Saturday 26 May 2018

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

Ask the GP...

Symptoms of an ingrown toenail include redness or inflammation along the side of the nail
Symptoms of an ingrown toenail include redness or inflammation along the side of the nail

Nina Byrnes

Advice from our GP on the treament of ingrown toenails and Vitamin B12 deficiency.

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 later, 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. The problem is exacerbated by wearing football boots for GAA. I've tried soaking the toe, using dental floss and filing down the side of the toenail (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.

The main cause of ingrown toenails is incorrect nail care. Toenails should be cut straight across. 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). 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.

Treatment depends on the severity. If the nail is mildly ingrown bathing it daily and applying some cotton wool or dental floss under the part that is in-growing may help lift the nail and allow it to grow out of the skin.

Wearing open-toe 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.

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. Wear appropriate shoes that protect the toes and allow them space.

Should I be taking a vitamin B12 supplement?

Vitamin B12 plays an important role in normal metabolic function and health. It is essential for the formation of red blood cells. It supports the normal function of nerve cells and is required for the replication of DNA. Unlike other forms of B vitamins, B12 is found in animal sources of food such as eggs, dairy and meat, or in fortified cereals. Those who avoid animal foods such as vegetarians and especially vegans are particularly at risk of deficiency of this vitamin.

B12 is absorbed in the stomach with a carrier protein called intrinsic factor. Deficiency of this protein causes a condition called pernicious anaemia, which results in B12 deficiency. Conditions that affect the stomach, such as gastritis, or other medicines that affect the stomach such as aspirin or drugs that neutralise or stop acid production, may also result in reduced absorption of B12.

Symptoms of B12 deficiency include fatigue, which may be extreme, lack of energy, numbness or pins and needles, muscle weakness, mood changes and difficulty with memory and concentration. A pale yellow tinge to the skin may be noticed and there may be mouth ulcers or inflammation and redness of the tongue. Deficiency is more common as you age occurring in one in 20 people over the age of 65. It is most common in those with a family history of the condition and occurs more commonly in women at a ratio of 1.6 to 1.

B12 deficiency is often just picked up on a simple blood test as in mild deficiency there may be no symptoms at all. If B12 levels are low, your GP will arrange further blood tests. These check for antibodies, which may reduce your ability to absorb B12. If these are present you have a condition called pernicious anaemia.

B12 can be replaced in a number of ways. If your diet is deficient it is important include foods that contain B12 or to take a supplement. Injections can increase levels quickly. Those who have pernicious anaemia are unable to absorb B12 and will require B12 injections. Injections are normally given every two to four days for a total of five to six doses. This brings B12 levels up to a normal level. Those with pernicious anaemia require an injection every three months for the rest of their lives.

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