Ingrown Toenail

“An ingrown toenail can make a big, burly guy wince and hobble like a wounded puppy,” says Dr Don Powell, president and founder of American Institute for Preventive Medicine.

Well, you wouldn’t call Andrew big and burly. He is a regular school kid who is not having fun with an ingrown toenail.

Andrew, accompanied by his mother Susan, is waiting for me in one of my examination rooms. Andrew is 13, and has trouble with one of the big toe nails. It has been digging into one corner of the overhanging skin resulting in infection and pain.

“Dr. B, Andrew is tired of pain and antibiotics. Besides the cost of the medication, Andrew has to miss many activities involving running and excessive walking,” says Susan. “Can you help?”

First, let me tell you something about fingernails and toenails.

The nails are appendages of our most versatile organ – skin. Besides nails, the skin has three other appendages – hairs, sweat glands, and sebaceous glands. Nails protect the tips of our fingers and toes.

The nail has a free end which we trim on regular basis. The two sides of the nail are under the skin folds. The root is at the base where the growth occurs. The average rate of growth of the nail is 0.1 mm a day or 3 mm per month. About 11/2 inches a year.

Fingernails grow faster than toenails. Both grow faster in the summer than in the winter. The nails grow rapidly in “nail biters” and slowly in people confined to bed. The growth is faster in males than females. Certain illnesses can arrest the growth.

What can go wrong with the nails?

The nail can be a window for physicians to suspect other illnesses. Normally, nails are flat and light pink. They are pale in anaemia. Nails in general and big toenail in particular can be sites of many problems. One of the common one being ingrown big toenail with infection and pain.

Infection of the toenails can be very serious in anyone who has diabetes or circulatory problems. It can result in gangrene and amputation.

“Dr. B, why do I have ingrown toe nail?”

Ingrown toenail of the big toe usually occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Andrew looked puzzled. “Dr. B, what can I do about it?”

Keep your feet nice and clean. Wear roomy shoes and clean cotton socks. Allow the outer corners of the nail to grow over the skin margins placing small piece of cotton soaked in an antiseptic just under the outer corners of the nail. Cut your nails straight.

If all this fails then surgical treatment becomes necessary. Simple whole nail avulsion or wedge removal of the nail can result in more than 50 percent recurrence rate. The best results are obtained by removing the root at the same time. This is done under local anaesthetic in a doctor’s office.

About 10 days of tender loving care of the big toe after the surgery usually results in satisfactory outcome. There is about 10 percent or less recurrence rate.

Andrew was ready for the surgical remedy. This was accomplished with satisfactory results.

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.)

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