A lady walked into the Clinic a week ago, and as she started explaining her condition, it was realised that while I did an article on ingrown nails, particular emphasis needed to be placed on treatment options, as many aren’t aware of what is advised.
A very common occurrence, an ingrown toenail develops when the sides of the toenail grow into the surrounding skin. The nail curls and pierces the skin, which becomes red, swollen and tender. The toe can also feel painful when pressure is placed on it. The big toe is most likely to be affected, either on one, or both sides.
Ingrown toenails can occur due to:
• incorrectly cut toenails
• tight-fitting shoes
• nail infections
• natural shape of the toenail.
There are several things you can do yourself to treat mild ingrown toenails and prevent them from getting worse, such as:
• trimming the nail straight across to help prevent it continuing to dig into the surrounding skin
• wearing comfortable shoes that are not too tight, and have space in the toe box area.
Lifting the nail
For a slightly ingrown nail (redness and pain but no pus), your doctor or podiatrist may carefully lift the ingrown nail edge and place cotton, dental floss or a splint under it. This separates the nail from the overlying skin, and helps the nail grow above the skin edge. At home, you’ll need to soak the toe and replace the material daily.
Surgery may be recommended in cases where an ingrown toenail is more severe. This may involve either removing a section of the affected toenail, or removing the whole nail. Left untreated, an ingrown toenail can cause the toe to become infected.
If your toenail does not improve, your GP or podiatrist may recommend that part or your entire toenail is surgically removed.
Partial nail avulsion
This is where part of your toenail is removed. It is the most common surgical procedure for treating ingrown toenails, is highly effective, and done under local anaesthetic. The edges of your toenail are cut away to make the toenail narrower, and give your nail a straight edge. This makes it less likely to dig into the surrounding skin. During the procedure, any pus will be drained away from your toe to prevent the area becoming more infected. If your nail is infected, a course of antibiotics may be prescribed.
Total nail avulsion
Total nail avulsion involves removing the whole toenail to reduce the risk of an ingrown toenail developing in the future. The procedure may be recommended if your nail is thickening and pressing into the skin surrounding your toe. As with partial nail avulsion, total nail avulsion is carried out using local anaesthetic. During the procedure, your toenail will be removed and you will be left with the indentation (the concave area of skin), where your toenail used to be. It is perfectly safe for you not to have a toenail and your toe will continue to function normally.
General rule of thumb
If you have the problem repeatedly on the same toe, your doctor or podiatrist may suggest removing a portion of the nail along with the underlying tissue (nail bed). This procedure may prevent your nail from growing back. Your doctor or podiatrist will use a chemical (phenol), to prevent re-growth, laser, or other methods.
After nail surgery
After having nail surgery, your toe will be wrapped in a large sterile bandage. This will help stem any bleeding and prevent infection. You should rest your foot and keep it raised for 1 -2 days after the operation.
After the anaesthetic has worn off, your toe may be sore and tender. To help reduce any pain, you may need to take painkillers and wear soft shoes or open-toed sandals for the first few days following surgery.
A final word, if you’re diabetic, greater caution has to be exercised when attempting to handle or treat the problem. Do NOT try to be your own GP or podiatrist as so many do; you could end up worse off for the effort!
Your feet mirror your general health . . . cherish them!