By John Sigle, DPM, FACFAS, Foot & Ankle Center of Illinois
Ingrown toenails are a common problem and many of my patients are in excruciating pain when they come in for treatment. In most cases, they have tried to treat it themselves by digging under their toenail with a sharp manicure scissors in the bathroom, or used a needle from the sewing box to drain the pus. Unfortunately, these actions only tend to worsen the infection. When asked why they waited so long to get treatment, their usual response is, “I was scared to have my toenail removed” or “I thought it would get better once the nail grew out.” Many battle the problem for years before seeking treatment. The reality is that if they had come in sooner, they may have prevented the situation from getting worse and relieved their pain faster. There are a variety of conservative measures that may be done at your home to resolve your condition and prevent further medical treatment. There are also non-surgical and surgical treatments available to provide fast relief of pain and effective recovery. After treatment, my patients go home feeling a whole lot better and generally wish they had come in sooner. There is absolutely no reason to suffer from ingrown toenails and to restrict your normal activities. Here is some helpful information to explain the causes, symptoms, complications, treatments, and preventive measures for recurring ingrown toenails.
What Are Ingrown Toenails?
Typically, your toenails grow straight out; however, this is not the case with ingrown toenails. Ingrown toenails occur when the corner or side of the nail grows into the skin instead of growing over it. The most common location for this occurrence is the big toe but other toes may be affected as well. Older adults who have curved, thick toenails are more susceptible to this problem but anyone can get an ingrown toenail. This condition is common among teenagers, particularly athletes who participate in football, basketball, soccer, track and cross country, and tennis.
What Are The Causes Of Ingrown Toenails?
There are many reasons why ingrown toenails develop. The main causes are related to improper toenail trimming (cutting nails too short or leaving a spicule of nail in the groove when rounding the corners), wearing shoes and socks that are too tight, and trauma (like stubbing your toes, getting them stepped on, or frequent jamming that occurs in athletics and fitness activities).
Other causes are attributed to genetics (where the nail is too large for the toe or the shape of the nail is curved), arthritis, diabetes, a change in body weight, a change in gait (usually attributed to an injury to the foot, leg, or back), and toenail fungus (a thickening of the nail and fungal infection in the nail bed).
What Are The Symptoms?
The most common symptom of ingrown toenails is pain as the nail gets embedded into the skin. If the nail gets infected, the symptoms are redness, swelling, soreness, tenderness, possible discharge of pus, and odor. A granulation of tissue (pink, fibrous, collagen-rich tissue) or proud flesh (tissue overgrowth) may also be present.
What Are The Complications?
Although ingrown toenails are a minor problem for most people, this condition may become quite severe for diabetics and people with poor circulation resulting in gangrene of the toe. Patients with pace makers and joint replacements are also at risk of bacteria spreading through the blood stream that may result in the spread of infection. It is critical for people at risk to seek medical treatment at the earliest sign of an ingrown toenail. Ingrown toenails may also cause a local infection of the nail fold (paronychia), scarring, and bacterial tissue infection (cellulitis). Chronic granulation tissue can even develop into a squamous cell carcinoma in rare occasions. A biopsy is often needed in chronic infections.
How Can I Treat My Ingrown Toenails Myself?
You can treat your ingrown toenails by yourself but it is critical to take precautionary measures to prevent more serious problems. Home care remedies include such things as soaking your foot in warm water three to four times a day, keeping your foot dry, elevating your foot as much as possible, wearing loose fitting shoes and socks with adequate toe space, and using ibuprofen or acetaminophen for pain relief. After soaking, you may use a sterile cotton tip to gently roll back the piece of overgrown skin. You may also gently lift the edge of the nail and insert a piece of sterile cotton or waxed dental floss between the nail and skin to facilitate drainage and to prevent further nail penetration. If this is done, change the packing daily. If your condition worsens and you do not see an improvement within two to three days, see your podiatrist.
What Are The Surgical Treatments?
If the conservative treatment does not work, minor surgery may be required. This is fairly simple and successful, and it provides long-term relief that is permanent. There are several procedures that may be used, and almost all of them are done in the clinic under local anesthetic. Probably the most common procedure is a partial matricectomy which involves the removal of the nail down the side of the nail that is causing the problem. In the worst case scenario, a complete matricectomy has to be done to remove the entire nail. In certain instances, we will allow the nail to grow back. The only time it will not grow back is when something is done to destroy the growth cells from regenerating the nail. The common way to prevent growth is to apply an acid to the growth center or surgically debriding the growth area. This treatment provides permanent relief.
What Can I Expect After Surgery?
It’s important to keep your foot elevated after surgery for few hours and rest. Patients are generally able to return to work or school the same day. I instruct my patients to participate in most activities on an “as tolerated” basis for a couple of weeks to facilitate healing and to wear loose fitting socks and shoes that do not put pressure on the surgical site.
How Can I Prevent Ingrown Toenails From Recurring?
The good news is that in the vast majority of cases, recurring ingrown toenails can be prevented by trimming your toenails properly, using good hygiene, wearing comfortable shoes and socks, and avoiding trauma to your toes. Athletes and people at risk have to pay even closer attention to protect their toes and to keep this problem from occurring again. If the condition recurs, use safe, conservative in-home remedies for a few days, and see your podiatrist if the problem worsens. You can avoid suffering and minimize down time if you follow these simple guidelines.
If you need assistance, contact the Foot & Ankle Center of Illinois at 217-787-2700 to schedule a visit with Dr. John Sigle. Feel free to visit our web site at myfootandanklecenter.com for more information and to view a short video about ingrown toenails and how to change your wound dressing.
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