Tuesday 18 December 2018

Dear Dr Nina: Should my son remove his ingrown toenail?

'The main cause of ingrown toenails is incorrect nail care'
'The main cause of ingrown toenails is incorrect nail care'

Nina Byrnes

My 16-year-old son has suffered from ingrown toenails on his right foot since he was 10 or 11. I think he's been in hospital four times now for a procedure. It's excruciatingly painful and he's in pain again now. He plays a lot of sports and it affects his ability to run. He's due to go in for another procedure to remove the ingrown nail in a few weeks but he's saying now that he wants the whole nail removed. Would this be the best option at this point? He says he feels crippled by this problem and it's awful to watch him in pain, but I'm concerned that something as radical as removing the whole nail might be something he'd regret in years to come.

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.

Teenagers' 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 your 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.

Other causes include trauma or damage to the nail, and some people have naturally very curved nails.

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 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 isn't settling with simple measures then a surgical procedure may be required. Wedge resection involves removing the affected part of the nail. It is done under local anaesthetic. The nail can regrow after this.

A slightly larger procedure involves removing part of the nail and treating the nail bed. The largest procedure involves removing the whole nail.

In the latter the nail is unlikely to regrow normally and whatever regrows will look different.

If your son has been having recurrent problems it is understandable that he may want a more definitive solution. He should discuss his symptoms, concerns and hopes with the surgical team looking after him. They can examine his toe and with him work out the best treatment option.

As he is 16 he is of the age of medical consent and he can make the decision as to which treatment he would like.

It is important that whatever procedure he has that he looks after the toe after and follows all the postoperative advice he is given.

Q. I’ve always liked listening to music using headphones but lately have noticed that I’ve got to put the volume right up to hear it. Do I need a hearing test? I’m worried I’ve damaged my ears.

Dr Nina replies: Hearing is a sense that many of us take for granted, yet studies suggest that one in six people suffer from some degree of hearing loss. Signs of hearing loss include: problems hearing over the telephone, trouble following a conversation of two or more people, needing to turn the TV or radio up high, trouble hearing if there is background noise, frequently asking people to repeat themselves, feeling people don’t speak clearly, misunderstanding what people say and replying inappropriately.

 Some people respond to hearing loss by constantly asking others to repeat themselves or by insisting that radios or televisions are turned up very loud. This can cause tension as friends and family members may become frustrated if they don’t understand there is a hearing problem. Those who are too embarrassed to try and follow conversation may socially withdraw, leading to isolation and the risk of depression.

The use of in-ear listening devices at high levels is very common and is well associated with hearing loss. In 2009 a European Commission report found that up to 10pc of people who listen to MP3 players and other devices for over seven hours a week at a high volume are at high risk of permanent hearing loss after five or more years of exposure. In order to avoid noise-induced loss, listen to such devices at no more than 60pc volume for no longer than 60 minutes a day.

If you think you have hearing loss it is important to attend your doctor for a proper medical check-up. The next step is to have a formal hearing assessment by a qualified audiology technician. Finally, if appropriate, using hearing aids can be life changing for those with hearing loss.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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