Ingrown nails
Hello HPA families. This month’s topic is a common issue in preadolescent children and teens. Ingrown nails most commonly affect the great toenail. This problem may affect other toes and fingers but less often. Ingrown toenails affect males twice as often as females.
- Ingrown nails have different subtypes. The most common happens at the end of the nail. A person may call this the “ corner or edge” closest to their second toe. Patients usually come to the office or call when this area of their toe becomes painful and the edge of the nail bed (tissue under the nail plate) has become swollen. This pain is caused by a sharp edge of the nail ( called a spicule) that breaks through the skin producing a small injury.
Most common causes
- Nail trimming – causes a sharp edge to break the skin or the trimming damages the underlying nail bed.
- Poor fitting shoes – Adds pressure to the sharp edge of the nail. This pressure then contributes to more inflammation of injured tissue.
- Sweaty feet
- Repeated trauma – sport related injuries from shoes or impact during sporting events.
- Congenital or acquired foot deformities
- Medication – less frequent and more common in older adults
Diagnosis
This part is straightforward. Appearance and history are all you need. A swollen edge of the nail bed is often painful with direct pressure to the toe or involved nail.
Management of ingrown toenail
The main goal here is to improve pain, reduce pressure to injury and avoid an ingrown nail from happening again. This can happen by remembering to cut nail straight across, wearing open toed shoes or shoes with a wide toe box.
PARONYCHIA- This is when an ingrown toenail has become infected. Often this will improve with daily soaking and improved cleaning. Applying triple antibiotic and bandaid 1-2 times a day will help as well. Your provider will decide if oral antibiotics are needed.
Conservative option –
Soaking foot in warm soapy water 2x/day then gentle cleaning of nail edges as pain improves. At times hydrocortisone cream may be applied to irritated skin to reduce inflammation. Ibuprofen and Acetaminophen for pain.
his option may take longer but can be effective for early mild cases.
Other options include different cleaning and splinting/coverings techniques we would cover during an office appointment.
Surgical options –
Saved for more severe cases, recurrent ingrown nail issues, you desire permanent nail removal or failed conservative treatment.
We would discuss partial or complete toenail removal during an appointment. Referrals to a foot specialist may also be encouraged based on your history.
Some of our providers perform nail removal procedures during a scheduled appointment.
If you have any further question or concerns regarding ingrown toenails please call our office.
Thank you,
Garett Shook, DO