Just like you’re reading this article now, for many people with an ingrown toenail, particularly if it’s their first time with one, they’ll also head online to seek out the best way to treat an ingrown toenail. And after hearing some interesting feedback from our patients in terms of their online search results, we decided to jump online to have a look ourselves – and set the record straight on what we found. And you can bet we were surprised! Here are seven treatment options presented by an article – and our thoughts on these findings.
“Soak the affected foot: Soaking the affected foot in warm water several times a day can help reduce inflammation and ease pain”
While regularly soaking the foot that has your ingrown toenail can help relieve your pain, there are two misconceptions here: first, this effect is very temporary. Next, it doesn’t actually treat, fix or resolve an ingrown toenail. The ingrown portion of your toenail still remains embedded in the surrounding skin, and so the pain and problem will continue to bother you – and is likely to continue to get worse over time.
“Wear comfortable shoes: Wearing comfortable, non-restrictive shoes can help reduce pressure on the affected toenail”
While we always support the advice to wear comfortable shoes, this advice also doesn’t fix the problem of your ingrown toenail. It can help you feel more comfortable and reduce your immediate pain – but it doesn’t remove the painful nail spicule from the skin. This advice also doesn’t clarify what shoes you should wear, beyond being comfortable and being non-restrictive. Specifically, you want shoes that either have a big, spacious toe box for your toe to sit freely in without being pressed on, or ones with an open-toe region.
“Lift the nail: Gently lifting the edge of the ingrown nail with a small piece of cotton or dental floss can help it grow out straight”
If treating an ingrown toenail was as simple as just “lifting” the ingrown piece of the nail out of the skin, then we wouldn’t have a whole clinic dedicated to treating this painful and frustrating condition – and the pain and frustration is often linked to not being able to do anything to ease the pain (beyond temporary medicated relief) at home. When cotton is used to lift the nail, in most cases the offending nail spicule is still left in the skin, continuing to cause ongoing pain and irritation, even if the severity is somewhat reduced. It also doesn’t stop the ingrown nail from recurring in the future.
“Apply antibiotic ointment: Applying an antibiotic ointment to the affected area can help prevent infection”
While it’s true that antibiotic ointment can help prevent infection, which can help ease symptom severity, this also does not fix the problem of your ingrown toenail. This is because antibiotics don’t remove a nail spicule of the skin and don’t treat the underlying cause of an ingrown toenail. We’ve written specifically about antibiotics here.
“Take pain relievers: Over-the-counter pain relievers such as paracetamol or ibuprofen can help reduce pain and inflammation”
It is correct that pain relievers can help reduce pain and inflammation, but once again, offering this temporary relief from your pain and symptoms does not fix or treat your ingrown toenail. The nail spicule still remains deeply embedded in the skin, and only growing further in as time passes.
“See a podiatrist: A podiatrist can trim or remove the ingrown nail and may prescribe antibiotics if there is an infection”
Yes! You absolutely should see a podiatrist for an ingrown toenail. The first piece of advice we can agree on – and yes we can remove your ingrown toenail, though we won’t prescribe you antibiotics for an infection. For those that do need antibiotics, which many of our patients don’t, these are prescribed only by your GP.
“Surgery: In severe or recurrent cases, surgery may be recommended to remove the ingrown nail and prevent it from growing back”
Again, ingrown nail surgery is good advice. This is called a Partial Nail Avulsion (PNA) and involves your podiatrist removing a small section of the nail (including the ingrown portion with the nail spicule) so that you no longer have the nail piercing your skin. We can also apply a chemical to prevent the ingrown edge of the nail from returning. We recommend this for both severe cases, and when this isn’t your first time having an ingrown toenail. So this one is spot on – finally!So the morale of the story? Don’t trust everything you read on the internet – unless it’s from qualified health professionals that specialise in treating the exact problem you have. If you’re currently struggling with an ingrown toenail, book your appointment with our podiatrists by calling us on 09 523 2333 or book online here.
