Ingrown Toenails

Many people suffer from pain and inflammation on the edge of one of their toenails, often called an “ingrown toenail“.  It is most common on the large toe, or “Hallux”, but can occur on any of the toenails.

An “Ingrown Toenail” is sometimes a bit of a misnomer, because generally the nail is not actually growing down into the skin of the toe.  It is usually the result of irritation to the skin, either through shoes or improper cutting, which causes redness and swelling.  Once the skin is swollen, even a normal-shaped nail will further irritate it, which can lead to infection if left untreated.  Less commonly, the nail itself is naturally curved, which can predispose individuals to this problem if the skin gets even a little irritated and swollen.

For prevention, be sure that the toebox, or front part of your shoe, is wide enough and tall enough to avoid undue pressure on the nails.  Also, take care to cut the nails in a gently-rounded shape, avoiding digging in too deeply at the edges.   Make sure that your shoes are long enough.

If you think you are developing an ingrown nail, first try soaking the toe two or three times daily for 15 minutes in warm water.  Epsom salts may also be added to further draw out any fluid.  After the soak, apply some topical antibiotic ointment such as bacitracin or Neosporin, and cover the area with a bandaid.  If this does not seem to help, it is time to see a podiatrist.

When evaluated by your podiatrist, sometimes a minor procedure to address the problem will be recommended, which can usually be done in the office.  If it is your first time with toenail problems, removing a portion of the offending nail back to the base of the nail plate may be all that is needed.  This is done after local anesthesia is applied to the toe.  The growth center, or “matrix” of the nail is not affected, so your toenail will grow in normally in this area after 9-12 months.  This gives the irritated skin ample time to recover and hopefully this will be the only treatment needed.

However, if you have suffered from pain related to ingrown nails more than once or chronically, there is another step to the above procedure which can be done.  The matrix on the edge of the nail may be killed permanently after the nail portion has been removed, either with a chemical called Phenol or by cutting out the matrix.  This is called a “matrixectomy”.  The advantage to this is that it permanently fixes the issue, and the remainder of the nail will still be allowed to grow in normally.