Ingowing Nails - what are the causes and treatments? - Burchell & Associates - Podiatry

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Ingowing Nails - what are the causes and treatments?


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An ingrown toenail, or onychocryptosis, occurs when a portion of the nail plate penetrates the soft tissue around it and triggers the bodies inflammatory response to heal it up resulting in swelling, redness and often infection. The appearance depends upon how long you have had the condition but you usually cannot see the piece of nail that is digging in. The tissues around it are swollen, inflamed, sometimes oozing pus and nearly always very sensitive to touch. Even a bed sheet resting on the area is too painful. The condition nearly always, but not exclusively, affects the 1st toe, although it can affect the 2nd toes.
This condition usually affects young men in the 15 to 40 age group.

What is the cause?
Bad nail cutting is nearly always the cause. The toe is dependant upon the nail for the soft tissue shape, if the nail is cot too short or the corners are "rounded off" the soft tissue rolls up to take the place of the nail that has been cut away. As the nail plate grows longer it is unable to move the soft tissue out the way and pushes into the tissue, so setting off the inflammatory response.

Ill fitting shoes, usually too short, can also contribute to the problem by pressing an involuted nail plate edge down into the soft tissue. This is also the case where you have a chubby 1st toe and the shoes squash the 2nd toe against the soft tissue of the 1st toe.

A episode of trauma to the nail plate such a dropping something onto it or stubbing your toe can push the soft tissue onto the nail plate.

An unusual gait cycle where you push off on the side of the 1st toe can also set off a painful nail. This cause the soft tissue to roll over and onto a nail plate which like trauma can penetrate the soft tissue.

A nail deformity caused either by disease, infection or an inherited pre-
disposition can lead to an ingrown toe nail.

What Treatment is available?
Home Treatment.
The best treatment is prevention.
In a mild case or a recent incident the toe should be soaked in warm salt water for 10 minutes then dried and the side of the nail packed with cotton wool; this helps to keep the side of the nail away from the soft tissues and prevent further penetration of the nail into the skin. An antiseptic cream can then be applied to keep infection at bay or away. If carried out regularly as the nail grows longer you can prevent further damage and pain.Patients with a poor circulation or diabetes should always seek chiropody treatment as soon as possible.

Podiatry Treatment.
The earlier a chiropodist can treat an ingrown nail the easy it is to achieve a quick, painless outcome in the long term. We are able to remove the spike of offending nail than has penetrated the skin with very little discomfort and apply an antiseptic dressing and pack with cotton wool. If necessary we can administer a local anaesthetic if the area is very painful, however it is not always necessary.A further one or two dressing appointments whilst the nail grows longer ensures that the problem does not reoccur. Remember unless the nail splinter is removed the problem is not resolved.

Nail Surgery.
If the nail is very curved or involuted, there is an inherited tendency for ingrown nails, there is a lot of granulation tissue or you have had the problem for a long time then nail surgery may be the best long term treatment. Surgery can often clear the ingrown nail up in a matter of two weeks and remove the pain overnight.
The surgery, which is carried out in the surgery, involves giving a local anaesthetic and removing the offending portion of nail and destroying the roots of that bit of nail so it does not grow again. The soft tissue over the following weeks and months will shrink back to the edge of the new nail and the toe may well look as if nothing had been done.
We need to see you for a standard consultation appointment to discuss the surgery option before we would proceed.
A leaflet detailing more about surgery is available.

Prevention is always the best form of treatment.
If the sides and corners of the nail are always visible then you cannot get an ingrown nail unless the cause is trauma which is often unavoidable.

Common misconceptions.
Cutting a "v" or "notch" in the end of the nail does not help. This is based on early surgery methods where a section of nail was removed from the middle of the nail plate and then stitched together to bring the edges of the nail away from the skin. It does not work.

Continually cutting the nail back cures the ingrown nail. Repeatedly cutting the nail shorter does keep the corner from digging into the soft tissue.
However over the long term the soft tissue will shrink back to the corner of the cut back nail and when you are no longer able to cut the corner shorter it will be impossible to get the skin out of the way of the growing nail. This is short term gain for long term pain.
Over the counter paints cure an ingrown nail. Over the counter products usually only soften the nail plate, they do not remove the imbedded nail from the soft tissue.They may also numb the pain letting you think the pain has gone, until you stop painting the area.

Burchell & Associates - Core value podiatry.
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