As a clinic specialising in ingrown nail care and treatment, we often see patients who have been battling with an ingrown toenail for many weeks and come to us to finally get rid of the problem. During the appointment, it’s surprisingly common to hear: “but I went to my doctor and got antibiotics – I’m not sure why they didn’t work?”The reason they didn’t work is because antibiotics are fantastic when it comes to treating infections caused by bacteria – but ingrown toenails are unfortunately a mechanical issue caused by the growth of the toenail into the surrounding skin. While an ingrown toenail can become infected, antibiotics would only be effective in treating the infection and would not address the underlying issue of the toenail growing into the skin. Hence, your ingrown toenail continues to persist and cause you pain while putting you at risk of recurring infections, given that the wound never gets a real chance to close and heal.
How Can You Tell If Your Ingrown Toenail Is Infected?
Some signs that an ingrown toenail may be infected include:
Redness and swelling around the edge of the toenail
Drainage of pus or other fluid from the area
Warmth and tenderness to the touch
Pain, especially when pressure is applied to the area
A fever, which is a sign of a systemic infection
If My Ingrown Toenail Is Bleeding, Does That Mean It’s Becoming Infected?
No. Ingrown toenails often bleed because a sharp piece of nail has broken the surrounding skin and is now growing into it. But if your toenail is bleeding, it does mean that you’re at risk of developing an infection. This is why it’s important to get your ingrown toenail treated promptly. Before you can get in to see a podiatrist, keep the affected area clean and dry, and avoid picking at or squeezing the nail or surrounding skin, as this can increase the risk of infection.
What Is The Best Way To Treat My Ingrown Toenail?
The best treatment option for you will depend on the cause of your ingrown toenail, its severity, and whether this is your first time with an ingrown toenail or the nail is a repeat offender. Here at the Auckland Ingrown Toenail Clinic in Remuera, we treat ingrown nails in one of three ways:
Conservative nail care: for first time ingrown toenails, as well as for those where the cause is unlikely to recur again in the future, our podiatrists are able to remove the offending nail spicule using our specialised surgical instruments, simply and easily. We will then provide you with a series of instructions on how to trim your nails in the future to reduce your likelihood of the problem returning. For tips on what not to do for an ingrown toenail, read this article.
Partial nail avulsion: for recurring ingrown toenails, our podiatrists specialise in removing the offending nail spicule permanently. This uses a chemical to prevent the problematic edge of the nail from growing back in the future, while giving you instant relief when the nail is removed from the skin.
Total nail avulsion: for recurring ingrown toenails that have a secondary problem, like a thickened, damaged or distorted nail, we can perform a total nail avulsion. This involves removing the entire nail and allowing it to grow back naturally, ideally without the previous issues.
Auckland’s Ingrown Toenail Experts
If you have an ingrown toenail and need help, get in touch with our ingrown toenail experts located inside the One Health building on Remuera Road, close to Newmarket. You don’t need to have been taking any antibiotics prior to your appointment. Our podiatrists will assess your toe and present you with a series of options to help you get the best outcome and much-needed pain relief. You can book your appointment online or by calling us on 09 523 2333
Having thick toenails can be frustrating, disheartening and painful for several reasons. They can be extremely difficult to cut through, can lessen the room in the toe box of your shoe and become painful – and can make wearing open sandals that show off the toes unappealing. Thickened toenails often become discoloured and can look like they have a fungal nail infection brewing.On top of all this: could thicker toenails increase your likelihood of developing an ingrown toenail? Actually – they can. As the nail bulk increases, part of the nail can start growing into the skin – whether that’s from a thicker nail having more frayed edges and nail spicules, from shoes ‘pushing’ against the end of the toe and nail and driving it into the skin, or simply from the way the thickened nail is growing.So what should you know about thickened toenails and how can you stop them from growing thicker? Let’s take a look.
