All About Ingrown Toenails

A common condition treated by podiatrists is ingrown toenails. An ingrown toenail occurs when a portion of the edge of a toenail irritates, and in severe cases penetrates, the sulcus (the groove where the nail edge meets the skin). The severity of an ingrowing toenail is variable. In many cases you can manage ingrown toenails conservatively, but in severe cases surgery may be required.

Fortunately, most ingrown toenails can be managed by podiatrists. In fact, podiatrists should be amongst the first medical professionals consulted if you have an ingrown toenail. A GP may prescribe antibiotics if an ingrown toenail is infected, however it is generally the podiatrist that treats the ingrown toenail so that the infection does not recur.

An ingrown toenail can occur in any toe at any nail edge, but are most common in the big toes.

What are the symptoms of ingrown toenails?

The most common symptoms of ingrown toenails include:

Pain or tenderness where the toenail edge meets the skin (sulcus).
Redness and swelling in the sulcus, extending out from that area in severe ingrown toenails. This is often a sign that there is an infection present.
The presence of pus (this can also be a sign of infection).

What causes ingrown toenails?

Involuted/incurvated toenails: The shape of a toenail varies from person to person. Some people’s toenails are curved which can predispose them to growing in at the sides.
Ill-fitting footwear: Shoes which are too narrow at the forefoot can put too much pressure on the toes causing pressure and friction between the nail and the sulcus resulting in trauma.
Poor toenail cutting techniques: Cutting too far down the sides of the toenail can result in an ingrown toenail. Sometimes a sharp piece of nail (called a spicule) can be left behind which can penetrate the sulcus resulting in an ingrown toenail. Sometimes people simply tear/rip their toenails instead of cutting them, (common in children and teenagers) leaving rough edges behind which are prone to becoming ingrown.

What does treatment involve?

If a toenail is ingrown, often it can be managed conservatively (which essentially means without surgical intervention). Using sterile podiatry tools, the podiatrist will aim to remove the portion of nail which is causing the irritation.

If the ingrown toenail is too far down, heavily infected and/or too uncomfortable to remove in this manner, the podiatrist may recommend a minor surgical procedure to remove the portion of nail which in ingrown.

The surgical procedure involves a nail edge resection and often a matrix phenolisation procedure (to prevent recurrence) which is performed by the podiatrist under sterile conditions in the treatment chair. It involves the administration of local anaesthetic (by the podiatrist) and the subsequent surgical procedure is therefore painless. It involves the removal of the offending nail edge, no stitches are required. The entire procedure takes approximately 1-1.5 hours. The podiatrist will then review the toe a day or two after the procedure and advise the patient on how best to care for the toe thereafter.

How can ingrown toenails be prevented?

Correct toenail cutting techniques: This varies from person to person as everyone’s toenails are different. Generally speaking, it is best to follow the contours of the nails, without cutting down the sides.
Appropriate and appropriately fitted footwear, to prevent excessive pressure and friction being placed on the nail sulcus: Podiatrists can provide you with information on suitable footwear.
Consult a podiatrist: Not only can a podiatrist treat ingrown toenails, they can also educate you as to how to best cut your toenails to prevent one.

The Biomechanics Lab are Podiatrists who help clients with a range of foot, ankle and lower limb complaints, including ingrown toenails. Danielle Champion and Steph Howard are able to assess and perform conservative or surgical treatment for ingrown toenails, and consults at Move for Better Health’s Magill & Malvern clinics.