Ingrown Toenail

What is ​​an Ingrown Toenail

An ingrown toenail occurs when the nail grows into the adjacent skin, causing discomfort, pain, redness, and swelling.

Occasionally, this may lead to an infection. While it can affect any toe, it predominantly occurs in the big toe. Ingrown toenails can be a source of severe discomfort, affecting daily activities and quality of life.

Symptoms

Ingrown toenails can manifest a range of symptoms, including the following:

• Pain and Tenderness: Individuals typically feel this along one or both sides of the nail.
• Redness: The skin surrounding the toenail often exhibits redness.
• Swelling: Swelling is often observed around the nail.
• Infection in the Affected Area: The affected area may show signs of infection. This is typically seen in the tissue around the toenail.
• Discharge of Blood or Pus: In some cases, the ingrowing toenail may leak blood and white or yellow pus, indicating a more severe infection​​.

Causes and Risk Factors

Ingrown toenails can be caused by a variety of factors:

• Improper Footwear
  Shoes that crowd the toenails, such as those with narrow toe boxes, can contribute to the development of ingrown toenails.
• Incorrect Toenail Trimming
  Angling the sides of the nail or cutting them too short can encourage the nail to grow into the skin.
• Toenail Injury
  Injuries to the toe, including stubbing, dropping heavy objects on the foot, or repetitive actions such as kicking a ball, can lead to ingrown toenails.
• Unusually Curved Toenails
  Individuals with naturally curved toenails are more susceptible to developing ingrown toenails.
• Poor Foot Hygiene
  Neglecting to maintain clean and dry feet may increase the likelihood of developing ingrown toenails.
• Repeated Pressure on the Feet
  Activities that involve repeated kicking or prolonged pressure on the feet, such as ballet, football and kickboxing, can cause toenail damage and increase the risk of ingrown toenails​​.

Non-Surgical Treatment Options

Non-surgical methods are often the first line of approach in treating ingrown toenails.

Pain Relief Medication

Pain relief medication, such as paracetamol, may be recommended for managing intense pain associated with an ingrown toenail. These medications can provide temporary relief and can make daily activities more comfortable.

Topical Antibiotics

Applying a topical antibiotic ointment or cream around the affected toenail can prevent or treat infections that may arise from the ingrown toenail. This is particularly effective when signs of infection, like redness or pus, are present.

Warm Water Soaks

Soaking the affected foot in warm, soapy water for 10 to 20 minutes several times a day can reduce swelling, ease pain, and soften the skin around the ingrown toenail. This can make other treatments, like lifting the nail, more effective and less painful.

Surgical Treatment Options

In more serious cases or when non-surgical methods fail to provide relief, surgical options may be considered.

• Lifting the Nail
  For cases where the ingrown toenail is less severe (with symptoms like redness and pain but no pus), the foot specialist may lift the ingrowing nail edge and place a splint, cotton, or dental floss underneath. This procedure is minimally invasive and helps the nail grow above the skin’s edge.
• Partial Nail Removal (Partial Nail Avulsion)
  In recurrent or more severe cases (characterised by inflamed skin, pain, and pus), the foot specialist may perform a partial nail removal. This involves numbing the toe with a local anaesthetic and then trimming or removing the ingrown portion of the nail.
• Complete Nail and Tissue Removal (Total Nail Avulsion)
  In chronic or recurrent cases, the foot specialist might suggest complete nail and tissue removal, also known as total nail avulsion. It involves removing a portion of the nail along with the underlying nail bed. The procedure is carried out under local anaesthesia, and various methods like chemical, laser, or other surgical techniques may be used to prevent the regrowth of the nail portion​​​​.

Prevention Strategies

Certain preventative strategies can help reduce the risk of developing an ingrown toenail.

• Proper Toenail Trimming: Toenails should be cut straight across, not too short, and without tapering or rounding the corners. This technique prevents the sides of the nail from growing into the surrounding skin.
• Footwear With Adequate Space for the Toes: Shoes and socks should fit properly, providing ample space for the toes. Tight or narrow shoes can press the nails into the skin, leading to ingrown toenails.
• Resting the Feet and Toes After Strenuous Activities: Allowing the feet to rest and recover after strenuous activities may help in preventing ingrown toenails.
• Avoiding Toe Trauma: Minimising the risk of injury to the toes, such as by avoiding dropping heavy objects on the feet or repetitive actions that stress the toes, can help prevent ingrown toenails.
• Maintaining Proper Hygiene for the Foot: Regular cleaning and drying of the feet can help maintain nail health and prevent conditions that can lead to ingrown toenails​​​​.