Nail Removal

Posted in Disease Information

Introduction

An ingrown toenail develops when the sides of the toenail grow into the surrounding skin.

The nail curls and pierces the skin, which becomes red, swollen and tender. The toe can also be painful when pressure is placed on it.

The big toe is most likely to be affected, either on one or on both sides.

The medical name for an ingrown toenail is onychocryptosis.

What causes ingrown toenails?

There are a number of possible causes of an ingrown toenail including:

• Incorrectly cut toenails
• Tight-fitting shoes, socks or tights
• Excessive sweating or poor foot hygiene
• Injury
• Nail infections
• Natural shape of the toenail

Treating ingrown toenails

There are number of things you can do yourself to treat mild ingrown toenails and prevent them from getting worse, including:

• Practise good foot hygiene by taking care of your feet and washing them regularly using soap and water
• Trim the nail straight across to help prevent it continuing to dig into the surrounding skin
• Gently push the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin)
• Wear comfortable shoes that are not too tight and provide space around your toes
• Painkillers, such as paracetamol, can be used to help relieve any pain (children under the age of 16 should not take aspirin)

Surgery may be recommended in cases where an ingrown toenail is more severe. This may involve either removing a section of the affected toenail or removing the whole nail.

Left untreated, an ingrown toenail can cause the toe to become infected.

When to visit Dr. B C Shah

If your ingrown toenail persists despite carrying out self care treatments, see Dr. B C Shah for advice.

Depending on how severe your ingrown toenail is, surgery might be recommended.

It is very important you visit Dr. B C Shah if you have diabetes and an ingrown toenail. Having diabetes could affect the healing of your toenail, particularly if your diabetes is poorly controlled.

Preventing

There are a number of measures you can take to keep your feet healthy and prevent problems developing.

For example, cut your toenails straight across, not at an angle or down the edges. Always maintain good standards of foot hygiene, including washing your feet regularly and drying them thoroughly. It is also important that your footwear fits properly and is comfortable.

Symptoms

The symptoms of an ingrown toenail will vary depending on how severe it is.

Mild symptoms

Mild symptoms of an ingrown toenail may include:

• Inflammation of the skin at the end of the toe
• Pain if pressure is placed on the toe
• Red skin in the affected area
• A build-up of fluid (oedema) in the area surrounding the toe

Moderate symptoms

Moderate symptoms of an ingrown toenail may include:

• Increased inflammation of the toe
• White or yellow coloured pus coming from the affected area
• Bleeding
• Infection of the toe

Severe symptoms

Severe symptoms of an ingrown toenail may include:

• Severe pain, redness  and inflammation
• An overgrowth of skin around the affected toe (hypertrophy)
• Severe infection of the toe

You should visit Dr. B C Shah if you have a persistent or severe ingrown toenail.

Causes

An ingrown toenail can be caused by a number of different things.

These include:

• Incorrectly cut toenails
• Tight-fitting shoes, socks or tights
• Excessive sweating or poor foot hygiene
• Injury
• Nail infections
• Natural shape of the toenail

These are described in more detail below.

Incorrectly cut toenails

Badly cut toenails increase your risk of developing an ingrown toenail.

Cutting your toenails too short, or cutting the edges, will encourage the surrounding skin to fold over your nail and the nail to re-grow into the skin.

Tight-fitting shoes, socks or tights

Wearing tight-fitting shoes, socks or tights places pressure on the skin around your toenail.

If the skin is pressed onto the toenail, it may be pierced. Tight-fitting footwear can also cause your toenail to curve inwards towards your skin, resulting in an ingrown toenail.

Sweating or poor foot hygiene

The skin on your foot can become moist and soft through excessive sweating or from poor foot hygiene, such as not changing your socks regularly.

Having soft skin around your toenails makes it is easier for your nail to pierce the skin and embed itself within it.

Injury

Injuring your toenail can sometimes cause an ingrown toenail to develop. For example, damage can occur if you stub your toe or if your nail is accidentally ripped off.

Nail infections

Sometimes, a toenail can become thicker and wider if it has been affected by a fungal nail infection, such as athlete’s foot.

