Toenail

What can you do about an ingrowing toenail?

Description: An ingrowing toenail usually affects a big toe. The inner or outer edge of the nail has grown into the skin and caused irritation, pain, or inflammation. Nobody knows exactly why an ingrowing toenail occurs. It may be caused by footwear (too tight, too narrow) or the structure of the toe and nail itself (slightly crooked, which means the nail edge presses into the skin too much) or cutting the corners of the nail too short.

Ingrowing toenails are relatively common among adolescents. This is probably the result of a combination of thin nails (due to rapid growth), and shoes that are too small (often because of rapid growth as well). Comment: the beginning of toenail fungus can resemble an ingrowing toenail and in the early stage may cause the same symptoms.

Tips for an ingrowing toenail

Cutting the nails: Regularly cut the nails straight, this reduces the chance of ingrowing toenails. Preferably cut the toenails after taking a bath or shower. The nails will have a high moisture content and be less vulnerable. Above all, do not cut the nails too short, and never bite or tear them off, as they may tear inwards.

Nail varnish: Nail varnish is a good solution for strengthening and protecting the nails. Unfortunately nail varnish remover does harm the nails, especially if it contains acetone. Therefore, do not use nail varnish remover too often, and choose one that does not contain acetone.

Additional examination: Further investigation is not usually necessary. Occasionally, the doctor may have an X-ray taken of the toe, depending on the findings.

Treatment

There are various treatment options, depending on the severity of the ingrowing toenail edge.

• If the toenail edge has grown into the skin a little bit, or risks doing so and causes irritation, simple measures may suffice. The edge of the nail can be elevated by placing a small piece of cotton wool under the nail and/or regularly massaging the skin downwards. This can be done by a pedicurist or podiatrist.
• If the extent of the ingrowth is more serious and causes pain, or inflammation with or without thickening of the skin and proud flesh (hypergranulation), a narrowing of the nail edge is often recommended. This can be achieved by cutting away the nail edge. The nail subsequently grows back. If the inflammation has subsided, the above-mentioned measures can be tried to prevent the toenail growing into the skin again.
• The nail could be permanently narrowed by not only cutting away the edge of the nail, but also narrowing the root of the nail. The section of the nail’s root can be cut or scraped away, or cauterised using a corrosive liquid (phenol).
• In some cases, depending on the doctor’s findings, it may be necessary to remove part or all of the nail.

You undergo these operations on the toenail as an outpatient in the outpatient clinic under a local anaesthetic by means of two anaesthetic injections into the base of the toe. Your doctor will consult with you about which treatment is most suitable in your particular case.

Post-operative treatment

You may experience some post-operative pain following the surgical treatment. The degree of pain may be light or moderate, depending on the nature of the procedure. Any discomfort can usually be relieved with mild painkillers. Elevating the foot can also relieve the pain. The bandage can be removed after a few days and replaced with a smaller one. The wound will have to be disinfected every day, possibly supplemented with disinfecting footbaths. You should be able to walk normally, depending on the pain, a few days (two to five) later.

This content was written by : Dr. Stijn Muermans, Dr. Mark van Dijk, Dr. Jan Van Oost