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Wednesday, 26 September 2018 08:38

Ingrown Toenails Featured

In a typical scenario, your teenage son in a rare moment of verbosity manages to say “ Mum, I think there is something wrong with my toe.”

They then peel back their sweaty sock to display a sight you never thought possible in a first world country. There, in all its manky glory, is a red swollen big toe and if you are particularly lucky not oozing copious amounts of an unspeakable liquid.

Fighting back a gag and trying to keep the necessary parental calm you enquire, “Is it sore?”

To which the heir to your genes and fortune grunts, “Yeah. A bit.”

All you can think at this stage is, how the hell did it get to this before you said anything? But being the adult in the conversation you manage to still the rising tide of anger and nausea and reassuringly reply, “ I think we better get the doctor to have a look.”

Ingrown toenails, or Onychocryptosis for those lovers of ancient Greek, are very common occurring in any age group but most often in adolescents and young adults.

They arise from the side edge of the big toenail rubbing and traumatising the groove of skin or sulcus that they sit in. This causes damage to the skin, swelling and often infection. A vicious cycle is then set up where the swelling causes the nail rub further into the skin or even grow into it over time. Once well established, they rarely respond to any treatment except surgery.

They are brought on by a number of factors including:

  1. The shape of the person’s nail especially if it tends to angle down and into the skin groove
  2. Tight fitting footwear compressing the toenail against the skin groove
  3. Repetitive trauma such as kicking a ball
  4. Feet left sweaty or dirty for too long causing weakness in the skin from moisture, abrasive dirt particles and infection.
  5. Nail abnormalities especially in the elderly
  6. Damage to the side of the nail by incorrect toenail cutting where a sharp or irregular nail edge is left behind.

Nails should be cut directly across where possible so that the corner of the nail projects beyond the side skin fold.

Early ingrown nails, before they become very swollen, can sometimes be managed by soaking the foot twice a day in warm water ideally containing an astringent/antiseptic like Condy’s Crystals. After the soak, the skin near the nail edge can be massaged away from the nail. Putting a small amount of cotton wool under the side edge of the nail to lift it out of the groove a little may also help. Sometimes the skin edge can also be pulled away from the nail by taping. Elaborate nail cutting such as cutting a V in the centre of the nail has been shown not to help.

Often it is all in vain or presented in a more severe form. In these cases you doctor will often advise a simple operation under local anaesthetic usually once the infection in the toe has been settled with antibiotics. This operation involves removing the side portion of the nail then in some way destroying the area of the nail called the matrix from which this edge of nail grows. This gives a permanent separation of the skin fold of the toe from the nail. Recovery takes about a week and usually is fairly painless.

For those of you who like a bit of gore this link demonstrates the operation. But, be warned. It is not for the faint hearted!

http://www.ebm-guidelines.com/ebmg/ltk.free?p_artikkeli=vie00030

This operation is commonly done at Busselton Medical Practice and if you are concerned about the toe then the earlier it is seen the easier it is to manage.