Ingrown toenails are probably the most common foot problem presented in our office. The misconceptions concerning ingrown toenails are astonishing.
An ingrown toenail quite simply is a painful condition whereby one or both sides of the nail curls down and invades the fleshy borders on the sides or tip of the toe. Any toe may be involved, although most commonly the great toe is affected. The initial signs of an ingrown toenail include mild redness, irritation, burning or thickening of the skin folds, which may or may not worsen after wearing shoes. As the condition progresses, the nail continues to advance into the skin, eventually piercing the flesh, introducing a great deal of bacteria and fungus which normally inhabit the nail plate. Hence, an infected ingrown toenail results. With continued neglect, the skin folds get more inflamed and continue to react by forming large bulbous “cherry red” granulomas. Furthermore, the infection may deepen and invade the underlying bone. This complex cycle can be corrected very easily with prompt recognition and attention.
The most common cause of ingrown toenails is improper cutting or “picking” of toenails. All nails should be cut straight across and allowed to grow out to the edge of the nail fold. Because of the fleshy nature of their toes, some patients are predisposed to tissue overgrowth on the nail.
Other common causes include fungal thickening of the toenail and bone spurs hidden under the nail plate. In both cases the nail is thickened and tented up in the center, thereby pressuring the sides down and into the surrounding skin folds. Bunion deformities , whereby the big toe leans against the second toe, may also cause irritation on the side of both toenails and lead to ingrown toenails.
Cutting a “V” into the center of the toenail has never, in our opinion , helped to alleviate pressure on the nail. Remember, the nail plate is rigid and will not simply bend out of the skin by cutting a wedge in the center. Furthermore, we have never found over-the-counter ingrown nail medication to be effective. In fact, both of the remedies only serve to delay proper treatment and increase the risk of infection.
The correction of an ingrown toenail is usually quite simple and can be done painlessly in the office with local anesthesia . The offending portion of the nail can be removed in such a way that permanent correction is almost always obtained. In you suffer with an ingrown nail, seek a permanent solution.