Dealing with painful Ingrown toenails

Ingrown or in-growing toenails are a very common condition. The most problematic areas are more often the 1st toe and perhaps the side of the second toe, if you are unlucky, it may even be on both sides of your nail.

Repeated trauma from footwear causes the nail to change shape so it becomes distorted over time. The alteration in the shape of the nail has been caused by damage to the growing area called the nail matrix.  Sometimes picking or tearing the nail edge causes a small section to grow downwards with a resultant opening up of the area to potential infection.

In appearance the side of the toe becomes puffy and swollen, the skin looks as if it has ‘burst’. The condition is called Onychocryptosis and the swollen ‘burst’ section is really Hypergranulation tissue, this being an overgrowth of tissue caused by the foreign object, in this case the sharp spur or splinter of nail.

If the nail is not producing Hypergranulation tissue but the area is simply painful to touch and reddened, it may be down primarily to footwear and the type of hosiery worn. All of these can have a major bearing on whether things improve at all.  A shoe with a shallow toe box area, a narrow width fitting or even plastic and fabric shoes, will make it much more difficult to treat.  Hosiery made from Nylon will increase the temperature inside a shoe: remember this material doesn’t absorb sweat—so where does it go? straight into the skin making it moist and smelly. The area that the nail grows along then becomes soft and the nail can puncture the skin allowing bacteria in —and a classic painful ingrown toenail can start. 

How can I treat this condition?

First thing is to allow plenty of room in footwear: your shoes should also be made of leather allowing toes to move and the skin to breath.  Having a pair of good quality nail clippers is important, because it certainly makes a difference to cut them properly- straight across if possible. A small ingrown nail file can be used to file carefully down the side therefore reducing the pressure on the skin. Finish off by using surgical spirit down the side to tighten up the skin. (This procedure should not be carried out if you are diabetic or your nail is infected) If you have a toe that presses against the second toe and hence aggravates the nail, use a shaped inter-digital silicone wedge to separate them. To help reduce the sweat and bacteria, wash your feet once or twice a day. Remember reducing the temperature can improve your general comfort; using socks with a high cotton content can also make improvements.

If the toe is badly infected or you have diabetes, a circulation problem or are taking anti-coagulants it’s very wise to consult your local Podiatrist or Doctor for advice. He may advise toenail surgery to either take away the nail or remove a small section permanently.

What happens during a toe nail operation?

Today this simple procedure is carried out under a local anaesthetic as an outpatient and you can return to normal activities almost immediately afterwards. The Podiatrist will discuss with you if you want the nail to grow back or not. Choosing to have the nail grow back is only recommended if the nail has been generally non-problematic up to the operation date. Secondly, discuss if it is necessary to have the whole nail removed or only the sides.  The Podiatrist will use a chemical, usually liquefied Phenol, to prevent the nail, or section of nail growing back. Subsequent dressings will roughly last about six weeks before final healing. Over this period the toe should be kept clean and dry between dressings, with the final outcome, a satisfactory pain free toe.

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