It is a misnomer that the nail naturally “in grows”.  Toe nails do not naturally in grow – the condition is caused by subjecting the nail plate to a combination of heat, moisture, trauma, improper nail trimming or persistent pressure that forces the nail inside the soft tissues of the skin. This can be very painful especially if the surrounding area becomes infected.  Untreated, an ingrown nail can leave your toe vulnerable to infection which can spread to the rest of the body.  

The photo to the right shows an ingrown toe nail on the big toe (Hallux) that is red, swollen and showing signs of infection.

Ingrown toe nails occur most often in the big toe but other toes can also be afflicted.  The most common cause of ingrown toe nails is incorrect toe nail cutting. Cutting the nail plate or its corners too low allows the flesh of the toe pulp to rise up in front of the free edge of the plate which is then pressed into the skin.  Also leaving sharp corners on the nail can cause the nail to be forced into the skin.

Other reasons that may cause ingrown toe nails are:
 

• Shoes with a narrow or inadequate toe box room can force the nail to break through the soft tissues of the skin.

• Swollen toes or sweaty feet can weaken the skin around the nail 

• Stubbing a toe or having one stepped on can cause a piece of the nail to penetrate into the skin.

• Frequent running can also be a cause, as can playing football as the toes are being subjected to repeated knocks on the inside of the shoe cap which can drive the nail plate into the skin.

• Bedridden patients can develop ingrown toenails if the sheets are too tightly tucked in.

• Obesity causes the soft tissues to be pressed up around the nail plate which then becomes engulfed.

• Involuted nails, where the sides of the nail curve round under the surface of the nail and start to pinch the nail bed beneath can sometimes penetrate the skin.

• The condition hallux abducto-valgus causes the pulp of the toe to be pressed on the corners of the nail plate.  Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe.  Other pronation abnormalities can cause the forefoot to suffer pathological stress which can be detrimental to the nail structures.

Treatment of an ingrown toe nail is dependent on the severity of the condition and if infection is present. Sometimes, all that may be required is to remove the offending nail portion which can bring immediate relief to the patient.  In severe or recurrent cases and where conservative methods of treatment have not worked, nail surgery may be required.  This is where part of the nail or the whole nail may be removed,  known as a partial or total nail avulsion.  A solution of Phenol is then applied to the area to prevent the nail growing back.  Hailsham Mobile Foot care does not carry out nail surgery but treats the discomfort caused by ingrown toenails with non-invasive methods.

To prevent ingrown toenails it is recommended to wear properly fitting shoes and socks, and to trim the toenails straight across and not too short, smoothing any sharp corners with an emery board.