FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

STRAIGHT TRIMMING KEY TO PREVENTING INGROWN TOENAILS

Question: I am having trouble with an ingrown nail on the big toe of my left foot. When I had this problem a few years ago, I had hurt my toe kicking a soccer ball. I don't remember doing anything to hurt my toe this time. Is there anything I can do to prevent having these problems in the future?

Answer: There are several things that could be contributing to your recurring problem with an ingrown toenail. Individuals whose big toes are twisted in and slightly under the second toe are at greater risk of developing this problem, as are individuals with thick nails. Wearing shoes that don't provide adequate room for your toes to move as you walk also increases your risks. Most commonly a person with ingrown toenails has one or more of the above predisposing factors and also doesn't properly cut his or her toenails.

I'll try to help you understand why the way you cut your nails is so important. When you look down at your big toe it may seem that the nail just lays flat across the end of the toe. However, the edge of the nail curls down toward the bottom of the foot. The skin folds up along the side of the nail's edge, creating a small trench. It is the edge of the nail that is down in the bottom of this "skin trench" that causes the trouble. Cutting the nail short so that the end of the nail is inside this "trench" produces a sharp edge that can push against the skin and puncture it. Bacteria invade the toe through this wound and cause the swelling, redness and pain that we call an ingrown toenail.

So, to prevent ingrown toenails, I recommend that you trim your nails straight across, not curved back like fingernails. This keeps the downward-curving portion of the nail smooth all along that skin "trench," without a sharp edge to irritate the skin and make the ingrown toenail.

Question: What can I do for my ingrown toenail?

Answer: If the skin at the edge of the nail is just a little irritated and tender, you may be able to get relief by soaking your foot in warm soapy water for 15-20 minutes twice a day. This softens the skin in that "trench" and helps remove any pus produced by your body's defense against the infection. You must be cautious about the way your shoes fit and the activities you do as your ingrown toenail heals, and remember to trim your nails properly.

When soaking and protecting your toenail fails to clear up the infection, it is time to see your family doctor or podiatrist. He or she will probably have you continue with the foot soaks and start you on an antibiotic. An individual whose nail still does not improve with this treatment or whose toe is seriously infected will need to undergo minor surgery to remove the part of the nail which is down in the "trench." This is a simple operation that is done in the office. The toe is usually dramatically better within a day.

Having the edge of a toenail removed doesn't prevent the recurrence of the problem. The nail will need to be carefully trimmed and filed until the edge has grown out past the end of the skin in that "trench." Those unfortunate individuals who continue to have episode after episode of ingrown nails despite proper care require a different type of nail surgery. The offending side of the nail is removed as before, but the corresponding portion of the nail matrix the area where the nail actually grows will also be destroyed. This creates a nail which truly does lay across the top of the toe. The portion of the nail that previously curved into the skin is no longer present. This provides a lasting cure for the problem. Your family doctor or podiatrist can advise you when surgery is the best choice for you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.