Ingrown toenails

Ingrown nails can be caused by external damage to the toe or nail, but usually develop because the nail has been cut too short, (perhaps in an arch shape rather than straight), or because of too small or too narrow shoes that forced the nail to curl and penetrate the skin. 

Genetic factors can also play a role. 

The risk of nail breakage is increased in connection with sports, when small wounds on the toe in combination with foot sweat, bacteria and short nails, can lead to problems.

Causes include:

• Shoes that squash the toes in the developmental stages of the foot (frequently in people under 21), which cause the nail to curl and dig into the skin. This is particularly the case in ill-fitting shoes that are too narrow or too short.
• Poor nail care, including cutting the nail too short, rounded off at the tip or peeled off at the edges, instead of cut straight across.
• Broken toenails.
• Trauma to the nail plate or toe, which can occur by dropping objects on or stubbing the toenail, or by the nail protruding through the shoe (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh.
• Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases or a genetic susceptibility, increases the chance of an ingrown nail, but the ingrowth cannot occur without pressure from a shoe.

Symptoms of an ingrown nail include pain along the margins of the nail (caused by hypergranulation that occurs around the aforementioned margins), worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind. Bumping an affected toe can produce sharp and even excruciating pain as the tissue is punctured further by the nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken early to treat the condition by keeping the area clean.

Here’s how you can prevent nail penetration:

• Trim your toenails straight across and make sure that the edges do not curve in
• Avoid cutting toenails too short.
• Wear proper fitting shoes, socks, and tights.
• If you tend to have nail problems, you can poke a piece of cotton under the nail to prevent it from growing into the toe.

The treatment of an ingrown toenail partly depends on its severity.

Conservative treatment: Mild to moderate cases are often treated conservatively with warm water and epsom salt soaks, antibacterial ointment and the use of dental floss. If conservative treatment of a minor ingrown toenail does not succeed, or if the ingrown toenail is severe, surgical treatment may be required.

Surgery: Surgical treatment for an ingrown nail is carried out by a podiatrist, a foot and ankle specialist. The surgical approach is the removal of the offending part of the nail plate known as a wedge resection.

Nail bracing: A less widely used treatment for ingrown toenails is nail bracing. Nail braces work by gently lifting the sides of the toenail and eventually retraining the nail to grow to a flatter shape over time. The total time needed for the nail to be reshaped is about 18 months.

If you have major problems with pain and deformity, you should get medical help. This is also advised if the nail penetration does not get better or the toe becomes inflamed or infected toe, despite your best efforts to alleviate the problem by yourself.

Seek urgent medical attention if you get a high fever in conjunction with a broken nail, especially if you have diabetes. You also need medical help if you have pain and numbness in your toes.

APPOTEK can help with ingrown nails. A nurse or a physician will make an individual assessment based on your symptoms, then may prescribe treatment or refer you to a podiatrist for further treatment.

If your child has a problem, he or she should see a doctor.