Signs & Symptoms Of Toenail Thickening
Toenail thickening occurs gradually. As such, you may not notice it developing, especially early on. As the condition progresses, some common signs and appearance changes include:
The nail becomes firmer and more difficult to trim
You may find dirt, dead skin and debris building up beneath the nail
You may feel pain or discomfort from pressure on the nail from footwear
Your nail may become brittle, may flake or split – if this happens you may find it your nail catching on your socks or hosiery
An unpleasant smell may begin at the nail
The nail may lift from the nail bed
What Causes Toenails To Become Thick?
Most often, our toenails get thicker as we grow older as a simple byproduct of our natural ageing process. With age, the rate at which our toenails grow slows down due to reduced blood circulation, especially in our extremities. This causes our nail cells to build up and our nails to thicken. Interestingly, men are more likely to suffer from thickening nails than women.
Am I At Risk Of Getting Thick Toenails?
While age is a common factor, there are a number of other risk factors that may contribute to the thickening of toenails:
Fungal nail infections – these may also create a yellow/white discolouration in the nails, there may be some brittleness or flaking, the nail may lift upwards, and there may be an unpleasant smell
Reduced blood flow to the feet – can also promote nail thickening, whether it happens naturally due to ageing or from medical conditions like diabetes or peripheral vascular disease
Repeated trauma or injury – this means repeated knocking or damaging the toe bed by objects falling onto the feet, stubbing the toenails, or even participating in sports: runners, dancers, football and rugby players commonly lose their nails and have thickened toenails
Footwear– the pressure from wearing tight or restrictive footwear such as high-heels or where toes are unable to be splayed can cause damage to the nail cells over time. When the nail growing cells become damaged, the nails may grow back thick and disfigured over time
Psoriasis – psoriasis is often mistaken for a fungal nail infection with thickened, discoloured, brittle or flaky nails
Can I Do Anything To Stop My Nails From Thickening With Age?
While we can’t stop the natural ageing process, we may be able to reduce the risk by completing regular exercise to help promote our circulation, being proactive in treating any fungal infections when we first notice them, and making the effort to wear quality ergonomic shoes that have plenty of space in the toe box for our toes to move freely. If our workplace means we’re at higher risk of falling objects on our feet, we can protect them by wearing steel-capped boots.
How Should Thickened Nails Be Trimmed?
It is very difficult to cut a thickened toenail without the correct tools, and many standard nail clippers have been broken in the process! It is recommended to file a thickened nail rather than cut it, in order to prevent harming the nail and the surrounding skin. Filing the nail 2-3 times a week can help to keep the thickness reduced, however, it can be awkward and difficult to do this safely at home. This is why patients choose to see our podiatrists, who professionally reduce the thickness of the nail easily and accurately with precision tools and the right equipment.
Qualified Podiatrists For Thick Toenails And Ingrown Nails
We’re proud to be Auckland’s leading podiatry team, trained in providing expert care for both thickened nails and ingrown toenails – including when both occur together! To safely and painlessly treat thick toenails, we start by using heavy-duty nail clippers to reduce the length of the toenails, and then use a unique burr to significantly reduce their thickness – and give them a clean, smooth finish. We also used a blacks file to clean down the sides of the nail, and beneath the nail where possible. Our patients greatly enjoy this process, and they often walk out feeling much happier and more confident to show their improved toenails with open-toed shoes and sandals. We can also help to determine the cause of your thickened nails to help reduce the likelihood of them recurring.Book your appointment with our podiatrists in Remuera by calling us on 09 523 2333 or book online here.
