OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Robert Hume, DPM

Prevention and Treatment of Ingrown Toenails

By Robert Hume, DPM

I routinely see several patients with ingrown toenails each week. Although the problem is quite common, improper treatment can lead to increased pain, disability, osteomyelitis, or even gangrene in susceptible patients.

Ingrown toenails are often self-inflicted and can be caused by improper nail trimming. Other causes include trauma, hosiery, poor-fitting shoes, and pressure caused by steel-toed boots. Fungal infections of the toenail also cause the toenail to change shape, generally in the form of increased curvature. This is a common problem, especially for the elderly, where the highly curved nail becomes much more prone to becoming ingrown. Whatever the cause, this condition can be quite painful requiring medical attention. It is also limb threatening in patients with diabetes or others who have poor circulation in their feet.

Prevention is the key. Wearing shoes that have square toe boxes to allow room for the toes instead of pointed shoes that cause pressure will avoid some of the problems. Proper nail trimming is also important. Trimming nails straight across and not too short so the edge of the nail can grow out freely is very important; however, some toenails are not very flat and have edges that are vertically orientated which make nail trimming a dilemma. Permanent partial nail border removal is necessary when nails become infected because of their shape.

Treatment can be as simple as foot soaks and antibiotics if the infection is relatively minor. Most often the nail is deeply imbedded acting like a foreign body, such as a splinter, and perpetuates the infection. In these cases, the infection will continue despite antibiotics until the buried portion of the nail edge is at least temporarily removed. If the nail becomes infected again, a simple but permanent procedure is necessary to eliminate the portion of the nail that continues to be ingrown. Permanent correction is a simple in- office procedure allowing the patient to return to work the same day.

This infection is serious for diabetics, or patients with poor circulation. These patients have lived with chronically misshapen nails that are prone to infection and sometimes do not seek treatment until it is too late. At this point, their diabetes has progressed to the point where even a simple procedure of permanent nail removal cannot be performed without severe risk of wound healing complications. Their toenails should have been examined much earlier in the course of their disease when surgical intervention was still possible. Remember—prevention is the key!

For more information, call Dr. Robert Hume> 715.835.8585