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Painful Toenails

Since returning from our Christmas break I have been inundated with patients with painful ingrowing or involuted toe nails so I thought I would let you know what an ingrowing toe nail is, how to recognise it and how to prevent them!

A true ingrowing toenail is one that pierces the skin of the toe and can be very painful. Sometimes it can weep or bleed in more severe case. They most commonly affect the big toenail, but can affect the other toes too.

In some cases people come to see me with a painful nail that hasn’t yet pierced the skin. We call a nail that is curling into the flesh but that hasn’t pierced the skin an involuted nail and although this is not technically an ingrowing toenail it can be just as painful. If you have an involuted toe nail it is likely to pierce the skin at some point and as such become an ingrowing toe nail so it is therefore very important that you seek medical input from a podiatrist as soon as you feel any discomfort with the toe.

Who gets it? Anyone can get an ingrowing toe nail and it isn’t always because of the way the nail has been cut (although this can be a cause). Those people who have sweaty feet are more prone because the excess moisture causes splits in the skin surrounding the nail. There are many causes of involuted or ingrowing toenails; Some people are prone to them because of a genetic predisposition causing the nail to naturally splay or curl out instead of growing straight, posture and gait (the way you walk) can also cause problems, a foot deformity such as a bunion or over pronation can also cause trauma, Cutting nails too short, or following the shape of the toe rather than the nail can also be a cause or tight footwear or hosiery can push the skin around the nail into it piercing the skin. Sometimes simply kicking something by mistake can lead to problems!

What can I do to prevent ingrowing toenails? Good foot and nail hygiene is very important. You should cut your nails straight across and not cut them too low at the edge or down the side. The corner of the nail should be visible above the skin, don’t be tempted to cut them following the shape of the toe.

Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials and choose socks and shoes of natural fibre. In the summer, wear open-toed sandals where possible. Ensure you have good fitting shoes and buy seamless socks or turn seamed socks inside out to prevent rubbing.

What to do if you are in pain or think you have an ingrowing toenail?

Contact your podiatrist and make an appointment as soon as possible. Whilst waiting for your appointment review your footwear – is there a shoe with more room? Ensure they are properly fastened to avoid movement when walking. If the skin has been broken or there is pus or blood, keep the toe covered with a dry dressing such as melolin, try and avoid Elastoplast as this can make the area soggy. You should soak your foot in a warm bowl of salt water for 5 mins every day, applying a clean dressing after toe is dried. This prevents infection and reduces inflammation. If the toe is red you should monitor for this redness spreading. If you feel it has spread you should contact your GP for antibiotics immediately.

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove the ingrowing spike of nail yourself. What can a podiatrist do? It depends on the severity of your condition. For the most basic painful and irritable ingrowing toenail, your podiatrist will remove the offending spike of nail and cover with an antiseptic dressing.

If you have involuted nails, your podiatrist may remove the bit that’s curling into the flesh and file the edges of the nail to a smooth surface. If you have bleeding or discharge from an infection, you may need antibiotics to beat the infection as well as having the offending spike removed.

If you are particularly prone to ingrowing toenails from underlying problems such as poor gait, your podiatrist may recommend correction of the underlying problem as well as a more permanent solution to the nail itself, such as partial nail avulsion (PNA).


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