Ingrown Toenails

A close up of a woman cutting the nail of a big toe on someone's foot. A red highlighted area indicates pain.

What is an ingrown toenail?

An ingrown toenail; onychocryptosis, is a common problem amongst people of all ages. They can interfere with your sporting activities, school or work, thus impacting your quality of life.

Ingrown toenails occur when the nail begins to protrude into the skin surrounding the nail or nail base. This causes trauma and inflammation, resulting in pain. Unfortunately due to trauma that the nail has caused to the skin, it creates a portal of entry for infections. If your toe becomes infected, this can increase your pain rapidly. 

Causes & risk factors

Your nails grow from the nail root that is located beneath the skin of your toe. This area is called the nail matrix and it can vary in size and shape. Your nails may produce a nail which is flat or curved, wide or narrow. Everyone is different.

A diagram showing the different shapes of people's nails and the nail matrix

Those people with curved or wide toenails are more prone to developing an ingrown nail, which occurs when the nail grows into the skin edges that surround it.

Apart from an abnormal nail shape, common causes for ingrown toenails include:

  • Improper nail cutting
  • Nail picking habit
  • Tight fitting footwear especially
    • High heels
    • Pointed toed shoes 
    • Some sport shoes, especially football and soccer boots
  • Abnormal nail shape (excessive curvature of nails)
  • Sweaty feet
  • Poor hygiene
  • Bunions 
  • Poor foot movement patterns 
  • Trauma to the nail 
  • Fungal infections
  • Although rare, bone spurs under the nail may be a cause of ingrown toenail

Symptoms

Ingrown nails may cause pain at the end of the toe or all along the edge. Apart from localised pain, ingrown toenails may also present the following symptoms:

  • Hot, swollen and tender area
  • As the condition worsens, it may become red and infected with increased pain
  • Pain is often worse when wearing shoes or under bed sheets
  • Sore to touch
  • In more severe cases, there may be oozing pus present and growth of hypergranulation tissue

A big toe with a yellow nail and severe ingrown toenail

Even though these features can quite successfully diagnose an ingrown toenail, your symptoms could also be a result of an involuted nail, a subungual corn or simply, a thickened nail. It is important to get an accurate diagnosis as incorrect treatment could damage the toenail, cause infections and worsen your pain. 

Treatment

Important Note:
If your ingrown nail is showing signs of infection;

  • Warmth 
  • Redness 
  • Discharge/Pus 
  • Pain and tenderness
  • Fever or feeling unwell 

You should seek out your GP or podiatrist immediately, as infections can turn from mild to severe quickly. 

Home remedies

If minor and there is no signs of infection, you can try the following ingrown toenail home treatments to fix or decrease your pain:

  • Salt, warm water foot soak (1L of water: 1 tablespoon of salt) can reduce your swelling and relieve tenderness. Do this for 10-15 minutes once to twice daily. 
  • Filing the corners of the nail to smooth sharp edges 
  • Avoid tight fitting and pointed toed footwear 

In-clinic

If your ingrown toenail shows no sign of improvement after treating it at home, then it's time to consult one of our podiatrists.

At The Feet People, we have seen over 13,000 feet fixed and have been successfully treating ingrown toenails non-surgically and surgically. Even though ingrown toenails are a very common condition, it can be challenging to self manage, so it is very important to get a correct diagnosis and treatment plan which will suit your individual situation.

The goal of our initial appointment is to relieve pain and reduce any infection or inflammation that is a result of the ingrown toenail.

If your toe is not infected, we may be able to carefully trim the ingrown nail edge, without any discomfort. This is a non-surgical treatment of your ingrown toenail. We can continue doing this at regular intervals, usually four to six weekly, to prevent your ingrown toenails from flaring up.

Depending on the severity of the ingrown nail and whether or not your ingrown nail is recurring, we usually discuss a permanent solutioningrown toenail surgery under local anaesthetic.

Common nail surgeries include:

  • Partial nail avulsion (PNA) with matrix sterilisation: The PNA involves removing the edge of the offending nail then sterilising the nail matrix with a chemical called Phenol. This is the most common procedure as it is the least invasive.
  • Total nail avulsion (TNA) with matrix sterilisation: The TNA involves removing the whole of the offending nail then sterilising the nail matrix with a chemical called Phenol. This procedure is rare and is only recommended in select cases.
  • Wedge resection: A wedge resection involves cutting a portion of the skin to expose the nail matrix and removing either a portion of or the whole nail matrix. The skin is then sutured back together. This procedure is more invasive but usually has a quicker recovery time because Phenol is not used. This procedure is usually recommended in select cases and is only offered by some of our senior practitioners.

If the nail bed is phenolised, 97% of cases do not reoccur. 

Each procedure is painless as it is performed under local anaesthetic and the recovery time is minimal. Most people can return to work the next day, as long as they are able to wear an open-toed shoe (e.g. sandals/thongs) for a few days.

Prevention

Ingrown toenails are a painful condition and we need to do all we can to prevent ourselves from getting them. Unfortunately, you can't change your nail shape or avoid all external factors from increasing your risk. Hence not all ingrown nails can be prevented.

Nonetheless, there are a few things you can do to decrease your risk of developing ingrown toenails. 

  • Nails should be cut straight across and be filed around the edges to avoid sharp edges growing into the skin.
  • Footwear should not feel too tight around the toes and you should always allow a thumb’s width of room between your toes and the tip of the shoe.
  • People can also consider open-toe shoes/breathable shoes to help with sweaty feet.

FAQs

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