By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

PROPER CUTTING, GOOD-FITTING SHOES THWART INGROWN TOENAILS

QUESTION: I have a lot of trouble with ingrown toenails. When I get them, I cut them out but they come back a few months later. Why do I keep getting this ingrown toenail? Can I do anything to prevent it from coming back?

ANSWER: An ingrown toenail -- officially called an onychocryptosis -- is a common adult complaint. It typically affects the big toe on only one foot. The primary cause of this problem is improperly cutting the toenails. If the nail is cut with an inward slope on the edges, it can predispose the nail to grow inward. Shoes that do not fit properly, especially in the toe region, can also trigger the process that leads to an ingrown nail. Obesity, previous significant foot injuries, abnormal gait and excessively sweaty feet can also predispose you to having an ingrown toenail. Ingrown toenails are also more common in people with certain diseases, including hyperthyroidism, diabetes mellitus, acromegaly and some congenital conditions, like trisomy 13 syndrome.

Spotting an ingrown toenail early and getting prompt treatment can prevent infection and avoid the need for surgical treatment of the nail. A stage I ingrown nail causes redness, slight swelling and a little pain on the side -- or “lateral” groove -– where the nail meets the toe. This is an easily treatable stage. Some moist heat and gently working the nail outward will usually bring relief. In Stage II, the pain increases, and signs of infection may be noted at the edge of the nail. In Stage III, the toe is swollen, painful, infected, and new, pink tissue may be seen growing in the lateral nail fold.

In stage I, as I said, moist heat is the key to treatment. This may best be accomplished by using warm soaks several times a day. The physician may put a wick of cotton in the edge of the nail to force it away from the lateral groove. If infection has set in, he or she will prescribe antibiotics as well as using a cotton wick to move the nail away from the lateral groove. If the nail is severely ingrown, and has become infected as in stage III, the nail may need to be removed. This can be done in a physician’s office under a local anesthetic.

So, the best treatment for ingrown toenails is prevention. First, I’d recommend you see your family physician to find out why you are having a recurring problem with your toenails becoming ingrown. I suspect that when you “cut them out” yourself, you are leaving sharp edges that then cut back into the toe as they grow. Your physician can cut your nail back properly and then use one of the methods I’ve described to make sure that it grows away from -- and not into -- the toe flesh.

Once your immediate problem is under control, you should practice good preventive measures. First and foremost, cut your toenails straight across and not too short. Also, it’s important to wear properly fitting shoes. If you have an abnormal gait, or a chromic problem that causes your ingrown nails to keep returning, it might be a good idea to consult a podiatrist and get some help in managing your nails to prevent these painful ingrown toenails from coming back.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.