We recently had a patient come in who was experiencing her very first ingrown toenail – and initially, the cause of it was a bit of a mystery. She had relatively flat nails (compared to the typical excessively curved nails we often see with ingrown toenails), her shoes were roomy and spacious at the toe box – she didn’t like shoes that cramped her toes. Her foot posture and gait pattern were also relatively neutral – we didn’t see any excess pronation (rolling inwards) that places more pressure down the inside of the toe with every step that can contribute to an ingrown toenail.We kept asking questions and investigating… (after all, knowing why an ingrown toenail has occurred helps guide how we treat it and how we help you prevent it from happening again in the future) until our patient remembered something, and reached into her jacket pocket. And this is what she pulled out (image on right).This is the shellac polish that she had applied at a nail salon two months ago. The polish had done a great job of staying on her toes for that long, but she recalled that about a week ago when she was in bed, she felt like her nail was falling off. Really, it was the shellac that was coming off – and taking some of the outer layers of her toenail with it.She said when she reached down to feel it, it was barely hanging on by the side of the nail – so she gave it a quick (and somewhat painful) tug to rip it off. And suddenly, everything made sense…
How Did Shellac Cause An Ingrown Toenail?
In this case, it wasn’t necessarily the Shellac on its own, but how the tough Shellac substance gripped firmly onto the nail and then pulled the surface layers of the nail off, peeling them away until it got down to the side of the nail. Here, it was hanging on, and our patient pulled it off – much like how many people choose to pull the nail as an alternative to using proper nail trimming instruments – a very common cause of ingrown nails.By pulling the nail off, it left behind a sharp nail spicule down the side of the nail – and it even left a similar sharp spicule of the natural nail that had been pulled off by the shellac – you can see it in the picture below.When a sharp nail spicule is left behind down the side of the nail, invisible to the naked eye, as the nail naturally grows out, it can grow into the surrounding skin and cause an ingrown toenail. Unfortunately, this tends to get worse as the nail grows, not better.
How Was This Ingrown Toenail Treated?
For this patient, we treated her ingrown nail using our conservative treatment method. This is a simple method we use for first-time ingrown toenails where the cause is something that is a one-off, and that isn’t likely to happen again. It doesn’t require any anaesthetic and involves our podiatrists using specialised tools to trim the nail to safely and effectively remove the nail spicule. Once the spicule is gone and nothing is pressing into the skin anymore, the pain and swelling can settle, and we would expect it to clear completely within a few days, after the wound from the ingrown nail has closed.
Recommendations For This Patient With Shellac For Next Time
We discussed a range of ways to prevent this from happening again – both relating to the Shellac, and to other factors, too. One thing we noted is that the shellac had been on for two months or even a little bit longer. As the shellac was thick and heavy, this contributed to its strong attachment to the nail and why it tore at the nail layers. We agreed that polish should only be kept on for a few weeks at a time to prevent this from happening again, and should be removed safely.If you’re struggling with ingrown toenails resulting from using shellac or visiting a nail salon, we can help. Book your appointment by calling 09 523 2333 or book online here.
Noticing some slight redness, irritation or swelling on the side of your toenail, especially if it’s still mild and in its early stages, may seem like no big deal. Some people presume that when the nail grows in by itself, it can grow right out. Unfortunately, ingrown toenails rarely get better on their own – and in fact, in some cases, they can cause complications. While ingrown toenails usually have a simple fix and don’t need to be serious or severe, today we thought we’d share what can go wrong with ingrown toenails and what you should look out for.
Ingrown Toenails: The Basics
An ingrown toenail is a nail that has pierced the surrounding skin. Often, it’s a small piece of the nail, like a little spicule that has been left behind after part of the nail was trimmed, that is the culprit. Once it has pierced the skin, it can cause great pain because it continues to move around with every step – much like walking with a splinter in the side of your toe.Ingrown toenails can affect one or both sides of any toenail, though usually affect the big toe. In most cases, the nail edge will curve down into the skin, however, the presence of extra or swollen skin surrounding the nails may obstruct regular nail growth and result in the nail growing into it.Initially, the nail may push tightly against the skin which can cause tenderness and redness, but it is the moment the nail cuts through the skin that it is deemed ‘ingrown’ and the risk of complications such as infection begin.
