One of the most misunderstood conditions that we treat is known as an ingrown toenail. Included under this title is also involuted, and onycryptotic conditions. Upon review of both professional and lay sources you will find a repetitive and erroneous theme, citing poor footwear, trauma, and inappropriate nail cutting techniques as the primary causes of these conditions.
Undeniably footwear does play a significant roll in the condition, but only as a complicating factor rather than the origin. A majority of cases are bilateral, or proceed to become bilateral eventually, which would rule out the possibility of trauma or nail care techniques being the primary cause.
“After over 35 years of practice and hundreds of successful surgical corrections of ingrown toenails, the primary cause of this most common of conditions lies in the biomechanical function of the foot. Almost invariably, the presenting individuals with ingrown toenails when viewed through weight baring and walking demonstrate a noticeable degree of compensatory pronation and subsequent associated functional Hallux Limitus.
In other words, this means a patient’s feet might roll in. As a result, when a person attempts to toe off, the big toe joint locks forcing the patient to turn their foot out wards. The weight of the entire body is then born briefly on the side of the big toe as they roll off. When this happens, patients will quickly sense the amount of pressure produced, which then becomes more pronounced in ill-fitting footwear. More over, when this action is repeated over years it is easy to better comprehend how patients describe their nails as becoming more and more ingrown.
Often the presentation of this condition is long past the point of prevention and requires the performance of a simple, painless and aesthetically pleasing surgical procedure, which permanently corrects the problem. It is vitally important that the cause is properly identified because, unless addressed in a unilateral situation, it is very likely that the same individual will return subsequently for similar conditions on the opposite foot. Also it is important to remember that the nail condition is merely a manifestation or symptom of the underlying biomechanical dysfunction. Most frequently the same functional instability can cause bunion deformities, toe contractures, planterfascitis, bunions and painful callouses to name but a popular few.
Prior to declaring a diagnosis of an ingrown toenail and subsequent treatment, we may ask our patients to weight bare using video gait analysis to offer the best treatment options possible.
Short term management: Soaking your foot in warm, salt water several times each day may help minimize the discomfort from an ingrown nail. Also, you can try inserting some cotton or waxed dental floss between the nail and your skin. To permanently address the condition please contact our office to determine the best course of treatment for your condition.
Antibiotics are sometimes prescribed if an infection is present. Where the situation is chronic, a part of your ingrown toenail (partial nail plate avulsion) may need to be surgically removed. The procedure involves injecting the toe with an anesthetic and gently removing the ingrown part of the toenail. This procedure is largely unique to podiatrists and chiropodists, producing the highest levels of success which if performed correctly with good aftercare will be painless and results in an aesthetically normal looking nail in most cases
You can prevent ingrown toenails by:
- Trimming your toenails straight across with no rounded corners.
- Ensuring that your shoes and socks are not too tight.
- Keeping your feet clean at all times.
- Most importantly!! if it is chronically reoccurring seek help as it will not resolve, and presents an open portal for infection.