Left untreated, foot conditions can cause significant pain, discomfort and limit mobility. Our practitioners are able to manage your foot and leg complaints with expertise. We are your trusted Podiatrist in Canberra. For further information or to make an appointment with one of our podiatrists, just call our clinic today.

What are ingrowing toe nails?

Ingrowing toenails are a common ailment of the toes. Almost everyone has had an ingrown toenail to some degree at some point in their lives! They are particularly common in teenagers and sports people and can really put a dampener on your sport activities and daily tasks.

A true ingrowing toenail (onychocryptosis) occurs when the side of the toenail cuts into the skin beside the nail (nail fold) causing a laceration. These cuts often become infected quickly because feet have a naturally high bacteria population and the nail fold becomes inflamed and can bleed a lot.

What are the common causes of ingrowing toe nails?

Ingrowing toenails can occur when:

• Shoes are too tight causing pressure on the nail
• Toenails are cut incorrectly
• A piece of toenail snaps off, usually due to trauma (kicking or similar), and grows back with a spike on the side. The spike then grows into the skin as the nail gets longer
• You pick or tear your toenails instead of cutting them?
• Feet are very sweaty, making skin softer and easier for the nail to cut into
• The toenails are naturally curved or fan shaped.

How can ingrowing toe nails be treated?

If you have a diabetes diagnosis, peripheral neuropathy, or blood circulation problems and an ingrowing toenail develops, you should seek the assistance of a podiatrist immediately.

If you are otherwise well and healthy, the following things may help in the short term to relieve the ingrowing toenail pain or reduce bacterial load in the area of the wound:

• Soak the foot in warm salt water (as salty as the sea) for 10 minutes
• Apply povidone-iodine (Betadine) liquid or ointment down the side of the nail
• Cover with a breathable island dressing
• Repeat this 2-4 times a day

This is unlikely to resolve the ingrowing toenail completely but it can help to reduce the bacterial load and inflammation.

If the ingrowing toenail is not resolving by itself, a podiatrist can remove the spike of toenail that is causing the laceration. Often, this can be done without anaesthetic relatively painlessly in a consultation with your podiatrist. Sometimes, in severe or deep cases, surgical removal of the spike is necessary. Your podiatrist can also provide this cutaneous surgery for you in their clinic rooms. A podiatrist is a foot and lower limb specialist who has undergone tertiary education in conditions of the foot and lower limb. Do ask them about their experience, but the podiatrists at ACT Podiatry have years of experience of toenail surgery and have generally seen it all. In most cases, removal of the spicule is all that is required to resolve an ingrowing toenail. Infrequently, antibiotics may be required to resolve any infection that persists after the spike is removed.

Generally, the podiatrist will use a surgical blade to carefully and gently lift and cut the free nail edge down the side of the nail to remove the spike. This is usually mildly painful and there is minimal bleeding. The podiatrist will cleanse the wound and dress it appropriately. When they do this, the podiatrist gets a good look at the nail shape and can tell you if they think it might need surgery later on, or whether that might be the only treatment required to fix the problem.

When is surgery considered for ingrowing toe nails?

If the podiatrist is unable to access the nail spike due to inflammation, bleeding from the inflamed tissue or movement because the toe is too sore to touch, they may recommend ingrown toenail removal surgery under local anaesthetic- a surgical procedure. Depending on the situation of the nail and your health, the procedure recommended is likely to be a partial nail avulsion (PNA) or, more rarely a total nail avulsion (TNA). Both of these procedures can be done with or without a phenol matrixectomy – where a chemical is applied to the matrix of the nail (where the nail grows from) to create a burn which stops the nail from regrowing. Usually if the nail is too wide or too curved or flared, then a phenol matrixectomy is recommended to address the nail deformity and prevent recurrence of the ingrowing toenail. It takes about three weeks for the wound to heal after this surgery and your podiatrist will check up on the healing and provide you with dressings as you go along. There is a 0-10% chance of the nail section regrowing after a phenol matrixectomy (so it doesn’t regrow very often at all!). IF you do have very stubborn regrowing toenails and recurring ingrowing toenails after a PNA, you can be referred to our podiatric surgeon, Dr Clayton Clews for a more invasive procedure called a wedge resection. This is only used in stubborn cases.

How can ingrowing toe nails be prevented?

To prevent ingrowing toenails from occurring ensure the following:

• Make sure your toes have room to wiggle and swell in your shoes.
• Get a lesson from a podiatrist about how to cut your toenails if you find it tricky at home. Sometimes a bit of good advice does wonders for preventing nasty events.
• Cut the toenails following the edge of the toe without venturing down the sides of the nail. File the corners with an emery board.
• Manage heavy sweating by using an antiperspirant deodorant on your feet daily and changing your socks at least daily.
• Make sure you wash and dry your feet thoroughly when you shower.