Friday 22 September 2017

Dear Dr Nina: Should I take action for an ingrown toenail?

Ingrown toenails may be prevented by good footcare
Ingrown toenails may be prevented by good footcare

Nina Byrnes

Our resident GP answers your medical queries.

Q: My eight-year-old was diagnosed by our GP with ingrown toenails - which run in the family. When we finally got a hospital consultation five months ago, we were told her toes were fine. However, six months on and she is suffering considerable pain and swelling, with pus around her toenails on her big toes.

Dr Nina: The problem is exacerbated by wearing football boots for GAA. I've tried soaking the toes, using  dental floss and filing down the side of the toenails (to great discomfort) but it's just getting worse.  Are there any home remedies I can try or should I be back at the GP? Will it resolve itself long-term if left alone, and how can I guard against my younger children developing the problem in the first place?

Dr Nina replies: Ingrown toenails occur when the edge of the nail grows downwards into the skin surrounding it. This most commonly occurs on the big toes. The nail curls and pierces the skin, which may become infected, red and sore. Ingrown toenails can occur in anyone but are most common in teenagers and older people. Feet tend to sweat more so the skin may swell and become moist and soft, causing it to split and allowing an ingrown toenail to occur. In older people, nails may become thickened and hard, making them more difficult to cut and causing pressure on the surrounding skin.

Symptoms of an ingrown toenail include redness or inflammation along the side of the nail. There may be pain if there is pressure on this area of the foot. If it's infected, there may be pus or bleeding. In more severe cases, the skin along the side of the nail may be obviously overgrown, covering the side of the nail. Nails may initially just be a little sore at times but, left untreated, more chronic pain and recurrent infection may occur.

The main cause of ingrown toenails is incorrect nail care. Our feet work hard and it is important to take time to cleanse and care for them correctly. Toenails should be cut straight across. This allows for the healthiest growth. Trying to follow the curve of the toe or cutting nails too short make ingrown toenails more likely. Wearing tight- fitting shoes or socks also puts pressure on the skin, pushing it into the nails, or it may cause the toenail to curve inwards. It is important to wash and dry your feet frequently and change socks daily (more frequently if feet sweat a lot). Wear breathable natural fabrics such as cotton and leather. Poor foot hygiene can cause skin to become moist and boggy and the nail may pierce it more easily. Infections such as athlete's foot are also more likely with poor hygiene and this causes moist, boggy skin too. Other causes include trauma or damage to the nail. Some people have naturally very curved nails. This predisposes them to ingrown toenails and so a particularly high level of nail care and attention is required in these cases.

Treatment depends on the severity of the case. If the nail is mildly ingrown, bathing it daily and applying some cotton wool or dental floss under the part that is ingrowing may help lift the nail and allow it to grow out of the skin. Wearing open-toed shoes and applying an antibiotic cream or taking simple painkillers may provide relief. In more severe cases, part of the toenail may have to be removed. If the toenail recurrently grows inward, both the nail and nail bed can be removed, therefore preventing that part of the nail regrowing. If the nail is not getting better, you need to revisit your GP as it may now require removal.

There are some GPs who will happily undertake this procedure in their office. Otherwise, referral to a podiatrist or surgeon will be required. Removal of ingrown toenails is usually done under local anaesthetic as a day-case procedure. Rarely, a general anaesthetic is preferred. Ingrown toenails may be prevented by good foot care. Cut nails straight but not too short. Keep feet clean and dry. Don't pick at nails. And wear appropriate shoes that protect the toes and allow them space.

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