Ingrowing toenails and gait. How does that connect? How does the way you walk have anything to do with getting an ingrown toenail? Painful ingrown nails are usually associated with bad nail cutting and trauma, but lowering of arches could be the cause. There could be a biomechanical issue with the foot. This could be the main etiological factor responsible for a persistent ingrowing nail. A podiatrist can check this out during a musculoskeletal biomechanical assessment.
Common Causes for Ingrown Nails
Nails can ingrow for many reasons The big toenail (hallux) is most susceptible. The big toe plays a pivotal role during the gait cycle. It a spring which levers body forward for propulsion. Here are some of the reasons for ingrowing nails:
- The nail is involuted in shape and does not grow straight at the free edge so it just grows and turns inwards
- Damage to a nail can result in a spike
- A fungal nail can become thickened and distorted
- A stiff big toe can keep banging onto a shoe’s toe-box resulting in nail trauma
- Badly fitting shoes, tight socks, surgical stockings
- Sweaty feet
- Sport
- Poor nail cutting
- Foreign body e.g. hair, splinter
- Fleshy toes whereby the skin tends to encroach on the nail plate
- Nail disease e.g. psoriasis
Chronic ingrown toenail. An example of ingrowing toenails and gait issues. Patient needed post surgery to wear orthotic insoles.
Stiff Big Toe and Ingrown Nails
It is not generally considered that in-rolling, termed pronation of the foot may be responsible. An ingrowing nail could be secondary to poor lower limb biomechanics. When the foot pronate excessively inwards the big toe can lock-up, rotate and become stiff. If it is stiff it becomes what is termed ‘incompetent’ or more technically called functional hallux limitus. There is increased micro-trauma to the nail plate from shoe box pressure. The nail becomes weakened, damaged and could ingrow.
Functional Hallux Limitus leading to ingrowing toenails
Are Ingrowing or Ingrown Toenails the Same?
In clinic it often observed that individuals with persistent ingrown nails have flattening of the arches with locked-big toes. The result is the same for other etiological factors. There is developing pain, swelling and inflammation. A lot of individuals who are experiencing tenderness from their nail often don’t have ‘true’ ingrowing nails. These are nails under mechanical pressure and stress. A ‘true’ ingrowing nail grows/ penetrates into the skin.
Involuted ingrowing nail
What Happens If You Leave an Ingrown Toenail?
If the section of nail piercing the skin is not removed it will continue to grow inwards and become infected. White or yellow pus will form. In chronic cases the body responds to the offending nail as a foreign body. A process of hypergranulation begins to occur. This is when there is an overgrowth of skin around and over the nail. This can be very red and vascular, so readily bleeds. It all becomes very distressing to the sufferer. The pain can limit individual to what shoes they can wear. This can be hugely problematic as it can interfere with work and daily activities.
Ingrowing Toenail is it best to go to Podiatrist or GP?
When an ingrown toenail has reached this point individuals must go to a qualified podiatrist. It is best to go to podiatrist before a GP. A GP will prescribe antibiotics for the infection, but this does not address the situation. It is advisable to avoid taking antibiotics unless necessary to reduce future antibiotic resistance. The ingrowing section of nail has to be removed. Podiatrists are experts at nail surgery. The sooner the troublesome piece of nail is removed the quicker it will resolve.
How Do Podiatrist Treat Ingrown Nails?
The spike or ingrowing nail section is gently removed. If very painful a local anaesthetic can be administered. The nail fold termed sulci can be packed with appropriate dressing to ease skin away from nail plate. Cotton wool or a special bacterial wick called Sorbact can be used as packing. Sorbact helps to draw away bacterial infection. Generally this works well for new ingrowing nails, but for the more chronic long standing ones these have to be operated on. Once the process of hypergranulation has started it is very hard to settle until you remove the whole side of the nail plate.
Nail Surgery is Safe and Comfortable
Nail surgery has come on a long way from the days when one would have to have a hospital admission and a general anaesthetic. A procedure called a Zadick’s used to be done. This involved cutting into the base of the growing nail to surgically remove it. Sutures would be required. This is totally unnecessary, ‘belts and braces’ approach. A simple nail surgery procedure can be done within an hour in a clinical setting. This procedure is termed wedge excision or total or partial nail avulsion.
Ring Block Analgesia for Ingrown Nail
Local analgesia needs to be administered for pain relief. This is termed ‘ring nerve block’. Administered at the base of a toe. Analgesia generally works very quickly. For those of a squeamish nature stop reading now……………. a tourniquet is applied to create a bloodless area. The nail is elevated and prised off the nail bed. Only the section that needs to be removed. A straight cut is made towards where the nail grows from. It is clamped with a pair of forceps and then rolled inwards.
Does The Nail Grow Back?
Yes, the nail does grow back even when a whole nail plate is removed. If it is considered that it may be an ongoing problem or the etiological cause cannot be eliminated, podiatrists recommend phenolisation. Phenolisation is when a chemical called phenol is applied to stop nail section growing back. Without applying phenol, healing is within 1 -2 weeks. When phenol applied healing is longer and is generally within 3-4 weeks.
Incredible Pain Relief
The relief a patient experiences after nail surgery is immense. Many people who have had ongoing issues with ingrown nails wonder why they did not have surgery before. The surgery is never as painful as they imagine, and the great results speak for themselves.
Why it can be a blessing to get an ingrowing nail
Patients after surgery still have to address the reasons as to why they may have got the problem in the first place. The causative etiological factor needs to be removed. Part of a podiatrist’s role is to identify and educate people on all of these potential issues and how to resolve. It is important to address compromised biomechanics. Poor foot alignment and function needs to be corrected. A high percentage of teenage patients manifests with ingrowing nail issues. It is often wrongly assumed to be due to bad nail cutting, hormones, sport etc. On examination it is observed that their feet are rolling inwards, pronating. If this is not addressed early in life, potential future muscular skeletal issues could develop. Having an ingrowing toenail can therefor be considered a blessing in disguise. An indicator of a potential bigger musculoskeletal issue.
Ingrowing Toenails and Gait
In-rolling of the feet and a stiff incompetent big toe can result in poor gait. Poor gait can lead to many lower limb problems An ingrowing nail is an indication that an individual’s biomechanics need to be adjusted. Preventive podiatric medicine can reduce the impact of potential biomechanical foot related pathologies occurring. Corrective and supportive orthotic insoles can improve foot alignment and function. A stiff big toe can be eliminated by elevating the arch therefor making big toe is more mobile. The big toenail is subject to less mechanical trauma. There is a reduced risk of getting an ingrowing nail.
Please check you medical insurance to see if you can claim for your nail surgey. We are BUPA registered for nail surgery.
