An ingrowing toenail pierces the flesh of the toe. It can feel like a splinter, can be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect others too.
Cutting nails incorrectly is the most common cause.
Genetic factors can make you prone to ingrowing toenails. Your nails may also have a natural tendency to splay or curl outwards or inwards into the flesh.
Tight footwear, hosiery and socks can also push your toe flesh into the nail so that it pierces the skin. Skin is easily penetrated by nail if you sweat excessively or don’t rotate your footwear, as this makes the skin moist and weak. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nail that are sticking out, you are also more likely to get an ingrowing toenail.
If left untreated, the infection can spread to the rest of the toe and foot and could lead to surgery. The quicker you treat it, the less painful the treatment.
Firstly, learn to cut your nails properly. Nail cutters aren’t ideal because the curved cutting edge can cut the flesh and nail scissors can slip. It’s best to use nail nippers because they have a smaller cutting blade and a longer handle. Cut your nails straight across and don’t cut too low at the edge or down the side. Also, cut them after a bath or shower when the nail is much softer.
Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid synthetics and choose socks and shoes of natural fibre and which fit properly. Keep your feet clean and dry and in the summer wear open-toed sandals to let air get to your toes as much as possible.
Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty foot bath. Then apply a clean sterile dressing and rest your foot as much as possible.
A podiatrist can remove the offending spike of nail. For toes too painful to touch, a local anaesthetic can be used. If your nail is involuted, the part of the nail that is curling into the flesh can be removed. Antibiotics can be prescribed if the toe is infected.
For those prone to ingrowing toenails, partial nail avulsion (PNA) may be recommended. This procedure is done under local anaesthetic where 8-10% of the nail is removed, so that the nail becomes narrower. After surgery, the overall appearance of the nail looks normal.