PODIATRY

Still Bothered by ingrown toe nails?

This isn’t the first and wont be the last time we write about this subject!

No matter how many times we address this condition at presentations, educational seminars and on an individual basis, the steady flow of new patients keeps coming with re-occurring ingrown toenails.

Everyone at some point in their lives will inadvertently cause a sharp edge or inflammation the the border of a toe nail.This may be due to poor skills at cutting or trauma from an impact or unusual activity. These are are usually easily dealt with, only occasionally requiring professional assistance. On the other hand if there is a history of repeat episodes to the same site, and it has becomes increasingly challenging to cut the corner of the offending nail this is most definitely not something to ignore.

Ingrown toenails are according to the Mayo Clinic

Causes

Causes of ingrown toenails include:

  • Wearing shoes that crowd the toenails
  • Cutting toenails too short or not straight across
  • Injuring a toenail
  • Having very curved toenails
  • Nail infections
  • Certain medical conditions

We have addressed this before but the VAST majority of ingrown toenails that I have encountered in over 35 years of clinical practice have been caused by abnormal pressure due to the way the individual walks. In simple terms, the feet roll inward more than they should during walking, this causes the big toe joint to lock (functional hallux limitus). As a result they are forced to toe off causing pressure to the inside of the big toe driving it sideways into its next door neighbour and over time changing the shape of the nail plate.

As a result the first thing we do upon some poor sole arriving with a big toe like the one below. Is absolve them of blame. They DID NOT cause this due to tight shoes, cutting down the side of a nail or having curvy nails.(Eye roll insert here).

The ingrown, painful, and often infected toe nail is clearly the patient’s primary concern, we still make sure to identify the underlying cause. If at a later date the cause is not addressed they can expect at least subsequent ingrowths in other nails, opposite side of same nail, bunion deformities, contractures in the smaller toes, callous and corn formation, thickening discoloration and deformity of the big toenails. Not to be alarmist, but the repetitive trauma if not addressed the the tip of the great toe can cause irritation to the underlying bone and abnormal growth, or subsequent abnormal changes to the soft tissue and even malignancy.

As he declared when I walked in the room, “you told me this would happen if i didn’t fix my flat feet, I guess I just got busy“. While there is little pleasure in being proved right, it is however nice to have this opportunity with his consent to photograph the before on the left and after on right. Generally just like him I usually get too busy to remember to capture the after image to demonstrate healing.

If you look at this last image, you can still see despite the correction of the ingrown nail he is still walking in the same manor, the subsequent trauma to the remaining nail plate causes the thickening and discoloration on the left side of the nail and dark capillary damage under the nail.

As always the best course of treatment for you begins with a good examination,history taking, gait analysis, all leading to a proper diagnosis of the underlying cause and a good explanation of the condition. Without any component how can you make an informed decision regarding your health care.

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