Ingrowing toenails (Onychocryptosis)

An ingrown nail occurs when part of your toenail pierces the skin that surrounds it and grows inwards. This is much like having a splinter in your toe, except that the offending nail edge is usually difficult to see, reach or remove. As a result, you may experience:

• Inflammation and redness on the affected side of the toe
• Pain on pressure, whether that is from you touching your toe, from your shoes, or even a bed sheet at night in severe cases.
• As a result of the pain, walking and playing sports can become too painful, affecting your daily activities and quality of life.
• As an ingrown toenail is an open wound, it may bleed, and is vulnerable to infection. Infected ingrown toenails may exude cloudy yellowish discharge.

Ingrown toenails may occur on one or both sides of the toenail. While 95% of ingrown toenails that our podiatrists see and treat are at the big toe, they can affect any of the toes, and in young children as well as adults.

The most common causes of ingrown nails that we see include:

• An improper nail cutting technique: toenails should be trimmed in a clean line that matches the natural nail shape, with no fraying, split edges or curving down the sides of the nails. When nails are rounded deep down the sides of the nail, and if frayed edges are left behind, they may pierce the surrounding skin and cause an ingrown nail.
• Pulling or picking the nails: being something we often see in teenagers, pulling the nail and ripping it off often leaves a sharp nail spicule deep down at the nail edge. This is often not visible or palpable until it starts growing out and pierces the skin, causing an ingrown toenail.
• Tight footwear: wearing shoes that are tight, narrow or pointed can create pressure on the sides of the toes that can push the nail into the surrounding skin. 
• Kicking sports: like soccer, that repeatedly expose the side of the toe to impact, and encourage the nail to press against the skin.

The shape of the toenail can also play a role, especially where the nail is particularly involuted or curved. This is often linked to uncontrollable genetic factors that dictate the features and shape of the nail.

To help reduce the pain from your ingrown toenail until you are able to have it professionally treated, you can try:

• Using a salt water foot soak: this can help reduce swelling and tenderness, to temporarily improve your comfort. Dilute one litre of water with one tablespoon of salt, and soak the affected foot for 10-15 minutes, up to twice daily.
• Switch to open-toed footwear where possible, or choose closed-in shoes with a wide toe box. This will help prevent your shoes from rubbing against the toe and causing further irritation and pain.
• Use non-steroidal anti-inflammatories (NSAIDs), where suitable, to help you get some temporary relief from your painful symptoms.

As ingrown toenails can get worse, and can also become infected without the right care, we highly recommend against ‘bathroom surgery’ - using unclean tools to dig down into your toenail to try to get some relief. We absolutely understand the need to try to get relief from your ingrown toenails, but in our patients’ reported experience, this does more harm than good. 

Cutting a ‘V’ in your nail for ingrown toenails

 We’ve often heard of patients cutting a ‘V’ in the centre of the nail as an attempt to treat or discourage their ingrown toenail. Unfortunately, this action having any benefits is a myth. Aside from there being no studies to support the effectiveness of this method, it also goes against the  natural way that ingrown toenails grow - that is, that the nail growing cells are located at the base of the nail (much like how the hair-growing cells are located on your head), and so the action you take to the end of the nail has no impact on these cells to alter the way that nail is produced. In fact - it may do more harm than good if your nail catches on your socks or sheets and painfully pulls at the nail.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists have two key ways that we successfully treat ingrown toenails: conservatively or surgically.

Conservative Treatment

Our conservative nail care appointments are non-surgical in nature, and are a good option for those who are experiencing an ingrown toenail for the first time, or where the cause is a one-off and is unlikely to recur in the future. 

During this appointment, we will remove the offending nail spicule, removing it from the skin where it has become embedded. We will then dress the toe, and teach you how to continue to dress it at home to reduce your likelihood of infection. We will give you advice on footwear, particularly where your shoes are likely to have contributed to the development of your ingrown nail. We’ll also discuss the best-practice principles of nail cutting, and advice on salt water and foot baths and how they can be used to support your toe to heal.

Surgical Treatment

For those who have had an ingrown toenail before, and where the ingrown nail is likely to continue to recur periodically, we may recommend a surgical approach. Don’t be put off by the term ‘surgical’ - this is a minor procedure that our podiatrists perform in our clinic several times every week. The two types of nail surgeries we offer are:

• Partial Nail Avulsion (PNA): a PNA is performed under local anaesthetic, making it painless for you. During this procedure, we remove the small, problematic section of your toenail that is prone to growing inwards. We then offer the application of phenol to the base of the nail, a chemical that destroys the nail growing cells, meaning that this small section of nail does not grow back. The result is a nail that has a smooth, straight nail edge, with an aesthetically barely noticeable difference. Your toe is dressed after the procedure, and you will need to return several times over the coming week for dressing changes and to monitor your progress.
• Total Nail Avulsion (TNA): a TNA is also performed in our clinic under local anaesthetic, but removes the entire nail, instead of only part of the nail. The nail can be left to regrow from scratch, or phenol may be applied to help prevent the nail from returning. Look TNA’s are normally preferred by those who also have damaged nails or nails that are infected by fungus, so want to ‘start again’ in the hope of growing a clear, healthy nail. It may also be preferred by those that have an ingrown toenail on both sides of their nail, as an alternative to having a PNA performed on both sides.