Causes Of Ingrown Toenails
The most common cause of ingrown nails we see is poor nail cutting technique (where nails are left frayed or curved down the sides) as well as picking or pulling the nails off. Tight footwear can also create pressure on the sides of the toes that can push the nail into the surrounding skin. The shape of the nail can also play a role, especially where the nail is particularly involuted or curved. This is often linked to uncontrollable genetic factors that dictate the features and shape of the nail.
Complications Of Untreated Ingrown Toenails
When ingrown nails are left untreated, they can get infected and you may notice yellow discharge and bleeding from the toe. If this infection is unmanaged, it can form an open sore, and ultimately an ulcer. If a secondary infection is then picked up and reaches the bone, you may develop a bone infection. While these latter complications are much less common and very avoidable if the right care is taken, we simply wanted to illustrate that ingrown toenails do carry very real risks to your health, and that you should treat them carefully and promptly.You may have a higher risk of these complications if you have conditions like diabetes or problems with blood flow and circulation. This is as good blood flow is necessary to support healing, close wounds and fight off infections. Without this, your wound stays open for longer and you are more vulnerable to a persistent infection.
Treating Ingrown Toenails
Here at the Auckland Ingrown Toenail Clinic, our experienced podiatrists make treating ingrown toenails easy, simple and painless. We remove the offending nail edge from where it is lodged in the skin, trimming that part of the nail that often lies deep beyond where you can see without the right instruments and experience. If you’re concerned about pain, we can use local anaesthetic to numb your toe.We can either do this as a one-off treatment, best suited for first-time ingrown toenails that are unlikely to come back, or as a permanent solution, taking extra steps to stop the problematic nail edge from growing back again – and eliminating the risk of another ingrown toenail in the future. Our treatment options include:
Conservative nail care – for first-time ingrown toenails, we remove the offending nail spicule if it doesn’t look like the nail will re-grow back and keep causing you pain.
Partial nail avulsion – for recurring ingrown toenails, we remove the nail spicule permanently, using a chemical to prevent the problematic edge of the nail from growing back in the future.
Total nail avulsion – for recurring ingrown toenails that have a secondary problem, like a thickened, damaged or distorted nail – or one with a fungal infection too – we can perform a total nail avulsion. This involves removing the entire nail and allowing it to grow back naturally hopefully without the previous issues.
To get help from our trusted podiatrists, our clinic is located in the One Health building in Remuera. Book your appointment by calling 09 523 2333 or book online here.
We were recently having a conversation with a patient who was advised that soaking her foot in Epsom salts would fix her ingrown toenail. While it helped her get some temporary relief from the pain, the pain kept returning every time – until three months had passed and her ingrown nail pain was worse than ever. This is when she decided to seek help, and was able to get permanent relief from her ingrown nail pain in one appointment.This example is one of many that we see where home remedies have been suggested without explaining that most of the time, they only offer temporary relief – much like taking a painkiller. Then there are a bunch of others we’ve heard, like cutting a V in the top of the nail, which simply don’t work at all. Here’s a look into the truth (and biology) behind ingrown toenails and their recurrence.
Had Repeated Ingrown Nails? They’re Likely To Keep Coming Back
The first thing to note is that if you’ve suffered from the terrible pains of ingrown toenails more than once, the reality is that you’re almost definitely going to suffer from them again. One-off ingrown toenails absolutely do occur, but the cause is usually a particular pair of tight shoes that push the nail into the skin and they don’t tend to occur again after you’ve stopped wearing them. Repetitive ingrown toenails are the best indicator that there’s something more going on, like your nail cutting technique, or that the nail has now started growing in an abnormal way that ends up penetrating the skin, and that it’s going to continue to happen unless you get professional help.
