Ingrown Toenails – Sometimes it’s the Little Things in Life that Hurt the Most!

Ingrown toenails can be debilitating! I’ve seen some of the most tough and resilient people brought undone by a little piece of toenail! If you’ve ever had one you’ll know exactly what I’m talking about. The mere thought of a tight bedsheet pressing on the toe can bring a grown man to tears!

So what are they, how do they happen and how on earth do you get rid of them? For all of you out there too scared to put your sore toe inside a shoe at the moment, read on…

What is an ingrown nail?

An ingrown nail happens when the edge of the nail grows into the surrounding skin and causes inflammation in the area. Sometimes they can get infected and can become red, pussy and bloody. The infection can also cause extra tissue to grow up, around and over the nail. This is called hyper-granulation and is the body’s response to the pressure. It can make your normally svelte toe look quite angry and swollen.

It is most commonly seen on the big toe but it can happen on any toe. 

It often starts as a bit of a sore nail (1) and then progresses to being sore and red (2) and finally sore, red and infected (3)!

What causes an ingrown toenail?

Ingrown nails can happen in a variety of ways. Sometimes you are just unlucky and they run in your family! Most things foot related are very hereditary and ingrown nails are no exception. It’s not so much the ingrown that is inherited, but more the type of nail and/or toe that you have. Some nails curl under (involuted), some nails are very wide and some toes are very ‘fleshy’ – all of these issues can lead to an ingrown nail. 

There are also some biomechanical factors that can lead to an ingrown nail. Hallux abducto valgus (or bunions) can lead to pressure on the nail plate which can cause it to change shape and grow in. Sometimes pressure from an errant 2nd toe can do the same thing. Even  the way you walk can lead to changes in the shape of your toenail and lead down the same path of pressure and pain.

Footwear can also play a big part in developing an ingrown nail. Tight or poorly fitting shoes can put pressure on the edge of the nail. Sometimes this will cause instant trouble but sometimes it’s a slow gradual change to the nail shape that will cause issues down the track. Steel cap boots are pretty famous (infamous?) for contributing to ingrown nails or for making a slightly ingrown nail worse as they are pretty unforgiving! They are specifically designed that way to protect your toes from outside forces but unfortunately it’s what is happening under the steel plate that can cause drama! Football boots are also pretty famous in the ingrown world as there is not a lot of space inside those babies and there is a lot of movement going on when you’re wearing them (side steps, stop/start, kicking, change of direction).

Trauma to the nail is another major cause of ingrowns. Macrotrauma like kicking the toe, tearing off a nail or dropping something on the nail can not only hurt like crazy but can also lead to an ingrown nail. Any major change to the nail plate or the nail matrix (under the nail) can lead to changes in the way that the nail grows. Sometimes it gets thicker, sometimes it changes shape and sometimes it does both! 

And then there is the last category – the way you care for your nails! Things like poor cutting technique, picking at nails, tearing nails, nail fungal infections, nail polish and even nail salons can all lead to ingrown nails. 

So, How do we Fix Them?

Sometimes an ingrown nail can be fixed by removing the cause. That is, stop picking your nails, wear better fitting shoes and cut your nails correctly. Other times, however, the nail is too far gone and you are left with 2 choices – regular maintenance of the nail to keep it comfortable or a more permanent solution that will solve the problem for good.

Option 1 – regular maintenance. This involves coming to see your podiatrist every 6-10 weeks to have the nail professionally cared for. The podiatrist will cut the nail and clear down the edges of the nail (the sulcus) to ensure there is no nail digging into your skin. It can be a little uncomfortable but it tends to keep the toe and nail out of trouble for a period of time. 

Option 2 – permanent solution! This is by far the best treatment for most ingrown nails. It’s a procedure called Partial Nail Avulsion (PNA). A PNA involves having a local anaesthetic into the affected toe and then removing the edge (sometimes edges) of the nail that is causing the drama. Once the nail edge is removed we use a chemical on the skin underneath that stops that piece of nail from ever regrowing. The rest of your nail is left in place and after a short period of time you will be left with a nail that looks very similar to your other nails but is completely pain free! It is a procedure that is done in the clinic, it is relatively risk free and does not have a long recovery time. All you need is a couple of days afterwards to take it easy and then you’ll be back to normal life. And wearing shoes without all the pain!

There is one more option that is similar to a PNA. It’s called a TNA or Total Nail Avulsion. This procedure is saved for the nails that are at the point where the only solution is to remove the whole nail. It is very similar to a PNA except instead of removing the edges, the entire nail plate is removed and the chemical is applied to the entire nail bed so that the nail doesn’t grow back. 

If you’ve ever had an ingrown nail, you will know how much it can affect your life. From making you uncomfortable in shoes to making you unable to go to work. It really is an easy issue to solve so don’t put up with the pain and discomfort. Come and see your friendly podiatrist for a permanent solution and get back to living your life the way you want to!