Ingrown Toenails

Ingrown toenails are one the more common foot problems treated by a Podiatrist. They can be very painful, with people limiting their activity to keep off their sore feet.

Ingrown toenails are caused by impingement of the skin along the margins of the nail by the nail plate. Some ingrown toenails are chronic, leading to repeated episodes of pain and infection.

Pain can be present without infection, and occasionally infection is present without pain. The usual signs of infection include: redness (erythema), swelling (oedema), increased warmth (calor), and pain.

Symptoms

• Pain along the margin(s) of the toenail
• Aggravated by wearing shoes, particularly those with narrow toes.
• In growing nails may be sensitive to any pressure, even the weight of  bed linen can be very uncomfortable
• There may be signs of infection.
• There may be drainage of pus, or a watery discharge tinged with blood.

Causes

• Abnormally shaped nail plate
• Improper trimming of toenails
• Tight fitting shoes which compress the toes together
• Socks or stockings that are too tight 
• Other toenail deformities (i.e. excessively thick nail plate)
• Trauma to the nail plate or toe

What you can do

• Cut toenails straight across, and leave slightly longer then the end of the toe
• Avoid tight-fitting foot wear
• If discomfort develops try soaking the foot in a basin of very salty warm water two or three times a day. If you are diabetic or have poor circulation the water should never be more than 35 degrees Celsius or 95 degrees Fahrenheit. Contact a state Registered Podiatrist  or Doctor immediately (qualifications for Chiropodists and Podiatrists are very confusing- but state Registration is the only qualification for Chiropodists and Podiatrists that is recognised by the  N.H.S.).
• An infected ingrown nail requires prompt professional attention.

What the Podiatrist may do

• Trim the offending spike of nail to relieve the pressure. Callous (dead skin) may have accumulated in the nail groove, which needs to be removed. Routine ingrown toenail care may need to be done periodically.
• Elevate the end of the nail plate to prevent impingement on the soft tissues
• Surgically drain an infection
• Prescribe special soaks and/or antibiotics
• Surgically correct a chronic ingrown toenail
• Completely remove a deformed toenail so it will not grow back.
• Remove the offending section of nail under local anaesthetic and permanently destroy the specific section of offending nail. This is procedure is known as phenolization- Click on the link below to read a Times online article about ingrowing nails and phenolization. www.timesonline

Complications of an ingrown toenail

• Infection, if present, may spread to the foot and leg, or into the blood stream causing septicaemia and other life-threatening complications
• Loss of nail plate from infection or inflammation of the nail bed.
• Chronic ingrowing nails can cause deformity of the nail plate and/or surrounding soft tissues.
• A small benign tumour called a granuloma can form along the nail margin.
• Diabetics and those with poor circulation to the feet must never attempt to treat an ingrown toenail at home, consult  a Podiatrist or doctor immediately.