Ingrown toenails are a surprising condition. They’re surprisingly painful; a reasonably common refrain is, "I know it looks like nothing but you would not believe how much it hurts". They’re also surprisingly hard to heal - sometimes, by the time people arrive in the clinic, it has been going on for six months, often without any neglect. And usually, they are surprisingly easy to prevent. They definitely fall into the category of “much easier to avoid than treat,” and you will save a lot of money doing so.
What actually is an ingrown toenail?
To understand how to prevent an ingrown toenail, think about what an ingrown toenail is. People often think that an ingrown toenail means the nail itself is curling and spreading at the sides. In fact, the sides of the nail can meet in the middle without causing much trouble. Pressure, friction, and sharp pieces of nail (often from incorrect cutting) are what cause the problem.
Who is most likely to get them?
Teenagers are particularly prone- their nails tend to be thinner, more brittle, and curl more. Teenagers sweat more, and a soft sweaty nail becomes more likely to fracture and break into sharp pieces. And, teenagers have hypertrophy of the tissue around the nail - in other words, the soft flesh at the edge of the nail comes up higher. That's why the peak age for ingrown toenails is 12-25. And it's why we might see more ingrown toenails at the moment, as people may become more lax about not changing shoes (or possibly fewer, if people are barefoot in the house).
Prevention is better than the cure
The easiest way, alas, is to start from the position of never having had an ingrown toenail. A wound will usually never heal quite as strong as the skin was before, and ingrown toenails make the skin under and beside your nail thinner and more fragile. The longer the ingrown toenail went without healing, the more likely it is that the skin has swelled and grown around it. Once it heals, that skin often remains.
How do I reduce the risk of getting one?
Cut your toenails properly, for one. Podiatrists often say to cut the toenails straight across, and I have plenty of people in to my clinic with perfectly healthy toenails who are worried they have done themselves an injury by following the old advice to follow the natural shape of the lunula or the nail itself.
Not usually, though. The reason you cut your nail straight across to avoid ingrown toenails isn't because a carefully shaped, manicure-style nail is likely to cause problems. It's because in cutting toenails, people frequently miss corners. A corner cut straight across is more likely to fracture straight across, leaving a right angled edge. A nail that you tried to round, but missed the edge on, is more likely to form a nice sharp spike just where it's hard to see.
Don't cut the nails too short - think well-groomed male manicure or those French manicure styles. A nail without any free white edge is cut too far back if you are prone to ingrown toenails. It makes it easier for the skin to push up ahead of the nail and the nail to pierce the skin. It's very common for people prone to ingrown toenails to cut the nail shorter and shorter at the edges, but this tends to make the problem worse. Try not to go beyond Hippocratic length, which is where the nail is as long as the end of the toe. If the nail projects beyond the toe it obviously becomes a bit more at risk of trauma or of hitting the shoe.
This is why people say to cut a 'v' in the nail, which does work if done as intended. It doesn't mean cutting a neat little 'v' in the middle, but cutting back the middle of the nail (to stop it hitting the shoe and deal with growth) while leaving the two edges of the nail (where they meet the skin) longer. If you can manage this style without breaking your nail it works quite well. Think of it as more of a broad gentle curve than a v.
Always remember to file after cutting. Gently use a slightly blunted toothpick to feel the edges of the nail and see if you have left behind a spike. If it's a small one, try and file it away. If it's at all awkward to get to, perhaps you should attend the podiatrist.
What not to do
Pulling at and picking your nails is always a bad idea. Just, don't do it. If you see a piece of broken or flaking nail, you can get a nail scissors and carefully, gently cut it off - or better yet, try a file first. If you habitually pull at your nails when bored, get a pair of nice socks and wear them whenever you are at home. Fuzzy, cosy house socks or toe socks might be an idea.
Keep your feet dry
Sweating is a common cause of ingrown toenails. If you attend work or school, try and change your socks when you get home, particularly if you work in safety boots or other not-very-breathable shoes. Use particular shoes for sports, workouts etc and only wear them for those activities. Try not to wear the same pair of shoes two days in a row, you should have at least three pairs of shoes you rotate between.
Wear cotton or wool socks, not nylon, and try to avoid tights which tend to hold sweat against the foot. Socks that are tighter or have pronounced seams can sometimes increase ingrown toenail risk, make sure your socks are the right size.
