An Ingrown Problem

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Despite how common ingrown toenails are, this does not make them any less painful. They can often be a very distressing factor of everyday life if left untreated and can put (in particular, elderly) sufferers at risk of poor mobility, falls, and de-conditioning. They can also be a nidus (source) of local infection if not managed appropriately by your GP or surgeon.

 

What are ingrown toenails?

Ingrown toenails can affect anyone at any stage of life, as early as childhood. For some reason (elaborated on later) compression of the nail bed leads to penetration of the nail into the cuticle (the dead skin at the base of your toenail or fingernail). This sets up a ‘foreign body reaction’ much the same way your body rejects a splinter of wood that finds itself under your skin. This causes inflammation and most crucially, pain.

There is no shortage of causes for why ingrown toenails develop, including:

• Improper toenail cutting technique
• Tight-fitting footwear
• Traumatic injury
• Nail plate thickening
• Pincer-shaped toenails
• Pressure from other toes due to foot deformity
• Rarely, use of some medications

 

What can I do about it?

Ingrown toenails are a condition that can be treated by most GPs. They may try to treat you with conservative measures before attempting surgery.

Conservative treatment involves:

• Careful trimming of the affected corner of the nail
• Applying antiseptic cream/ointment
• Applying an antiseptic dressing on top
• Sometimes, referral to a podiatrist (foot care specialist) for trimming and filing down the overgrowth of skin that develops
• Placing small pieces of cotton wool under the corner of the nail to protect the skin

A more invasive form of GP treatment may include resection (removal) of the offending piece of toenail. This will involve:

• Injection of local anaesthetic to the affected toe in a ‘ring block’ will make your toe completely number for the rest of the procedure
• Pulling the part of the toenail that is ingrown until it is detached from the rest of the nail
• Any skin that looks infected and producing pus or an ulcer will be removed also and cleaned
• A special dressing that prevents bleeding
• Oral antibiotics
• Soaking the foot twice daily in Epsom salt or saline solution until the wound is healed
• Surgery is the last option, and is considered if the toenail becomes recurrently ingrown or if conservative measures have failed. In this instance, your GP may refer you to a general surgeon and you may be put on a short waiting list for the procedure. The most commonly performed procedure for this is called a 'wedge resection'.

 

How do I prevent ingrown toenails?

Cutting your toenails is not as straightforward as you may think! Many sources say to cut toenails straight across instead of cutting corners and leaving potentially sharp ‘spicules’ leading to ingrowth.

Wearing appropriate footwear that is not too tight and fits the contours of your foot will also prevent formation of these nasty pains.

Finally, avoiding trauma to the foot by playing sport and working with the right kind of foot protection may make all the difference.

 

References:

• Benzoni, T. (2016). Ingrown Toenails: Background, Pathophysiology, Epidemiology. [online] Emedicine.medscape.com. Available at: https://emedicine.medscape.com/article/828072-overview [Accessed 23 Apr. 2018].
• Bryant, A. and Knox, A. (2015). Ingrown toenails: the role of the GP. Australian Family Physician, [online] 44(3), pp.102-105. Available at: https://www.racgp.org.au/afp/2015/march/ingrown-toenails-the-role-of-the-gp/ [Accessed 23 Apr. 2018].
• Goldstein, B. and Goldstein, A. (2018). Management of ingrown toenails. [online] Www-uptodate-com.proxy.library.adelaide.edu.au. Available at: https://www-uptodate-com.proxy.library.adelaide.edu.au/contents/management-of-ingrown-toenails?search=ingrown%20toenails&source=search_result&selectedTitle=1~20&usage_type=default&display_rank=1 [Accessed 23 Apr. 2018].