By Dr. Elizabeth Vulanich
July 26, 2012
Although there are numerous reasons for toe pain, one of the most common conditions seen in a Podiatrist’s office is an ingrown toenail.
What causes an ingrown toenail?
Causes for ingrown toenails are numerous, however common causes are improper cutting of the toenail or injury to the toe. One may also inherit the tendency for an ingrown toenail. In those cases it is due to inheriting a particular shape of toenail such as either a very broad, flattened toenail or a toenail with a very high arched shape. Certainly shoes which are poorly fitting and especially high heels with narrowed toe boxes also increase the likelihood of developing this problem. Toenail fungus may cause the toenail to become very thick or otherwise alter the nail shape predisposing to an ingrown toenail. Less commonly, some medications may change the shape of the toenails resulting in development of this condition.
An ingrown toenail may present initially as a toenail margin which is tender in shoes or with pressure. It may progress to an inflamed, red, warm, swollen, draining and infected toe which is exceedingly painful and interferes with the ability to wear a shoe. To best avoid this painful condition, it is recommended that toenails be cut straight across regardless of nail shape and to avoid improperly fitted shoes.
What should I do if I suspect it is an ingrown nail?
Early in the development of an ingrown toenail it may be helpful to soak in warm water several times a day. Applying topical antibiotic ointment and avoiding tight shoes may also be beneficial. Too often self- treatment, “digging out the toenail”, results in a worsened not improved condition. If you have tried conservative treatment without success it is time to visit with your podiatrist.
What will the doctor do?
Depending upon the stage of the ingrown toenail, your Podiatrist may simply cut out (avulse) a portion of the toenail. If the condition has been a frequent problem and/or if the toe is acutely inflamed, the toe may be anesthetized and the offending portion of toenail may be removed permanently such that the removed portion does not grow back. This is a little more involved procedure and includes destroying the portion of the nail root (matrix) which produces the painful portion of toenail. Home care typically involves daily soaks, antibiotic ointment, and bandage until the site has completely healed. Oral antibiotics are not regularly prescribed.
An untreated chronically ingrown toenail is not only painful but may actually encourage the development of fungus infection of the toenail. In worse cases, a chronic ingrown toenail may result in a severe infection involving the bone of the affected toe and ultimately require amputation.
To prevent and ingrown toenail, cut your toenails straight across but not too short. Wear properly fitting shoes, and protective shoe gear when indicated. Do not pick or tear your toenails! If you have toe pain that does not resolve despite your conservative attempts at treatment, it may be time to see a professional.