Does your nail hurt when you touch it? Is your toe red and swollen? Is there a sharp pain when you hook your toe? Is there a discharge along your toe? Do the covers on your bed feel uncomfortable on your toe? Do tighter shoes and walking increase your pain? Chances are you have ingrown toenails. Good news, though! The prognosis for recovery is excellent, and complete healing is expected!
What are the typical signs?
An ingrown toenail is a growth of the nail into the surrounding skin. The first symptoms are mild inflammation and pain on pressure. When the nail persists in the skin, there may be signs of superficial infection with more redness, swelling and associated discharge. In an advanced stage of ingrown toenail, red granulation tissue forms, and the toe is painful to walk on and more swollen. It’s important to treat ingrown toenails at all stages to prevent infection from forming and spreading to the skin, bone and system.
What are the possible causes?
There are many possible causes of ingrown toenails. Here are a few of them:
- Poor nail clipping
- Nail fungus
- Nail trauma
- Bad shoes (often too tight)
- Congenital (pinched or deformed nail anatomy)
- Excessive perspiration
- Obesity
- Hereditary
Although the main diagnosis is made clinically, it may be useful to perform an X-ray of your toe to rule out other underlying causes and to rule out other diagnoses.
What can I do at home to reduce pain?
- Soak in a liter of lukewarm water, preferably with two tablespoons of epsom salt. You can soak 3-4 times a day for 10-15 minutes, trying to massage the skin outwards. (It’s important to wash your hands first).
- If there’s a lot of discharge, apply a dry bandage/pad without ointment to protect it and absorb the discharge.
- If the redness progresses and the discharge is whitish, the application of a bandage with an antibiotic ointment such as bactroban/polysporin is useful.
- Make sure you wear wide shoes to avoid rubbing and trauma.
- Bandage to stretch the skin and relieve pain (Figure 1)
- Take over-the-counter acetaminophen/ibuprofen to reduce associated pain
- Avoid over-cutting your nail, which can aggravate the problem and lead to superficial infection
Figure 1: Bandage
Reference: Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails.
Can you get rid of them when home treatments fail?
There are conservative and surgical treatments that your podiatrist can perform for you. Conservative treatments can resolve the problem temporarily or permanently. However, studies show that surgical treatments are the most effective in avoiding the risk of long-term recurrence and in permanently resolving the problem.
Here are the podiatrist’s treatments:
Preservatives
- Medical nail clipping: Clipping of the infected portion of the nail to reduce pressure and allow healing. May or may not be performed under anesthesia.
- Orthonyxis (See Figure 2): Application of a nail orthosis to correct nail deformity.
- Application of a therapeutic bandage (See Figure 1) to protect the toe and stretch the skin.
- Prescription of topical and oral antibiotics (rarely necessary) as required
Surgical
- Ingrown toenail surgery (Matricectomy): An effective means of removing the nail root under anesthesia, either permanently (Chemical root removal) or temporarily (No chemical application).
- Soft tissue surgery: Under anesthesia, a surgical procedure that removes a portion of the skin and nail and requires stitches.
Figure 2: Orthonyxis
Reference: Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails.
Consult your podiatrist for diagnosis and the right treatment plan. You don’t need a doctor’s bill or a referral to see a podiatrist, make an appointment now.
Article written by Dr Olivier Daigneault, podiatrist
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Dr Olivier Daigneault
Podiatrist
