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Ingrowing toenails: Your questions answered!

Updated: Sep 22, 2020

Ingrowing nails is a painful condition where the sides of the nails grow or press into the surrounding skin. It can cause pain, redness, swelling and sometimes can get infected.

Here are 10 of your most common questions about ingrowing toenails answered by a podiatrist.

1. What causes ingrowing toenails?

Most commonly podiatrists see ingrown toenails develop due to the genetic shape of the nail and the skin surrounding it. Sometimes toenails can be curved, curly or fan shaped, which can put you at a higher risk of developing recurrent ingrown toenails. Another common reason people develop ingrown toenails is their toenail cutting techniques. Podiatrists, don't like seeing nails be cut too short or cut deep down the sides. Lastly, direct trauma or various medications can also contribute to developing an ingrown toenail.

2. How do we treat ingrowing toenails?

There are a many ways which ingrown toenails can be treated. Broadly, there are two main pathways; conservative or surgical. Which route taken depends entirely on your particular circumstances. If the ingrowing component of the nail is at the end, usually we are able to conservatively remove it with some clippers and nifty techniques immediately in the clinic chair. If there is a current infection, or it is ingrowing further up the nail, we may need to administer a local anaesthetic (which is actually a good thing... no more painful toe!) and remove the ingrowing edge that way. This procedure is called a partial nail avulsion, and whilst this is not permanent we can offer to make this a permanent procedure by using a chemical called phenol to prevent the nail from regrowing at that edge. In addition, here at FALL we are actually blessed to work with Dr Gray, who is a Podiatric surgeon - this means that we can offer a few more types of surgical correction; a wedge resection or an exostectomy (removal of a small amount of bone).

3. Are ingrowing toenails genetic?

Absolutely, it is common for patients to come to us with their parents who mention that they have also had this problem in the past. This is because we can inherit the same shape of toenails as our parents.

4. Can medications cause ingrowing toenails?

It sure can! Podiatrists regularly see ingrown toenails result from some medicatgions. Examples include chemotherapy treatments or Isotretinoin (a drug used to treat persistent acne).

5. How to prevent ingrowing toenails?

It is important to remember that not all ingrown toenails can be prevented, however there are some at-home practices you can use to avoid exacerbating, or causing an ingrown toenail. Wearing shoes with wide toe-boxes will reduce external pressures on the toenail (so no pointy shoes please) and trying not to cut your toenails too short, or too far up the sides. The correct technique is to cut them so that there is a alway a little border of nail visible past where it joins the skin.

6. Can ingrowing toenails be permanently treated?

You bet they can! Here at FALL we offer several permanent procedures to correct ingrowing toenails. The procedure best suited to you will depend on the presentation of the ingrowing toenail and the cause of it. The first procedure is called a phenolisation, where the edge of the nail is removed and a chemical called Phenol is applied to the nail matrix to prevent it from growing at that location. The next two options can be performed by Dr Gray, our podiatric surgeon. They are called a wedge resection and an exostectomy.

7. Will antibiotics solve the ingrowing toenail?

Not necessarily, infection and ingrown toenails are actually separate entities which co-exist. What we commonly see in practice are chronic ingrowing toenails which has become infected. Antibiotic use will resolve the infection, however the toenail will still be growing into your skin, which will generally cause a recurrent infection. This is where podiatrists are required; the pain will not settle and the ingrowing nail will not resolve until the spicule of nail is removed.

8. Do Epsom salt soaks resolve ingrowing toenails?

Epsom salts soaks can alleviate symptoms and provide pain relief as soaking in a warm salt bath will soften the skin surrounding the nail. However, the offending spicule of nail will mostly likely not dislodge and will still need to be removed by a podiatrist.

9. Do shoes cause ingrowing toenails?

Not all the time, but definitely some of the time. Shoes with narrow toe-boxes and shoes which are slightly too small in length can all apply external pressure to the edge or top of the nail which can caused the nail to grow in.

10. How you do you know if your ingrowing toenail is infected?

An infected ingrowing toenail will appear very red, swollen, hot and may have pus present. Its best not to leave an ingrowing toenail too long as this increased the risk of contracting an infection.

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