Ingrown Toenails Myth or Fact?
The myths and facts surrounding Ingrowntoenails could not have been better presented when actor Mark Wahlberg 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’! Wahlberg, 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 is a reference to disability. Perhaps ingrown toenails share a similar comedic fate as bunions. However, I have had an ingrown toenail, albeit mild compared to many of my patients. I do know the inconvenience and discomfort are far from funny.
While training, I was informed by one lecturer 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. Sadly, this did, in fact, happen to a 17-year-old male when the local casualty officer in Australia failed to see his patient had an ingrown toenail. The boy, barely into adulthood with much to live for, died. Those with poor immunity are at the most significant risk and include patients being treated with powerful drugs to suppress cancer cells. We are reminded that immunity is about having sufficient specialist defence cells to ward off disease. Clinical experience and ignorance are also described in my link to CRPS – where the patient, this time in the UK, had an ingrown toenail and ended up with a leg amputation!
Naming the beast
The ingrown toenail has a number of names. Ingrown toenails are the most common and suggest that part of their 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-koh-kryp-toh-sis). IGTN for ingrowing toenails 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 is familiar to both the toe and finger, so Whitlow adds a name to provide further confusion. To really appreciate the three toe types of IGTN, we need to know a bit about anatomy. Don’t worry. I will keep it simple.
Variations of ingrown toenails
The hard nail is made from packed cells called keratin and sits on the flat end of the toe. It has a groove down each side. The grooves form gutters that we call sulci (sulk-eye) or sulcus if the singular is used. IGTNs are problems that arise in the sulci. The nail builds around the groove and creates a small area of inflammation. This arises due to one of three factors.
- Nail shape (tight curvature),
- Breach of the skin layer
- A skin bridge forms from nail to groove.
Avoiding pain
You should not experience more pain than needed, as you would expect from dental treatment. If the clinician is unable to provide an anaesthetic, then ask to see someone who can provide this service. Only registered people trained as podiatrists or medically qualified people can provide local anaesthetics. All registered podiatrists have been trained in using local anaesthetics from 1988 onwards. Pain is the giveaway, 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 more prominent the bulge, the greater the chronic state. Chronic is our medical language, which means over some time, nothing improves, and the conditions smoulder without improvement. The cherry red bulge is known as hypergranulation.
Adolescent boys and girls experience similar occurrences, 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 that form the smell. Fresh sweat on the skin does not smell.
Antibiotics do not cure ingrown nails but provide a temporary fix if infected
Self-management of the ingrown toenail is not always possible. Antibiotics are not the correct treatment but will clear up infection temporarily. Nail eruptions will continue until professionally managed. Antiseptics and suitable cleaning methods are imperative, and it is worth having a well-stocked first aid kit. While patients should help themselves to solve problems and prevent foot ailments from 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.
Thanks for reading ‘Ingrown Toenail’ by David R. Tollafield
Published by Busypencilcase Reflective Communications Est. 2015
First published July 2019. Modified February 2025
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