Why We Don’t Recommend Treating Ingrown Nails At Home
Without knowing exactly what you’re doing when it comes to ingrown nail care, you could be encouraging the nail to continue to become ingrown, and it may leave you in much more pain than when you started.Take the way your nail is cut, for example. If you think that cutting down into the corner and removing the piece of nail will discourage it from growing there again – the reality is the exact opposite. Curving down and removing that painful nail edge will likely encourage the nail to keep curving and growing down – unless you know what you’re doing and understand the characteristics of nail growth.
Even Antibiotics Don’t Fix Ingrown Toenails
To better illustrate how deep the misconceptions about ingrown toenails go, many people take antibiotics for their ingrown toenails, without realising that antibiotics don’t remove the sharp nail spicule from the surrounding skin – they just help fight against any infection present, thereby reducing inflammation and pain. The nail is still left in the skin, and your pain will continue to come back until it’s removed. This is why antibiotics must be used hand-in-hand with a treatment that fixes ingrown nails.
How To Fix Ingrown Nails For Good
Fixing ingrown nails means removing the part of the nail that has penetrated the surrounding skin and is serving as a sharp splinter down the side of the toenail. To fix them for good means preventing the problematic edge of the nail from returning and growing back. We do this using a procedure called a partial nail avulsion (PNA). It involves removing a small part of the nail (the part that causes you pain!) and applying a chemical that will stop that small portion of the nail from growing back and continuing to cause you grief, over and over again.
Our patients love this procedure because:
It’s done simply and effectively in-clinic
It’s completed in 60 minutes (with the procedure time typically around 20 minutes)
It’s performed under local anaesthetic so is pain-free
You do not need to take any additional time off work or school following the procedure and can go home immediately
You don’t need any special boots or braces while the toe heals
The procedure causes very little post-procedure discomfort
We dress your toe, provide you with a take-home dressing pack and re-dressing instructions
We monitor your progress to ensure it’s healing well
While we perform conservative one-off care for first-time ingrown toenails or those with a definitive cause that is not likely to recur, the PNA is our best recommendation for those that are repetitively putting up with and suffering from ingrown toenails. We have great success with the procedure and have prevented hundreds of patients from continuing to regularly suffer. Our team are experts when it comes to ingrown toenails and we love seeing the difference that having this procedure makes in the lives of our patients.For more information about the PNA procedure, click here. To book an appointment, you can give us a call on 09 523 2333 or book online.
There’s a lot of information out there about ingrown toenails, and unfortunately, some of it is not accurate. Which, when you’re struggling with an ingrown nail and the methods you’re reading online aren’t working, can be very frustrating, disheartening, and painful. So today, we’ve debunked some of the top ingrown nail myths that we hear regularly from our patients – many of whom have tried treating their ingrown toenail on their own for weeks first, without success.
1. It’s Not An Ingrown Nail Unless It’s On The Big Toe
This one stems from many people being unsure of the cause of their toe and toenail pain on their smaller toes, despite having similar signs and symptoms to previous ingrown nails they’ve had on their big toe. The truth is:
Yes, you can absolutely develop ingrown toenails on the lesser toes, and we see this often
The side of the toe is likely to appear red and swollen, and pushing on the area will elicit pain
As the nail is so much smaller, it’s usually a very quick and easy fix
Some of the time, there’s notable debris built up in the side of the nail (including discharge from the nail piercing the skin) that when removed, can instantly feel significantly better
2. Cutting a ‘V’ In The Centre Of Your Nail will Fix An Ingrown Toenail
While it is true that other cells in the body work by ‘coming together’ during repair and therefore could hypothetically ‘pull away’ from the sides of the ingrown toenail, unfortunately that’s not how the nail cells work or grow. Your nail grows in only one direction – out. What you do to the ends of your toenails doesn’t change this – nor does it change the painful nail spicule that is embedded into your skin when you have an ingrown nail.We recommend saving yourself the hassle – and the potential of shredding through socks and hosiery with your sharp nail edges after a ‘V’ cut out.
