Ingrowing Toenail

Ingrowing Toenail

What is it?

An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, and can be extremely painful. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too.

A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin isn't an ingrowing toenail, but can feel very painful and also appear red and inflamed as well.

Who gets it?

Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not reach their toes!)
Women often develop them as a result of cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.

Is it serious?

If left untreated, the infection can spread to the rest of the toe. The quicker you treat it, the less painful the treatment.

What causes it?

There are many genetic factors that can make you prone to ingrowing toenails, such as your gait (the way you walk), a foot deformity such as a bunion, restriction to big toe joint, hammer toes or excessive pronation (flattening) of the foot. Your nails may also naturally splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh. Fleshy toes and the wearing of toe protective shoes can also contribute to this problem.

Tight footwear, tight hosiery such as support tights can also push your flesh onto the nail so that it pierces the skin. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nails that are sticking out, you’re more likely to get an ingrowing toenail.

However, one of the most common causes is not cutting your toenails properly.

What can I do?

Cut your nails by following the nail curvature rather than 'straight across'. If you cannot see properly do not try to cut your nails as you may cut your skin. Get someone else to do it. Do not cut the nail too close to the skin.

If you think that you have an ingrown nail consult a podiatrist who will be able to provide a long term solution by correct cutting and clearing any nail spicule (spike) or in some cases removal of the nail using local anaesthesia. Salt baths may be appropriate prior to seeing a professional or anti-biotics from your GP. Do not delay in receiving treatment as early intervention may prevent the need to remove part of the nail and or gross infection.

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove the ingrowing spike of nail yourself.

What can a podiatrist do?

It depends on the severity of your condition. For the most basic painful and irritable ingrowing toenail, your podiatrist will remove the offending spike of nail and cover with an antiseptic dressing.

If your condition is chronic (long standing) or the nail shape too contorted, removal of part or all of the nail may be the best choice of treatment. Your podiatrist will discuss this with you and may inject a local anaesthetic before removing the offending portion or whole nail together with the root which will then be cauterise to stop the nail or portion of the nail from regrowing. The initial administration of the anaesthesia may be uncomfortable but once the toe is numbed there is little or no pain.

If you have involuted nails, your podiatrist may remove the bit that’s curling into the flesh and file the edges of the nail to a smooth surface.

If you have bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, you’ll need antibiotics to beat the infection as well as having the offending spike removed.