If your toenail becomes brittle, pieces of nail may break off, making it easier for the nail to pierce the surrounding skin and for an ingrown toenail to develop.

Natural shape of your toenail

If you have naturally curved or fan-shaped toenails, your risk of developing an ingrown toenail is increased. This is because the sides of your nail are more likely to press into the nail fold (the skin surrounding the nail).

Treatment

If your ingrown toenail symptoms are mild, you can treat them using self-care measures. More severe cases may require surgery.

Self-care measures

If your ingrown toenail is in the early stages and it is mildly inflamed, there are a number of things you can do to prevent it getting worse. These include:

• Practising good foot hygiene by taking care of your feet and washing them regularly using soap and water
• Trimming the nail straight across to help prevent it continuing to dig into the surrounding skin
• Gently pushing the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin)
• Wearing comfortable shoes that are not too tight and provide space around your toes
• Painkillers, such as paracetamol, can be used to help relieve any pain (children under 16 years of age should not take aspirin)

Nail surgery

If your toenail does not improve, Dr. B C Shah may recommend that part or all of your toenail is surgically removed.

Partial nail avulsion

Partial nail avulsion, where part of your toenail is removed, is the most common surgical procedure for treating ingrown toenails. It is about 98% effective.

The procedure is carried out under local anaesthetic (painkilling medication), which is injected into the base of your toe. The edges of your toenail are cut away to make the toenail narrower and give your nail a straight edge. This makes it less likely to dig into the surrounding skin.

After the edges of your toenail have been cut, a chemical called phenol will be applied to the affected area. This prevents the nail growing back and stops an ingrown toenail developing in the future.

During the procedure, any pus will be drained away from your toe to prevent the area becoming more infected. If your nail is infected, a course of antibiotics may be prescribed.

Total nail avulsion

Total nail avulsion involves removing the whole of your toenail to reduce the risk of an ingrown toenail developing in the future.

The procedure may be recommended if your nail is thickening and pressing into the skin surrounding your toe. As with partial nail avulsion, total nail avulsion is carried out using local anaesthetic.

During the procedure, your toenail will be removed and you will be left with the indentation (the concave area of skin) where your toenail used to be. It is perfectly safe for you not to have a toenail and your toe will continue to function normally.

After nail surgery

After having nail surgery, your toe will be wrapped in a large sterile bandage. This will help stem any bleeding and prevent infection. You should rest your foot and keep it raised for 1-2 days after the operation.

After the anaesthetic has worn off, your toe may be sore and tender. To help reduce any pain, you may need to take a painkiller, such as paracetamol, and wear soft shoes or open-toed sandals for the first few days following surgery.

You can remove the bandage two days after having nail surgery. Soaking your toes with salt water will help the area heal.

Preventing

There are a number of things you can do to help keep your feet healthy and prevent problems developing.

Cutting your nails

Your chances of developing an ingrown toenail are greatly reduced by cutting your nails properly.

You should cut your toenails straight across, not at an angle or down the edges. You may find it easier to cut your toenails after having a bath or shower because they are likely to be softer.

Good foot hygiene

Maintaining good foot hygiene will help prevent problems developing with your feet.

Keep your feet clean by washing them every day with soap and water. Dry your feet  thoroughly and apply moisturising foot cream (not body lotion).

Use a foot file or a pumice stone to remove hard skin on a regular basis. You should also change your socks (or tights) every day so that your feet remain as clean and fresh as possible.

Correctly fitting footwear

Wearing comfortable shoes that fit properly is also very important for ensuring that your feet remain healthy, and for avoiding problems such as ingrown toenails.

If your shoes are too narrow or too tight, your toes can become overcrowded. Shoes that are too loose can put pressure on your toes when you walk.

It is better to shop for shoes in the afternoon. During the day your feet swell, so if a pair of shoes fit in the afternoon when your feet are at their largest, it is more likely that they will be comfortable.

Seek medical help

You should visit Dr. B C Shah if you have problems with your feet. They will be able to examine your feet and give you advice about the right shoes to wear to help your condition.