3. Ingrown Toenails Are Only For School-Aged Children & Above
It makes sense that this sounds viable, after all, school comes with strict shoe requirements that kids must stay in all day everyday, and footwear is a primary cause of ingrown toenails. While it’s true that we see a lot of ingrown nails in school-aged children, we also see them in babies and toddlers too! If your young child has a red and swollen toe, or it looks like they have an ingrown toenail, bring them in for an appointment.
4. An Ingrown Toenail Will Get Better On Its Own
Think of an ingrown toenail like a sharp, big splinter – but instead of disappearing into the skin, being attached to your nail means that it continues to pierce through, growing as your nail grows, and leaving a painful, open wound where it has pierced the skin (which is vulnerable to infection). This is not something that goes away or just gets better on its own – not without removing the painful nail spicule first.There are definitely things you can do to help relieve your painful symptoms – soaking the nail, taking painkillers, taking antibiotics, but none of these actions remove the nail from the skin.
5. Antibiotics Will Fix An Ingrown Nail
Antibiotics are a fantastic medication for managing infections. And if you have an infected ingrown toenail, it’ll do a great job to kill that bacteria and give you relief. But what antibiotics don’t do is remove hard, sharp pieces of nail from the skin – which is the only way to truly fix an ingrown toenail. Unfortunately, many people are simply given antibiotics from their GPs and told to wait it out and soak their toes, which while it can give them some much-needed relief from their painful symptoms, that relief is only temporary as the nail is still lodged in the skin. Having the ingrown nail removed will give you symptom relief and prevent it from continuing to bother you.
6. Ingrown Nail Surgeries Leave Ugly Looking Nails
It makes sense to think that when part of your nail is removed as part of a partial nail avulsion procedure to permanently fix ingrown toenails, that your nail will be left looking less than ideal. But as a clinic that specialises in ingrown toenail surgery, we only remove the very bare minimum of the edge of your nail so that the difference is barely noticeable. The only difference is that your nail will appear to have a very straight nail edge, instead of one that curves down the side. Our podiatrist will be able to explain exactly how much of the nail we’ll need to remove at your appointment, and what cosmetic results you can expect.
Got Any More Ingrown Nail Questions?
We’re here to help – email them to us at info@performpodiatry.co.nz and we’ll get back to you as soon as possible. To book a consultation for your ingrown nail, call us on 09 523 2333 or book online here.
If you’re an avid skier, snowboarder, soccer player, or have a tendency to stub your toe, you won’t be a stranger to the dark brown bleeding beneath the surface of your nail that we medically refer to as a subungual haematoma. But with New Zealand having one of the highest rates of melanoma in the world, with approximately 4,000 people diagnosed each year and with melanoma accounting for nearly 80{b6e5f00fb20603d91e0eda9e5a923147a5347bc67df2eafaea32baa070f26b9a} of all skin cancer deaths, do you know how to spot it when it’s beneath your toenail – or did you realise that it can occur beneath your toenail?It absolutely can, and here’s what you should know.
What is a melanoma?
A melanoma is a type of skin cancer that develops from the cells in the skin that produces pigment – the colour of our skin – called melanocytes. When these normal cells divide uncontrollably, melanoma can occur quite quickly. This means it can start as a small spot and grow to be serious in as little as six weeks.If you’re wondering why these cells grow uncontrollably, Melanoma New Zealand describes it as the “cells in the body don’t obey the “instructions” about how to divide, how to grow and when to die. This happens when the genetic information in the cells is damaged, for example by exposure to the sun and damaging ultraviolet (UV) rays. When this happens, cells don’t die (to be replaced with new cells) when they are supposed to, and they grow and divide more rapidly than they are supposed to”.
What are the signs of a melanoma?
