An ingrown toenail is a common problem where the corner of nail (known as a nail spike) curves down and digs into the skin. Big toes are the most commonly affected, but this can affect all toes.
Causes
- Ill-fitting shoes with an inadequate toe box
- Tight stocking
- Incorrect trimming of the toenail or a lack of regular trimming
- Trauma caused by repeated pressure (e.g. playing sports involving kicking or running) or injury by stubbing the toe
- Nail deformity caused by either fungal nail infection, psoriasis, or chemotherapy
- Hot sweaty feet causing the skin around the toe to become soft and easily penetrated by the toenail
- New nail growing wider than before after nail plate separation (e.g. following an injury or fungal nail infection)
- Genetic predisposition
Symptoms
- Pain or discomfort
- Redness
- Swelling
- Discharge.
- Over granulation – excess tissue growth on the side of the nail.
The last of these is an overreaction of the body to the ingrown nail where it is trying to reject the nail spike and heal itself.
Infection can occur in the toe itself or in extreme cases the infection may spread to the rest of the foot or leg. This is called cellulitis.
Cellulitis is an infection of the skin where the bacteria has entered the body from the ingrown toenail damage. If untreated, this can be dangerous and would need urgent medical attention.
Treatment for an ingrown toenail
Do not neglect an ingrown toenail. Dealing with it sooner is better than later.
Self-management
In the early stages where the symptoms are mild, the toe can be soaked in warm soapy water for 10 minutes (several times a day initially). Then the area should be carefully dried and an antiseptic cream such as Germolene applied. This will soften the skin and reduce bacteria on the skin surface.
This will also allow you to massage the skin on the side of the toenail and gently push it away from nail. Avoid wearing tight fitting socks or shoes. If possible, wear open toe sandals until the problem has resolved.
Getting advice and treatment
If the above does not work, you should seek advice from your GP, or a foot care specialist such as a foot health practitioner or chiropodist.
At TheFootNurse we can identify the cause of the discomfort and remove the spike of the nail. You may need a dressing following any treatment to help healing, reduce or prevent infection and prevent further trauma/injury.
During your consultation TheFootNurse can assess and establish the underlying cause for your ingrown toenail and give advice regarding correct footwear, how to manage hot sweaty feet and correct nail cutting technique.
You may also need antibiotics if you get an infection or symptoms do not subside.
We also offer a face to face or telephone follow-up appointment to check that the toe has healed properly and does not require further attention or intervention.
In cases where the ingrown toenail is reoccurring or not fully resolved with more conservative treatment, TheFootNurse may recommend referral so that a specialist can discuss further treatment including surgery with you.
In general, this will involve considering whether a partial or full removal of the toenail is needed.
Ingrown toenail surgery
This is often a simple quick procedure carried out under local anaesthetic. You can be referred by your GP, TheFootNurse or by self-referring to your local NHS podiatry service. There is often a wait for the initial assessment and surgery.
The procedure can also be accessed through most private podiatry services in your local area. The cost may vary from one practitioner to another so make sure you ask them for a full price which should include the initial assessment, surgery, and any follow up appointments.
There are several procedures available depending on severity of infection and potential post-operative complications. Theses surgical options include partial nail resection or complete nail excision with or without application of a liquid agent that stops any nail growing permanently (phenolization). Theses type of procedures are 95% effective and are safe in patients with diabetes.
Avoiding ingrown toenails
With the exception of being genetically disposed (blame the parents again! :-), the other causes of an ingrown toenail can be managed or avoided to some extent.
Bad shoes
Unfortunately, we become used to wearing bad shoes from an early age. Many styles of shoes force the front of our foot into too narrow a space.
This can cause a range of foot problems (calluses, corns, and bunions), but also increases the risk of an ingrown toenail developing.
We are not saying you have to bin those high heels, winkelpickers and cowboy boots.
But perhaps minimise wearing them and treat your feet to some foot-shaped shoes the rest of the time. Fortunately, in the last few years, better shaped shoes have become more common and much more attractive than the “sensible shoes” of yesteryear.
This could work for example on your commute, and whilst driving and has the bonus of saving wear on your more fashionable shoes.
Trauma
Sports (and some types of dancing) which involve an impact to the toe can cause an ingrown toenail.
You may not want to give up some activities, but try to be aware and minimise trauma. Make sure that the rest of your foot care is top notch. Check your toes more regularly so that you can deal with any problems early.
If your feet are at risk of injury at work, wear proper safety footwear (I wear my safety boots for gardening too!)
Poorly fitting shoes can also do this (even for gentler activities).
Get your feet measured accurately. We can do this, or a good shoe shop will. They should have a gauge which measures foot length and width accurately.
You may be surprised to find that the size of your foot has changed. Avoid just buying the size you always buy.
Excessive sweating
Some people have a condition which causes them to sweat a lot more than others even when it is not hot, or they are not exercising (hyperhidrosis – see further information below). But most of us will sweat when exercising or if it is hot. This make an ingrown toenail more likely.
You can reduce this risk by controlling the sweat:
- Choose suitable socks for your activity. There is a lot of conflicting advice about this on the Internet, but we advise to stay away from cotton and consider “wicking” socks.
- Plan to wash and dry your feet and change your socks after hot activities. Change your socks at least once during the day if you suffer from excessive sweating.
- See a pharmacist about foot powders and antiperspirants which help control moisture.
- Choose suitable shoes for your activity (e.g. consider vented rather than waterproof shoes/boots in hot weather).
Further information for an ingrown toenail
Please note that these are links to sites outside of our control. Although we have checked the sites at the time of writing and believe them safe, please browse at your own risk.
Some articles may contain descriptions and photographs of surgical procedures.
NHS advice on ingrown toenails (https://www.nhs.uk/conditions/ingrown-toenail/)
NHS Information on Hyperhidrosis (https://www.nhs.uk/conditions/excessive-sweating-hyperhidrosis/)