In this article our podiatrists look at some of the causes and symptoms of an ingrown toenail. We also show you how to prevent a recurring ingrown toenail so that you can enjoy effective, long-lasting relief from pain. You’ll be pleased to wear any kind of shoes again without worrying about the sore toe that comes with it!
Ingrown nails form when the edge of a toenail starts growing into the soft tissue of the toe. Learn how to reduce pain caused by ingrown toenails and stop it from coming back again!
In the 2020 Foot Health Survey conducted by the Australian Podiatry Association, in a sample study of 1000 Australians, a whopping 10% reported that they suffer with ingrown toenails.
Of this sample, only 44% of the group knew that a Podiatrist could help them manage their ingrown toenail!
What is an ingrown toenail?
An ingrown nail by definition is when the nail pierces the skin edge. When left untreated an ingrown nail may lead to pain and infection. The infection can range from mild and self-resolving, to systemic and requiring hospital admission. It can no doubt become a great source of anxiety when a toenail is sore and cannot be managed by clippers or scissors at home!
What causes ingrown toenails?
A lot of people suggest simply cutting the toenails straight across as a means to prevent an ingrown nail, however it really isn’t that simple. Most commonly occurring in the big toe, an ingrown toenail is technically when the nail edge pierces the soft tissue on the sides. Through this cut in the skin, bacteria can enter through which causes an infection to take hold.
Common causes of ingrown toenails include:
- Poor nail cutting or picking at nails
- Nail trauma
- Narrow/shallow shoes
- Fungal toenails
- Previous ingrown toenails
Poor nail cutting
The best advice with cutting toenails is to follow the shape of the nail. It is important to make sure that the nail is cut all the way across and that no pieces of nail or shards remain behind, particularly in the corners of the nail. Those who have difficulty with eyesight can mistakenly cut their toenails short without going the full way across predisposing an ingrown nail.
Nail picking is also common and can cause issues as a result. Young boys and teenagers are common culprits for this one! Other medical conditions can cause clients to tear at their nails which can leave them short and with sharp edges. Bad habits also tie into nail picking too.
The genes play a large role in nails that unfortunately can be very difficult to prevent. Often a Podiatrist will see a pattern of nail growth issues in parents and their children. Nail shape is hereditary in many cases.
Trauma to toenails in a single incident can affect the way that nails grow for months and years ahead. Examples of nail trauma include repetitive shoe pressure, acute accidents, objects being dropped onto nails, and nails coming away from the skin.
Shoes that are too narrow or shallow can place a high amount of pressure onto the feet. When it comes to the toes, a narrow and shallow toe box can cause changes to the shape of the nails over time. This can lead to not only ingrown toenails, but also thicker and fungal nails too. Have a close look at the shape of your foot against the shape of your shoes and see how well they match.
Tobacco from smoking causes changes to skin elasticity. It is common to see thicker toenails in clients who smoke cigarettes. Over time with smoking, the toenails will also become more curled in. The change in shape as well as thickness combined are what cause the issues to occur.
Fungal toenails are when a nail fungus invades the toenail causing thickness, discolouration and odour. Due to the thickness and shape changes it is more common for an ingrown nail to occur.
What causes chronic or recurring ingrown toenails?
Chronic or recurring ingrown toenails are toenails which keep getting sore and infected over and over again. These can become very frustrating to those affected. It is very tricky to find shoes that are comfortable and fit well without causing another episode of infection. It can also seem an impossible task for someone to cut their own nails without it leading to an ingrown!
It is often the case that the nail shape is permanently deformed by the time that the nail is continually growing in. The root cause of the issue is not being dealt with and so the problem continues. Technically once a toenail has ingrown it is common for it to occur once again too. It is important to have the nail properly assessed and treated to make sure that the pain and inflammation does not come back again and again needlessly.
What are the symptoms and signs?
An ingrown toenail will show all typical signs of infection when it is inflammed.
Signs to look for with ingrown toenails:
- Shiny skin around toe
- Discomfort ranging from a dull ache to extreme pain
- Build up of skin on edge of toe
- Most often big 1st toenails affected (followed by neighbouring 2nd toenails)
Common complaints with an ingrown toenail range from discomfort to significant pain rendering walking and wearing closed in shoes impossible. Sometimes blood and pus will be present around the edges of the nail, or present inside of socks or shoes.
What happens to untreated toenails?
Unmanaged toenails can head either one of two ways – they can spontaneously resolve or they can worsen. In spontaneously resolving nails they are the mild and minimally infected nails to start with. In more advanced cases, the infection can remain present for months or years untreated!
When infection spreads without treatment the issue can become a lot more serious. Monitor for redness that is seen tracking away from the toe and up the foot. If this is happening it is recommended to seek immediate medical treatment. This can turn septic and requires hospital admission to treat the advancing infection. In rare cases such as in those with diabetes, renal failure, and neuropathy, an ingrown toenail can lead to severe infection, poor healing, and digital amputations.
What is the treatment for ingrown toenails?
Treatment for ingrown toenails involves removing the problem portion of the toenail to make sure there is a smooth edge. It is important to seek treatment for an ingrown toenail before it becomes highly infected and painful. If it is feeling like this it is never too late to get treatment, however the earlier the intervention the quicker the healing and comfort can be.
Treatment by a Podiatrist will involve gently trimming away the portion of nail that is digging into the skin edge. Nail and skin care is commonly performed by podiatrists at Pod Fit Podiatry using sterile and single use instruments.
Depending on how much nail is pushing into the border of the skin and a clients level of pain will determine the need for local anaesthetic. Once the toe is numb the toenail edge is either temporarily trimmed, or more permanently removed.
A nail procedure is a common treatment method to fix ingrown toenails. The best practice here involves a case-by-case approach. It is best to have your toenail assessed for advice on what treatment technique is right for you and your nail.
Steps involved with nail procedures include that the toe is made numb, the problem edge is trimmed out and cleared, a treatment called phenol is applied to the nail matrix (nail bed), and the toe is finally dressed.
After a nail procedure either temporary or permanent it is typical to experience some soreness or throbbing that night and the next day. Pain does vary from client to client, and it is advisable to wear open shoes and start wound care immediately to allow the fastest healing possible.
Prognosis after your nail has been treated is excellent. For example school kids with ingrown nails will have their nail procedure performed on a Friday and they are back at school in shoes on a Monday. It really does depend on a clients profession, shoes and activity demands. Other factors such as age, general health and other comorbidities affect speed of wound healing.
What nail care routine do you recommend while your toe heals?
There are many effective self care strategies to use while a toe is healing. The best healing toes are the ones which are kept clean and dry. It helps to salt water bathe, apply antiseptic, and use a breathable dressing while the toe is healing. Keeping the toe covered while in shoes is helpful for the first 1-2 weeks. Other factors including good nutrition, sleep, and overall health in the early stages can be very helpful to promote quicker healing times.
What will happen if you leave an ingrown toenail untreated?
Nails left untreated can self resolve or can worsen, and repeat with time. It is important to have the nail properly assessed and managed so that it can be prevented or fixed for good. Without treatment intervention, nails can dig into the skin every few months over the course of many years – which can seem futile when really this issue is completely preventable from the start!
What should I do with my ingrown toenail?
The best ingrown toenail treatment (in our humble opinion) is to see the experts who understand and manage toenails the best – your local Podiatrist!
Pod Fit Podiatry’s approach is backed by sports medicine research. Knowing how to prevent a recurrence of an ingrown toenail is as important as treating the problem.