Thin, flat toenails rarely cause issues if the nails are trimmed straight across or following the margin of the end of the nail across its entire width. Thick or curving nails can create pressure issues resulting in discomfort or pain. Curved nails can increase pressure to the nail margin, causing irritation and resulting in inflammation or reactive thickening of the skin, leading to a painful callus or corn. This is not a true “ingrown” toenail, but it can feel the same as pressure is the culprit.
A true ingrown toenail results in an injury to the skin in the nail margin.
This only happens in one of three ways: inappropriate trimming, trauma or inherited characteristics. Toenails do change shape and consistency in life as inherited characteristics.
Ingrown toenails can be quite painful, as the nail acts as a dirty knife that advances forward and deeper daily with nail growth.
Removal of the ingrown portion of the nail is necessary for relief. Decreasing pressure in the nail fold can be achieved by skilled trimming with professional tools, but many times local anesthesia to the affected toe is necessary for patient comfort and anxiety. This requires injections to the toe, as there are no topical or “spray” options.
The side portion of the nail causing the issue can be removed either temporarily or permanently, depending on patient choice and medical history. Only rarely does the entire nail need to be removed.
There is no way to “train” the toenail to grow differently with a particular trimming method, wedging material into the nail fold or applying “Outgrow”-type products to the area.
Urban legends regarding toenails and treatments abound, but the only way to change the shape of the nail plate is to destroy the portion of the matrix or “root” of the nail creating the issue, be it pressure against the skin or a true ingrown toenail.
Chemical matrixectomies are generally the standard for permanent toenail removal. Matrixectomies use either acids or bases to chemically denature the matrix so that the nail will not grow back on that side. They are less painful, have a higher success rate, have a lower postoperative infection rate and allow for normal bathing and shoe wear the next day. The tradeoff is they drain quite a bit while healing requiring daily cleansing and simple wound care and take a month or more to fully heal.
Toenail discomfort can be a nuisance at minimum, but simple treatment can usually provide satisfactory results. There are options for temporary removal of ingrown toenails or permanent removal for repeat ingrown toenails or painful curved nails. Removing only the offending affected side(s) of the toenail is typically done, so the aesthetics of the nail are not greatly affected.
David B. Raynor, DPM, is a podiatrist in Inverness and can be reached at 352-726-3668 or at www.AdvancedAnkleAndFootCenters.com with questions or suggestions for future columns.