Painful Ingrowing Toenails
Painful ingrowing toenails can become very debilitating and make a daily walk during the Covid-19 crisis a miserable affair. The pain can be excruciating, and toes can become infected. The body treats the ingrowing nail section as a foreign body and in it’s protective response a process of over-healing occurs. This is called hypergranulation. It is characterised by the appearance of proud flesh which is inflamed and can be very vascular, bleeding on the slightest touch. The hypergranulation is often accompanied with a secondary bacterial infection with the presence of exudate (pus). A course of antibiotics will help to resolve the infection, but the ingrowing nail section needs to be removed.
Chronic Ingrowing Nail Self-Help
In ‘lock-down’ if you can not get an emergency appointment with a podiatrist you can try to alleviate the issue by:
- Soaking infected ingrowing nail for 5-10 minutes in warm saline water daily
- Dry the area thoroughly with non-fibrous material e.g. kitchen towel
- When drying the toe push the skin fold outwards
- If you are flexible, try to prise the corner of the nail away from the skin
- If you have proper nail nippers (not scissors) snip as much of the offending ingrowing nail plate away
- If you cannot do this, try packing the nail fold (sulcus) with cotton wool to push skin away from nail fold
- The cotton wool should be a very small piece twiddled into a thread/ wick
- If you can use a small blunt, clean thin probe to tuck the wick under the edge of the nail plate to lift it away from the skin
- Apply an antiseptic cream and a clean dressing
- Change dressing daily, but don’t keep changing the side packing. Let it fall out before replacing.
- Stick to wearing sandals, take pressure off the nail plate.
Preventing an Ingrowing Nail
The best treatment for ingrowing nails is not to get one in the first place, and act very quickly when one starts to develop:
- Cut nail plates straight across distal to see corners free from nail folds
- If nail plate curves inwards at sides (involutes) you need to try and cut slightly down into the nail fold to free the corners
- Use nail nippers and not scissors
- Careful not to leave any spikes/splinters
- Pack the nail fold with a wick as above for chronic ingrown nail
- Never pick or tear a nail piece off
- Apply cuticle nail softener and push sides outwards away from nail
- Don’t let toe get soggy or mascerated in footwear or under plasters
- Don’t keep touching the toe as this can be an irritant and make matters worse
- Ensure you are wearing roomy good fitting footwear
- Draw around your barefoot, then place your shoe over this outline and draw around the shoe. Is there room for your big toe?
- Get open-toed sandals on
- Check to see whether you have low, in-rolling arches (pronation). This may be the reason for a persistent in growing toenail, as you lose the spring in your step and big toe locks
- Wear footwear with a contoured instep
- Think about wearing an arch support or use padding to push-up the arch. This will free up movement in the big toe.
- Avoid hill walking if big toe is getting subject to trauma on the declines
If you are struggling to cope with your ingrown nail and the infection is getting worse then please seek podiatry help. A podiatrist can quickly resolve the problem, negating the need for an unnecessary course of antibiotics.
We would urge all diabetic and immune-compromised patients to have their toenails cut professionally by a podiatrist.
