Navigating the Maze of Ingrown Toenails with Expert Care

By: Jordan Duffy

A common question, oft heard around podiatry clinics, is “what can I do about my sore toenails?” Whether it is piercing the skin and infected, constantly breaking, or just curvy and unsightly, twisted toenails are pesky and persistent. While seemingly small, ingrown toenails can cause significant discomfort, inconvenience and can hinder day-to-day living. In this blog, we’ll unravel the mysteries of ingrown toenails, exploring causes, symptoms, and most importantly, effective and exciting new interventions when treating ingrown toenails to keep your feet happy and pain-free.

The Culprit: Ingrown Toenails

Causes:

Ingrown toenails are a common, and often painful condition. Ingrown toenails occur when the edge of a toenail grows into the surrounding skin, leading to pain, redness, swelling and potential infections (Park & Singh, 2012). Common culprits include improper nail trimming, excessive pressure to the nail plate such as tight footwear, skeletal abnormalities, obesity, diabetes and arthritis (Guler et al., 2015).

Recognising the early signs is key to successful treatment and prevention. Persistent pain, swelling, redness, blistering and even the development of pus around the nail edges are indications of an ingrown toenail (Park & Singh, 2012). Ignoring these signals can exacerbate the issue and lead to more severe complications (Exley et al., 2023). In many cases, the problem can be recurring so professional attention and treatment is essential.

When to Seek Professional Help

When it comes to ingrown toenails, knowing when to seek professional podiatry help can make all the difference in your comfort and overall foot health. If you’re experiencing persistent pain, swelling, redness, and/or signs of infection and pus, it’s definitely time to reach out to our expert podiatrists for specialised care. 

However, if you are concerned about the potential of an ingrown toenail, due to curved or otherwise unsightly toenails, your podiatrist is a great person to talk to about your options, the realistic risk of complications, and, if nothing else, put your mind at ease. 

Ingrown Toenail Bracing: The latest non-invasive, pain free treatment for ingrown toenails.

Nail braces are crafted to realign the natural curvature of a nail, this adaptable system ensures the correct positioning of the toenail to treat ingrown toenails (Guler et al., 2015). The benefits of bracing the nail is that it offers a pain-free experience, requires no downtime and is particularly suitable for individuals such as children, anxious individuals with needle phobia, those with diabetes mellitus, and poor circulation (Chiriac et al., 2014). They offer a safe and painless alternative, with the sides of the nail being gently lifted and the nail forced into a flatter shape over time. 

Currently there are three main categories of nail bracing. 

1.Wire nail bracing

These braces are made from steel wires; the wire is applied over the dorsal (top) surface of the nail and curved under its lateral (outside) edges. A loop bridges the levers and draws them together. The wires are then trimmed and the edges covered with an artificial nail mass to protect footwear. The braces are applied after measuring the nail of the individual, and the pressure is modified monthly based on the presence of symptoms

2. Fibreglass plate bracing 

This brace is made from fibreglass plate; fibreglass plate is measured for the nail, and then adhered over the dorsal (top) surface of the nail with an adhesive. After the adhesive is dry, a sealer is then applied to the area. Once in place, the brace applies a gentle, constant force to the toenail, gradually lifting it up and away from the skin.

3. Bracenfix™ 

Bracenfix™ provides support to the proximal end of the nail as it grows, preventing it from curling and becoming involuted. Bracenfix™ utilises a unique hardened composite material, cured by LED light, to act as a supportive brace on the nail plate. By maintaining the correct shape as the nail grows, it reshapes the pathway for healthy new nail growth, providing lasting relief (Chiriac et al., 2014). Additionally, upon curing and hardening, it causes the brace to slightly contract, creating internal tension which further helps to realign the growth of the nail. 

While nail bracing serves as an excellent intervention and treatment for ingrown nails by providing support and promoting proper nail growth, it’s important to acknowledge that it does not entirely eliminate the need for surgical intervention (Guler et al., 2015). While bracing can help alleviate symptoms and prevent recurrence to some extent, severe or recurrent ingrown toenails may still require surgical procedures to address underlying issues and provide long-term relief. Therefore, while bracing is a valuable tool in the management of ingrown nails, it’s essential to consult with a podiatrist to determine the most appropriate course of action, which may include surgical intervention when necessary.

Surgical Interventions:

There are multiple surgical options available for treating ingrown nails and a trained podiatrist will look at taking the safest and minimal intervention for the best possible outcome. One of these methods is a partial nail avulsion surgery with Phenol.

What is a Partial Nail Avulsion?

Partial nail avulsion surgery with phenol is a minor surgical procedure commonly used to treat ingrown toenails. It involves the removal of the offending nail edge causing the ingrown toenail under local anaesthetic to minimise the discomfort. Phenol, a chemical compound, is then applied to the nail bed to prevent regrowth of the ingrown portion, ensuring long-term relief.

Benefits of Partial Nail Avulsion Surgery with Phenol

Long-Term Relief: One of the primary benefits of partial nail avulsion surgery with phenol is its ability to provide long-term relief from ingrown toenails. By removing the ingrown portion of the nail and preventing regrowth with phenol, recurrence of ingrown toenails is significantly reduced, if not eliminated altogether .. 

Minimally Invasive: Compared to traditional surgical techniques, partial nail avulsion with phenol is minimally invasive, resulting in less trauma to the toe and faster recovery times (Eekhof et al., 2012). Most patients can resume normal activities shortly after the procedure, with minimal downtime required (Park & Singh, 2012).

High Success Rate: Partial nail avulsion surgery with phenol boasts a high success rate in effectively treating ingrown toenails. Studies have shown that this procedure offers lasting relief for most patients, with minimal risk of complications (Exley et al., 2023).

In conclusion, navigating the maze of treatment options for ingrown toenails requires a multi-faceted approach that combines innovative interventions, and professional expertise. By recognising the early signs and symptoms, seeking timely professional help, and exploring advanced treatments like bracing and partial nail avulsion surgery with phenol, individuals can find lasting relief from the discomfort and inconvenience of ingrown toenails. 

Reference

Chiriac, A., Solovan, C., & Brzezinski, P. (2014). Ingrown toenails (unguis incarnatus): nail braces/bracing treatment. Baylor University Medical Center Proceedings, 27(2), 145-145. https://doi.org/10.1080/08998280.2014.11929093 

Eekhof, J. A., Van Wijk, B., Neven, A. K., & van der Wouden, J. C. (2012). Interventions for ingrowing toenails. Cochrane database of systematic reviews(4). 

Exley, V., Jones, K., O’Carroll, G., Watson, J., & Backhouse, M. (2023). A systematic review and meta-analysis of randomised controlled trials of surgical treatments for ingrown toenails part II: healing time, post-operative complications, pain, and participant satisfaction. Journal of Foot and Ankle Research, 16(1), 55. https://doi.org/10.1186/s13047-023-00655-7 

Guler, O., Tuna, H., Mahirogullari, M., Erdil, M., Mutlu, S., & Isyar, M. (2015). Nail Braces as an Alternative Treatment for Ingrown Toenails: Results From a Comparison With the Winograd Technique. The Journal of Foot and Ankle Surgery, 54(4), 620-624. https://doi.org/https://doi.org/10.1053/j.jfas.2015.04.013 

Park, D. H., & Singh, D. (2012). The management of ingrowing toenails. BMJ : British Medical Journal, 344, e2089. https://doi.org/10.1136/bmj.e2089