produced in the skin. This means their skin is softer and the nail can dig in and ingrow more easily.
What can happen if it is not treated?
If the affected toenail is left untreated the toe will become more red and inflamed. Pus and infection may develop. If not dealt with appropriately this infection can continue to fester and result in severe pain that will make regular daily activities particularly difficult. Early treatment is extremely important for people with diabetes or poor peripheral blood flow as their risk of infection and complications is even greater.
Ingrown toenail treatment options
The good news is that with a trip to the podiatrist you can walk out with your toe feeling a whole lot better!
Initial conservative treatment involves removing the segment of nail that is causing the issue. This can usually be done without causing too much pain. Please don’t be concerned about the pain. Ingrown toenail removal doesn’t have to be a painful experience if good technique and local anaesthetic is used.
Prevention is better than cure! We always make sure to educate patients on how to avoid an ingrown toenail in the future through good cutting technique and avoiding problematic footwear or other risk factors (see above).
Ingrown toenail surgery
If the ingrown toenail is a recurrent and ongoing issue, a permanent removal of the problematic edge (or edges) is recommended. This is a minor procedure, often referred to simply as ingrown toenail surgery or a partial nail avulsion, which involves the nail edge being removed under local anaesthetic and the nail matrix destroyed. The small section of nail that causes the problem will not grow back. This procedure is performed within the clinic in a sterile environment to reduce the risk of infection. It is relatively pain free and only requires you to take it easy for a few days while your toe recovers.
If you have any questions about ingrown toenails or any type of toenail pain please don’t hesitate to get in touch!