Ingrowing toe nails occur where the side of the nail ‘digs in’ to the adjacent skin causing discomfort/pain, often with associated inflammation, and occasionally producing infection & granulation tissue. The incidence of ingrowing toe nails is significantly higher where the nail is abruptly curved/involuted (as opposed to being flat).
Other factors that can contribute to the development of an ingrowing toe nail are,
- Tight pointed footwear that squeeze the toes together
- Over zealous pedicure
- Trauma to the toe (common in sports such as football, rock climbing, rugby etc )
- Excessive sweating on the foot (particularly common in adolesent and young adult males)
If these predisposing factors are present, especially in a nail that is involuted/abruptly curved, then the prevelence of ingrowing toe nails will be high. Since genetic predisposition is predominately responsible for dictating the shape of a toe nail (including an involuted nail), it is therefore not uncommon for there to be a familial history associated with the development of ingrowing toe nails. If you have a pronounced involuted/abruptly cuved toe nail then the odds of developing an ingrowing toe nail are stacked against you!
By definition a true ingrowing toe nail is where the edge of the nail has embedded itself or penetrated the skin around the side of the nail. In a relatively short period of time the skin will produce red vascular granulation tissue in an effort to protect and repair itself. A localised bacterial infection is not an uncommon feature of ingrowing toe nails particularly where symptoms have persisted for some time.
In the early stages of an ingrowing toe nail there will be discomfort along the edge of the nail without any inflamation, however the longer the nail continues to ‘dig in’ the more likely it would be for the area to become inflammed, granulating, and infected. At this stage since effectively the condition is comparable to having a foreign body (the edge of the nail) embedded into the skin it would be very rare for the condition to resolve spontneously without intervention (even with the use of antibiotics).
In its earlier stages we would treat an ingrowing toe nail conservatively by trimming back the offending edge of the nail. This is a simple and painless treatment and would normally provide instant relief of symptoms.If the ingrowing toe nail is a little more established then this is sometimes undertaken having numbed the toe with a local anaesthetic prior to treatment. Additionally we would also provide the patient with antibiotics if indicated.
Where the ingrowing toe nail is well established (particularly where there is granulation tissue) and/or there has been a history of the nail ‘digging in’ then a PARTIAL NAIL AVULSION (PNA) is undertaken. This is a painless minor procedure, undertaken when the toe has been numbed, that will provide the patient with a guaranteed instant cure.
The cost of a Partial Nail Avulsion includes all follow up dressing appointments and the provision of all the dressing materials. Our practice specialist for the treatment of ingrowing toe nails is Mark Hollinshead. Mark set up and headed a specialist unit for the treatment of ingrowing toe nails for the local Community NHS Trust between 1991 until 2002. During such time Mark treated tens of thousands of ingrowing toe nails and is therefore able to offer unrivalled experience and expertise for patients with ingrowing toe nails.
