‘Myths & Facts Ingrowing Toenails’

Myths and Facts surrounding Ingrowing Toenails could not have been better presented when Mark Walberg described his nail on national TV with Ellen DeGeneres. This was obviously that sort of condition that was going to achieve a ‘high yuck factor’! Walberg who had flown in for the interview with his nail problem and was asked by DeGeneres,

‘are you shot up with pain stuff?’
He responds,
It’s worn off now!’
‘So now you are feeling it?’
‘I’m feeling it,’ he replies to an audience packed with excited ladies.
‘The energy’ however is helping him, he explains to DeGeneres.

 

Publicity and the nail are bedfellows, often for the wrong reason. The blunt if not misinformed joke, and reference that someone is disabled and inference that they shouldn’t be as it is only an ingrowing toenail often resonates as an anecdote, and perhaps shares a similar fate with bunions. 

As a podiatrist, I have had an ingrowing toenail, albeit mild compared to many of my patients and the inconvenience and discomfort is far from funny. Whilst training I was informed at my old Alma Mater that you could, in fact, die from an ingrowing toenail. This was stretching the truth by more than a mile. The only way you can die from such a condition is IF you develop a rapidly spreading infection through cellulitis and septicaemia. Those with poor immunity are at greatest risk and include patients being treated with powerful drugs to suppress cancer cells. We are reminded that immunity is about having sufficient specialist defense cells to ward off disease.


Naming the beast

Ingrowing toenail has a number of names. Ingrown toenails are the commonest and suggest part of its origin is growing into the flesh. If you are playing scrabble or want to impress others, you could say I have an onychocryptosis(on-ee-kohkryptoh-sis). IGTN for ingrowing toenail is the shorthand version we in the health care professions like to use.

The problem here is that IGTN has many appearances and three types of nail pain associated with IGTN can be described. In hands we see the ‘Whitlow’, the skin on one or other side of the nail bed is inflamed and painful. A small amount of white discharge (pus) may be visible. I will leave the NHS website to explain the origins of Whitlow (click on NHS) which can form something similar but also has other origins.

Paronychia refers to the inflamed skin around the nail and common to both toe and finger, so Whitlow just adds a name to provide further confusion. To really appreciate the three toe types of IGTN we need to know a bit of anatomy. Don’t worry I will keep it simple.


Ingrown nail variations

The hard nail made from packed cells called keratin sits on the softer flatbed end of the digit with two side grooves. The grooves form gutters that we call sulci (sulk-eye) or sulcus if singular. It is in the sulci that the problem occurs. The nail builds around a small area of inflammation. This occurs due to one of three factors. Nail shape (tight curvature), breach of the skin layer and a bridge of skin forming from nail to groove.

You should not experience more pain than needed as you would expect from a dental examination and treatment. If the clinician is unable to provide this service, then ask to see someone who can provide a local anaesthetic in an outpatient location. Only registered people trained as podiatrists or medically qualified people can provide local anaesthetics.

Pain is the give away; tenderness to touch. The red swollen component shows that it will not improve without treatment. A discharge implies the damage is increasing. The lack of healing then is demonstrated by the appearance of the cherry red bulge. The larger the bulge the greater the chronic state. Chronic is our medical language means over a time period nothing improves and the conditions smoulder without improvement. The cherry red bulge is known as hypergranulation.

In adolescent boys and girls the occurrence is not dissimilar today as both carry out similar activities and wear trainers a good deal of the time. Boys do have the additional unpleasant odour called bromidrosis or pongy feet) more frequently than girls. The smell that arises comes from the bacteria living within the sweat and producing chemicals which form the smell. Fresh sweat on skin does not smell.

Antibiotics do not treat the ingrown nail.

Treatment is not always possible by self-management. Antibiotics are not the correct treatment but will clear up infection temporarily. Nail eruptions will continue until professionally managed. Antiseptics and good cleaning are imperative. While patients should help themselves to solve problems and prevent foot ailments progressing, there is a narrow boundary between self-help and seeking professional help. You can see that onychocryptosis is not a condition that can be managed without experience. At the first sign of inflammation use a sterile plaster and cover the skin and nail for 24-48 hours. If inflammation spreads or the toe swells seek help.

Please download the full article here if you want to have a further guide. Always seek the advice from a registered podiatrist for nail problems.

 

 

Thanks for reading ‘Myths and Facts of the Ingrown Toenail’ written by David Tollafield 13/7/19.