In my time in podiatry I have seen grown men and women reduced to tears as they recount their troubles with their dreaded ingrown toenail(s). It can be incredibly frustrating for the mature, respectful and health conscious of us out there the amount of pain which an infected ingrown toenail can cause. I can vouch personally that as a young adult I suffered from an ingrown toenail and let me tell you, like many young men, I suffered loudly, and to anyone that would listen.
Firstly, the name: ingrown toenail, ingrowing toenail, paronychia or even oncyhocryptosis. How does the saying go? A rose by any other name? Well each of the above are enough to strike fear into the hearts of those who have suffered at the whims of an ingrown toenail. Each of the names (and I will stick to ingrown toenail for simplicity) indicate the condition where the nail edge on either side pushes onto and then into the soft fleshy skin which makes up the sulcus of our nails. The pushing initially can sometimes feel like a dull ache, and might only be present when our toes are being pressed back against the nail itself, say in tight fitting footwear, on contact with bedsheets or if we twist our feet when we push off when we walk (think a little bit of a catwalk style strut, toned down, and completed every step).
Eventually the nail continues to grow, or we push back further and harder from the soft and meaty edge of the toe and BANG. OUCH. We have have a full blown ingrown toenail with an open lesion where the nail edge has pierced the skin. Yes, this is usually painful although not always with some conditions. Now whenever we have an open lesion there is a risk of infection as our skin is no longer able to keep all the little bugs that live outside of us outside, and some of them make their way in. Once inside these uninvited guests set up shop and start partying, causing an infection. Some signs that you have let some unwanted guests in are spreading redness, pus, odour and throbbing of the toe. To carry the party metaphor on a little further, our bodies bouncers in our immune system can struggle to overcome the avalanche of bacterial guests coming through when our overall immune system is down, or there are just too many bugs in the first place. As our feet are the furthest part from immune central and with many times decreased blood flow. Couple that with how we keep them hidden in warm socks and shoes it doesn’t take long for a little hole in the toe from a tiny little nail to resemble a fat, red, swollen and throbbing monster toe.
It’s as simple as treat the infection, remove the nail edge from where it has caused a hole, and then heal the hole. Longer term as nails grow there is a very high risk that the ingrown toenail will return, as nails essentially just grow out blind, pushing onwards and outwards into whatever is in their path, including your own toe! Let’s break down the parts.
Local wound care needs to be practiced, so break out your first aid kit and grab the saline, antibacterial dressing such as betadine or savlon and then some sterile dressings or gauze. If you do not have all of these in your first aid kit you can make do using a mix of salt and warm water in place of saline, and a large elastic bandage (bandaid/elastoplast/cutiplast or similar) in place of guaze.
Start by washing your ingrown toenail in either saline, or your warm salty water bath. When you have washed as much pus and anything not attached to your toe away it’s time to apply the antiseptic, WARNING, be ready for a sting. Apply your antiseptic for wound care (such as betadine liquid) to the opening at the edge of the toe. Careful not to spill betadine on anything light coloured, the iodine component will stain.
Finally, after allowing the toe to dry for 2 minutes cover with sterile gauze or bandaids.
This local wound care treatment will remove the bacterial load at the source, although if the infection is within the toe already (redness spreading up the foot) it’s already too late. You need to put down your device that you’re reading this on and get to your GP or hospital emergency department for antibiotics ASAP. No, right NOW.
This can be very tricky to do, as our own feet seem to get further away with age, our ability to do very precise and delicate work with sharp instruments gets impaired. If you are confident and competent to complete yourself then by all means, grab your nail clippers and remove the offending edge. If you’re not confident, or have any changes to your circulation to your feet then please, call us and let our expert Pride Podiatry team help you out here.
All our bodies heal at different rates, and there are many factors such as circulation, systemic diseases, medications, pressure and nutrition which impact our bodies healing system. The most simple and safe method to heal up the hole left by an ingrown toenail is to repeat the first step (Ingrown toenail: treating the infection) including the wound care with betadine and sterile dressings until the hole has healed. This method removes unwanted bugs, and provides a dry, clean and stable environment for healing. Of course if you have an allergy to any of the products, or any other risk factors affecting your ability to heal you need to consult an expert podiatrist. The above is only a broad guide for general ingrown toenail wound care.
So now your ingrown toenail has healed up, pain free, infection free and is only a recent nightmare. How can you stop it from coming back? To explain in detail you need to go all the way back to the basics of why they occur in the first place although addressing as many of the factors as possible is a starting point. Another post on this will be coming soon:
Now if you are like me and are naturally blessed with meaty toes and from a family with wide growing nails then we’re pretty much on a hiding to nothing, they will likely come back without professional intervention. The simple professional intervention we use can take the form of a one off, quick and safe procedure where the edge of the nail is removed right down to the nail matrix (where it grows out from) and cauterised to prevent regrowth. Alternatively regular podiatry care can be undertaken where expert use of instruments such as a blacks file and westminster clippers can often keep the ingrowing toenail edge at bay.
Some of us are not candidates for regular podiatry or a simple procedure due to other conditions, where we live and what we expect from our feet. For those in this boat it is best to consult your Pride Podiatrist or other professional for a personalised plan.
To summarise, if you have an ingrown toenail, you can suffer alone be it in silence or very loudly like I did. You can try the advice above. However, if you do suffer from an ingrown toenail, please call us and book an appointment. A personalised treatment plan will be detailed and your painful ingrown toenail will be just like many more that have come before you, a war story for us all to tell who have been through the agony. A thing of the past. History.
Finally a warning, this post does not replace personal advice, and includes general information only. If you suffer from an ingrown toenail it is always recommended to consult a podiatrist ASAP. If you have any co-morbidities or allergies to any products mentioned do not use and again, consult your podiatrist.