It is estimated that more than 7 million American suffer from ingrown toenails each year. This condition spans all ages, from younger children to older seniors. Ingrown toenails occur when the corner or side of the nail grows into the skin instead of growing over it. Ingrown toenails most commonly occur in the big toe, but other toes may be affected as well. There are different reasons why ingrown toenails develop.
For younger people, the nail usually gets embedded into the skin because the nail is wider than the nail bed. Older adults who have curved, thick toenails are more susceptible to this problem. Often, this condition can be taken care of at home with proper nail cutting techniques, practicing good hygiene, and wearing proper fitting shoes. If the pain gets too severe and home remedies fail, it’s usually time to see a podiatrist.
Unfortunately, most of the patients I see with this condition are in excruciating pain because they waited too long to seek treatment or because they took it upon themselves to perform “bathroom surgery.” Some patients attempt to correct the problem by digging under the toenail with a sharp manicure scissors or razor blade. Some use a needle from the sewing box to drain the pus. Others use pliers to remove the nail. When asked why they waited so long to get treatment their typical response is, “I was scared to death to have my toenail removed.”
The most common cause is attributed to ingrown toenails is improper nail cutting, either cutting nails too short, or leaving a spicule of nail in the groove when rounding the corners. Other causes are from wearing shoes and socks that are too tight, and trauma to the toes. Of course, genetics are attributed to this condition where the nail is too large for the toe or the shape of the nail is curved. Arthritis, diabetes, a change in body weight, a change in gait (usually attributed to an injury to the foot, leg, or back), and toenail fungus (a thickening of the nail and fungal infection in the nail bed) can also be a cause.
Although ingrown toenails are a minor problem for most people, this condition may become quite severe for diabetics and people with poor circulation resulting in gangrene of the toe. Patients with pacemakers and joint replacements are also at risk of bacteria spreading through the blood stream that may result in the spread of infection. It is critical for people at risk to seek medical treatment at the earliest sign of an ingrown toenail. Ingrown toenails may also cause a local infection of the nail fold (paronychia), scarring, and bacterial tissue infection (cellulitis). Chronic granulation tissue can even develop into a squamous cell carcinoma in rare occasions. A biopsy is often needed in chronic infections.
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Home care remedies include such things as soaking your foot in warm water three to four times a day, keeping your foot dry, elevating your foot as much as possible, wearing loose-fitting shoes and socks with adequate toe space, and using ibuprofen or acetaminophen for pain relief. After soaking, you may use a sterile cotton tip to gently roll back the piece of overgrown skin. You may also gently lift the edge of the nail and insert a piece of sterile cotton or waxed dental floss between the nail and skin to facilitate drainage and to prevent further nail penetration. If this is done, change the packing daily. If your condition worsens and you do not see an improvement within two to three days, see your podiatrist.
If the conservative treatment does not work, minor surgery may be required. This is fairly simple and successful, and it provides long-term relief that is permanent. There are several procedures that may be used, and almost all of them are done in the clinic under local anesthetic. Probably the most common procedure is a partial matricectomy which involves the removal of the side of the nail that is causing the problem. In the worst-case scenario, a complete matricectomy has to be done to remove the entire nail. In certain instances, we will allow the nail to grow back. The only time it will not grow back is when something is done to destroy the growth cells from regenerating the nail. The common way to prevent growth is to apply an acid to the growth center or surgically debriding the growth area. This treatment provides permanent relief.
The reality is surgical procedures are fairly easy and the most uncomfortable part of the procedure is numbing the base of the toe with anesthesia. As soon as the toe begins to numb, the remainder of the procedure is pain-free. Most procedures are performed within five to 10 minutes. Patients are amazed at how good they feel and how easy the procedure was. I love treating ingrown toenails because I can send the patient home feeling a whole lot better.
The good news is that in the vast majority of cases, recurring ingrown toenails can be prevented by trimming your toenails properly, using good hygiene, wearing comfortable shoes and socks, and avoiding trauma to your toes. If the condition recurs, use safe, conservative in-home remedies for a few days, and see your podiatrist if the problem worsens. You can avoid suffering and minimize down time if you follow these simple guidelines.
Please do not perform bathroom surgery. Let the pros perform your ingrown toenail surgery. It’s usually a simple and quick procedure. Contact Dr. John Sigle at (217) 787-2700 to schedule an appointment or visit myfootandanklecenter.com for more information.