Ingrown toenails are among the most common and painful of foot problems. But sufferers need not endure chronic pain. Ingrown nails can, with few exceptions, be permanently cured.
Ingrown nails occur when part of the nail pushes into the skin. The nail acts the same as any foreign body such as a dirty splinter would and induces a local inflammatory reaction and infection.
The area quickly becomes inflamed. As the toe swells, pressure builds up against the many nerve endings found in its tip. This is why ingrown nails are so exquisitely painful.
Ingrown nails are started and made worse by many factors including heredity, injury and poorly fitted shoes. The three most common causes are illustrated and discussed below.
1–Nails cut inappropriately. As a rule, nails should be cut straight across. When cut at an angle, a small, fishhook-like piece is sometimes left in the corner (figure 1). As the nail continues to grow out, the piece is pushed into the skin.
2–Injury. Nails grow from a nail root (also called the nail matrix, figure 1). Damage to the nail matrix from injury may be another source of trouble. It is here that the shape of the nails is determined.
3–Heredity. The nail in figure 2 is curled at the sides. Even if cut correctly, it may become ingrown.
The skin in figure 3 is seen to grow over the side of the nails. The nail itself is normal but the effect is that of an ingrown nail.
Stuffing cotton or other material under the nails tip to “train” it to grow correctly as a long term fix is usually ineffective. It often serves as another source of irritation. The nail’s shape has already been determined at the matrix.
Cutting the corners of the nail will temporarily relieve the pressure but the nail will grow back as before. Treatment must be directed at the source of the problem which is the nail root.
Home remedies for the treatment of ingrown nails are popular. One remedy is to cut a “V” at the center of the nail presumably to reduce pressure at the sides. But the nail is a solid plate and it simply doesn’t work.
Soaks are popular too. A warm (not hot) Epsom salt or Burrows solution will help reduce the inflammation. But if the nail is severely ingrown, until the piece of ingrown nail is removed, the swelling, infection and pain will continue.
Knowing this, many patients attempt to dig out the offending nail themselves (often mutilating their toe in the process). Such bathroom surgery is not recommended.
If the nail has become ingrown due to improper cutting, the nail will probably regrow normally after the ingrowing portion is removed. However, if the nail is deformed, a permanent correction is preferable to prevent future infections.
In the office, under local anesthesia, just the offending nail margin is painlessly removed (about 1/4″ of nail). The nail matrix is then treated to prevent regrowth of the ingrowing portion of the nail.
Years ago, the nail root was surgically cut out. It was a rather painful procedure. New techniques have made the procedure a surprisingly comfortable one. Few patients require any post-operative pain medication. Full healing may take several weeks for a partial nail removal (and 4 – 6 weeks for a full nail) but there are very few restrictions on activities during the healing process.
Many patients express concern about how the toe will look afterwards. Because the removed nail has usually been buried under the skin and deformed anyway, the final result is usually a better looking, pain-free toe.