Ingrown toenails, more scientifically known as onychocryptosis, are a nail disorder commonly experienced by young adults and middle-aged individuals. It can occur at any age and frequently prevents children from playing sports or adults trying to complete basic daily tasks.
What may appear to be an insignificant issue can manifest itself over time in the form of a painful, swollen toe leading to a decline in quality of life. Despite being easily treated early on, most people succumb to the pain before it becomes unbearable. At this point the toe could be infected and treatment becomes challenging.
The definition of an ingrown toenail is when a rough, toughened edge of a nail - named a spicule - penetrates the skin (known as the periungual dermis) causing painful inflammation, and the area becomes a portal of entry for bacteria so can lead to infection.
The individual may now be subject to careful reconstruction with a scalpel. Although treatment is not as painful as many expect, patients can become frustrated as the nail grows back. All hope is not lost; your qualified podiatrist will have a few tricks up his/her sleeve.
Who gets ingrown toenails?
Data gathered from various locations suggest there is no gender predilection, although some studies report a higher incidence in females over males and vice versa. Ingrown toenails are often bimodal in presentation, commonly affecting people in their 2nd and 5th decades of life.
While up to 5% of the general population experience ingrown toenails, it is diabetics and those with lower extremity oedema (swelling) who are among the most affected.
What causes ingrown toenails?
The cause can be down to a combination of factors, ranging from genetics to poor nail care, or from a trauma or simply due to tight socks or footwear. Toenail deformity and fungal infections can also play a role.
Symptoms include pain, swelling and redness around the area, indicative of infection, and fluids may present, however not always.
Risk factors that increase likelihood for ingrown toenails include nail care, such as improper nail trimming or when the nail tears. Did you know that cutting the nail straight across will allow it to grow out properly?
Damage, such as repetitive trauma (e.g. running) or accidental trauma (e.g. stubbing your toe) may influence the likelihood for it to develop, as well as excessive sweating (hyperhidrosis) which makes the skin and nail soft, resulting in separation of the nail.
How do they develop?
There are four stages of ingrown toenails and your podiatrist will clarify which your condition falls into and provide appropriate treatment accordingly.
Stage 1 (inflammatory stage)
Presence of erythema (redness + inflammation), oedema (swelling) and pain when pressure is applied.
Stage 2 (abscess stage)
Increased pain, redness, inflammation and swelling. Serious drainage (watery) and infection may be present. There will be hypertrophy (excessive growth) of the nail fold.
Stage 3 (granulation tissue)
All symptoms have worsened.
Excess tissue growth covers the nail plate.
Failure to find treatment could result in chronic deformity of the nail plate.
Stage 4 (deformity)
All worsened symptoms are still present.
Severe chronic deformity of the nail, including distal (far) and proximal (near) ends of the nail.
How to treat ingrown toenails?
Your podiatrist will determine which stage your condition is, all with the aim of reducing pressure in the area and easing pain. If an infection is present and appears to be significant enough to impede treatment, it will warrant a letter to your GP regarding a course of antibiotics.
We highly recommend assessment from a qualified podiatrist initially, especially if you feel one may be developing. It’s always best to seek treatment preventatively rather than let the condition escalate. However, you may be recommended some of the below self-care measures as a follow up.
Trim nails straight across to prevent spicules of nail growing into the skin
Soak your feet in warm water with Epsom salts for 20 minutes, 3 times per week. Following this, using cotton wool, push the skin away from the nail
Ensure you wear comfortable shoes with enough space at the toes to ease pressure on the nail
You can take painkillers if the pain is severe. Young children should not take certain medications, such as Aspirin, and always check with your pharmacist or GP if unsure