Apply a foot powder (corn starch will do fine) between your toes in the morning, after drying your feet carefully, and wear open toed sensible supportive sandals when you can.
Teenagers may need a good liquid antiperspirant applied to the feet and more frequent changes of socks. Wet skin swells and wet nails split.
Too big for your boots?
The last thing I will say about shoes is that many people are wearing shoes that are the wrong size, and we rarely wear shoes that are too big. If you have a too-small shoe it will push the nail and the flesh together. The basic rule of thumb is that you should be able to fit a marble's width, or the width of your index finger, between your longest toe and the inside of the shoe, and perhaps a thumb's width if you are doing hillwalking or running. It's very easy to permanently ruin a toenail, and you only get one pair of feet, so you need to mind them. Many people suffer ingrown toenails that would have been avoided entirely with a bigger pair of shoes.
Squashed toes?
Toe separators can also help those of you who tend to have the problem occur on the left side of the left big toenail or the right side of the right. You can get these online, in Dealz, or in most pharmacies. Wear them daily and wash them regularly.
I’ve got an ingrown toenail, what do I do now?
Firstly, don't reach for the Stanley knife. If you are on the ball, many ingrown toenails can be treated quickly with simple at-home measures.
Before doing anything, wash your foot and the sore area carefully with a mild soap and clean running water, and do the same with your hands, making sure to brush under the nails with a nail brush, and wash the back of the webbed area between the thumb and the hand, the backs of the nails, and between the fingers. There has been so much education on that recently I think everyone in the country must know how to do this by now.
Wear a clean pair of disposable gloves, ideally, and bin them after you use them.
Dry the foot with a clean towel, and take some skin-friendly tape, zinc oxide, silk tape, whatever you have in hand (this is a good one to keep in the first-aid kit). If you are prone to ingrown toenails you should buy some now, before you have a problem. Use the tape to gently pull the skin away from the nail and relieve pressure. This also allows you to see the area. Is there any sign of a wound, any blood, any pus? A small amount of redness or swelling can just be the skin reacting to the pressure, but can be the sign of a wound. If there is any sign of a wound, make sure the soap and water has got right into the toenail and put a good clean plaster on it. Be careful not to touch the shiny white square part of the dressing that is in contact with the wound. Bin the gloves and do the same the next day.
If there is no sign of a wound, you can see a free edge of the nail, and you can see where it is causing pressure, you can try using a very small piece of tissue paper, rolled up, between the skin and the bit of the nail that is causing the irritation. It should be very small, and you need to be very gentle when putting it between the nail and the skin. Again, wear gloves when doing this. Remove the tissue the next day and repeat. If this doesn't solve the problem in a few days, you should see a podiatrist.
Ingrown toenails get infected at the drop of a hat and all your dealings with them should be mindful of this. Always wash your hands before and after, wear a new pair of disposable gloves each time if you can get them, and carefully wash the affected area.
If it does look like there might be a wound there, put a clean plaster on it and wash the area daily and change the plaster. I always say, no-one ever died of having a clean plaster on their foot unnecessarily. Try not to use antiseptic creams on the feet; they tend to make the wound too wet. An antiseptic dressing, like a Savlon-brand plaster or an iodine dressing, can help if it starts to look infected.
When you may need help
You may need to consult your doctor on an antibiotic if it is particularly infected, painful, or if the infection does not clear up with a few days of careful treatment. You should go to a podiatrist as well, if the wound has reached this point, to make sure the actual piece of nail that is causing the problem is taken out.
Taking care of your toenails
Never neglect an ingrown toenail. The longer they are left, the harder they are to treat. Many people have spent literally hundreds of euros on a painful, swollen toe over months, that could have been saved with about five euro of supplies and careful minding when it first came on, or avoided entirely with some caution in fitting shoes and cutting nails. Prevention in this case is far better than cure.
If you do end up needing to come in to visit a podiatrist, if you're nervous or if you tend to faint, tell us. No-one becomes a podiatrist because they want to really frighten people, or for the glamour or the glory. By and large, podiatrists just want to help you get your feet better. Tell us if you're worried about treatment and we will try and help work with you about it.
Photo by Karla Alexander on Unsplash