What Is An Ingrown Toenail?

Although an ingrown toenail is very common, many individuals don't truly understand what it is. The simplest explanation is a condition where a spike, shoulder or serrated edge of the nail has grown into the skin, usually at the nail edges. It usually produces significant pain and may become inflamed, red, shiny and tense (Paronychia) with swelling of the toe.

Common causes of ingrowing nails include:

Nail Injury: Breaking, splitting or other injury to the nail may cause an edge to catch the skin.

Poor Nail Care: Failure to cut the nail often enough or cutting the nail too short (especially by curving the sides) can lead to ingrowing of the nail.

Shoegear: Tight shoes or shoes that are too small can cause ingrown toenails.

Nail Anatomy: Genetics is the most common cause of ingrown toenails. This includes shape of the nail, curvature of the nail and even strength of the nail.

How Is An Ingrown Toenail Diagnosed?

The medical term is onychocryptosis or encurvation of the nail border into the skin. The diagnosis is simple and can be done even at home by answering these three questions:

Does The Toe Hurt (especially on the sides or tip of the nail)? Although there are other reasons the nail or toe may hurt, this is usually the first sign that you have an ingrown toenail.

Is The Toe Red or Swollen? Erythema (redness) to the toe is an important sign of inflammation (not necessarily infection) from the irritation caused by the ingrown toenail.

Is The Toenail Curved? Curving of the nail, by definition, is indication of an ingrowing toenail. This may include abnormal appearance of the nail border including pus, drainage or beefy red tissue.

How To Treat At Home

Although ingrown toenails can be treated at home (and often are), you should be very careful doing bathroom surgery or aggressive at home treatments as you can create more serious problems. That being said, there are things that can be done at home:

Lift The Edge Of The Nail. When the ingrown toenail is just starting, you can reduce the pain and often prevent it from getting worse by lifting the ingrowing edge of the nail.

Trim The Nail Corner. Since the initial presentation is usually the tip of the nail, cutting off the nail corner will often reduce the pain, but as the ingrown progresses you will be unable to trim far enough back and will need assistance.

Soaking The Toe In Warm Water and Epson Salt. Soaking the nail can be helpful to reduce pain and especially if the nail is infected. This does not, however, solve the problem.

Remember, at home treatment is only recommended initially since you will often not be able to solve the problem and you ultimately may make it worse.

Why Treat Your Ingrown Toenail?

The truth is, an ingrown toenail can cause significant discomfort and can interfere with ability to walk. If left untreated, there are three long-term problems that may occur:

Pain In Shoes or With Walking. Inability to function normally or wear shoes can be problematic.

Severe Infection. Left untreated or even with at home treatment, a significant infection can occur leading to severe pain, progression to infection in the foot or even bone infection causing loss of toe.

Deformity or Loss Of Nail. Due to the infection, sometime the nail will become deformed over time or you may even lose the nail.

When To See The Doctor

My recommendation: "If You Have An Ingrown Toenail, See A Specialist!" That being said, I know many people are wondering when a doctor should be seen. Here are three reasons the ingrown nail should be treated by a doctor:

The Toe or Toenail Is Infected. When the ingrown toenail is red, swollen and painful, it usually indicates infection. This nail should be treated to prevent progression of the infection.

It Is Not Getting Better With Home Care. You have tried to treat it at home or maybe you haven't treated it, but the toenail is getting more swollen, more painful and is starting to interfere with normal activities...you should get it seen by a doctor.

You Have Activities You Don't Want To Miss. The biggest reason I recommend treatment by a doctor is if you have something important coming up and you don't want to miss it! (vacation, trip, wedding, conference, camping work activity, other important activity)

If you are wondering, that is usually an indication that you should get seen!

How Your Ingrown Toenail Should Be Treated

When it comes to treating ingrown toenails, there are really only two ways they should be treated. Of those two ways, only one solves the problem long-term. We therefore recommend treatment #2:

Temporary Treatment. In rare situations, Dr Gibson will recommend temporary treatment. Temporary treatment consists of just trimming out the side of the nail.

Permanent Treatment. The most commonly recommended treatment is a matrixectomy (removal of the nail bed or the tissue the nail grows from). This can be done utilizing a chemical burn (as in phenol matrixectomy) or surgical matrixectomy (where the matrix is cut out). In most cases this will resolve the problem forever...1% of the time there may be recurrence.

The Proprietary Treatment Protocol
at Mountain West Foot & Ankle Institute

THE GIBSON PROTOCOL

Specialized Treatment For Ingrown Toenails

Diagnosis Confirmed: Through careful evaluation the diagnosis can be confirmed easily. The procedure will not be performed if the nail is not ingrown.

Same Day Repair: Careful removal of a small sliver of nail (leaving the nail looking normal) on the same day. This is a procedure done under local anesthetic to the toe with either: 1) destruction of the nail border or 2) surgical removal of the nail border.

Specialized Bandaging: Application of a pressure bandage to be utilized for at least 6-8 hours until
initial bandage change.

Post-op Care: An Ingrown Healing Kit is to be utilized by patients including a proprietary Essential Healing Salve (to be applied daily), Epson salt to allow 1-2 soaks a day (15 minutes each) and bandaids to be utilized for at least the first week.