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The Painful Ingrown Toenail

Ingrown toenails are a common foot complaint that can affect all ages. Also known by Podiatrists as Onychocryptosis, an ingrown toenail is most often caused by part of the toenail protruding into the side of the nail sulcus. This allows bacteria to enter resulting in painful infections. It can range in severity from mild (without infection) to very severe (painful with weight of a sheet at night). Whilst it most commonly affects the big toe the lesser toes can also be affected; this can make wearing shoes or simply walking extremely painful.



Cause of Ingrown toenails


There are many causes of Ingrown toenails. It can be inherited, the shape of the nail itself may be widening out or curving in excessively to the sides causing aggravation.

It may be caused by a spike remaining when cutting the nail incorrectly or picking the toenails instead of cutting.

Trauma to the nail such as dropping something on it may cause it to grow back irregularly and this damage to the base can result in curvature into the sulcus. This can also happen through sports such as soccer, netball, and running where there is high impact or friction on toenails.


Excessive external pressure from poorly fitting shoes, high heels, or even tight socks can cause the nail to rub and become irritated and irregular.

A fungal infection can distort the shape of the nail causing it to grow thicker or break away and often leaving the affected nails protruding into the skin.


A previous medical procedure on the nail where there was nail left or not fully cleared may cause regrowth or reoccurring ingrown toenails.

Finally, there can be a bony growth or cyst or pathology beneath the nail itself causing the nail to change shape or become thickened and painful.


It is important to see your Podiatrist if you suspect an Ingrown toenail to examine the exact cause of the Ingrown nail and determine the best course of treatment. Failure to do this can result in reoccurring infections or pain.



Signs and symptoms


Initially you may feel pressure in the nail sulci from the shoe or when the nail is touched. There may be some redness and inflammation or swelling round the area. Often a worsening infection will be very red, bleed or there may be fluid coming from the nail sulci. The sooner you can seek treatment for the nail the sooner you will get relief and prevent a worsening infection.



How can 4life Podiatry help?


At 4life Podiatry we are experts in the treatment of Ingrown toenails. Book in as soon as possible for assessment of the toenail. This will identify the cause of the Ingrown toenail and appropriate treatment options.


If the ingrown toenail is not complicated and, in most circumstances, the nail sulci can be cleared on the day providing immediate relief.


If the nail infection is more severe or closer to the base of a minor nail procedure can be performed under a Local Anaesthetic for permanent resolution. It is performed in the clinic in a sterile setting with minimal discomfort and post-operative healing time. This is called a partial nail avulsion or PNA.


If antibiotics are required, your Podiatrist will assess this. Often removing the nail, itself is enough to clear the infection without antibiotics. Your Podiatrist will assess this at the time of your consultation.


If your Podiatrist suspects an underlying cause further images can be obtained. Assessment to rule out fungal infections and footwear or biomechanical causes is also considered. They may make some recommendations on shoes, toenail cutting, foot hygiene to prevent reoccurrence.


Most Ingrown nails are readily resolved in the clinic by your Podiatrist.



Nail surgery


A partial nail avulsion (PNA) is a minor procedure performed in the clinic by your Podiatrist. At 4life Podiatry we are skilled at injecting a local anesthetic to ensure the procedure is pain-free.


A small section from the side of the nail plate is removed and a chemical (Phenol) is applied to the base of the nail to prevent it from growing back into the side. There is a very minimal chance of regrowth as the procedure is designed to be a permanent solution.


One or multiple nails can be performed during the same procedure. It is rare that a full nail may need to be removed but if the Podiatrist decides this may be the preferred option it can be discussed at length in your initial consult.


Once the procedure is finished a dressing will be applied for 48hrs and then at-home care discussed. A review a week later with your Podiatrist is recommended. Often the nail will need to be redressed at home for 3 weeks post-operatively. There is very minimal scarring or evidence the procedure has been performed.


Nail surgery is should not be a cause for concern as it is a low-risk effective procedure with minimal pain and permanent resolution. If you have queries, please book a consultation at reception and a treatment plan can be further discussed.


by Karina Schuberg (Senior Podiatrist)

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