The signs of a melanoma beneath the toenail are the same as the signs of a melanoma anywhere else in your body. You want to look for asymmetry, an irregular border, colour, difference compared with normal moles, change or evolution, firmness and growth. Here’s what we mean, using the analogy ABCDEFG:
Asymmetry: melanomas are more likely to be asymmetrical or have an irregular shape, compared with a normal mole or freckle with a symmetrical shape.
Border: they are also more likely to have an irregular or jagged or poorly defined border; normal moles have smoother, clear borders.
Colour:melanomas tend to be multicoloured with different colours or shades rather than being all one colour. They may be brown with black, red, pink, white or blue tints, while normal moles and freckles are usually just brown.
Different: it may look different from other lesions, sometimes called the ‘ugly duckling’.
Evolving: harmless moles usually stay the same size, shape and colour for many years, but melanomas change size, shape and colour.
Firm: to the touch
Growing: most are larger than 6 mm and keep growing.
When we look at melanomas beneath the toenail specifically, we may notice:
Brown or black streaks in the nail without any known injury
Streaks on the nails that increase in size
A bruise on the nail that will not heal or move up as the toenail grows
Toenails that separate from the nail bed
Darkening skin next to the nail
A nail that bleeds or develops a nodule
Thinning, cracking, or distortion of the nail plate
One of the key indications of subungual melanoma is “Hutchinson’s sign.” This is when a person has nail pigment that extends onto the skin surrounding the nail.
What should you do if you notice a spot beneath your toenail?
First – avoid painting your toenails so that the toe can be easily examined. Next, you can book in either directly with your dermatologist, or one of our experienced podiatrists first to seek their professional opinion. While we won’t be able to diagnose your melanoma, we can discuss it with you and provide advice on your options and next steps. We understand how concerning having a spot beneath the nail can be, so we are here to help.For any questions or to book an appointment, give us a call on 09 523 2333 or book online here.
When it comes to ingrown toenails, there are a lot of questions that we get asked every day. From the common questions like why on earth they’ve affected you and how you can prevent the pain from ever coming back, to whether epsom salts can fix ingrown toenails, we’ve taken a handful of your FAQs and answered them today in our blog. If you’ve still got a question, check out our general FAQs here, give us a call, or send us a message!
Does trimming a V in the nail help prevent an ingrown toenail?
It used to be thought that cutting a V in the centre of the nail could discourage an ingrown toenail from growing. Now, this has largely been disproven by considering the nail anatomy and the physiological process by which a nail grows and lengthens – which starts from the base out, as opposed to growing out from the end of the nail and being influenced by the ‘V’ shape. This shape can also leave your nail vulnerable to ‘catching’ on your socks and shoes and being pulled, which can then irritate the area of the nail that has ingrown.
Can medication fix an ingrown nail?
It’s natural to want to take painkillers to help ease the pain, or to get a script for antibiotics if your ingrown toenail has become infected – and there’s nothing wrong with either. But no, neither of them – or any other medication – are solutions or treatments for ingrown toenails. Instead, painkillers temporarily mask pain (until they wear off and it comes back), and antibiotics help kill the bacteria causing the infection – but neither removes the ingrown nail from the skin it has pierced – which is the cause of your pain.
I keep treating my ingrown toenail but it keeps coming back. Why?
In this case, it looks like you’re treating the symptoms, which is the nail growing into the skin, as opposed to treating the cause behind why it keeps doing this. Without treating the cause, it’s likely to keep coming back periodically. Causes of ingrown nails can include:
Wearing tight, narrow, pointed or generally ill-fitting footwear – wearing shoes that are too tight or poorly fitting can cramp your toes together, pushing your nail into the surrounding skin. This encourages the nail to pierce and penetrate the skin, and unfortunately, will continue to do so in the future if you continue to wear the same shoes regularly
Picking or pulling the toenails – we’ve all known someone who ‘picks’ their toenail and rips it off instead of cutting the nail using nail scissors or clippers. As the ripping tends to go down the side of the nail, it often leaves behind nail spicules that, due to their location, can’t be seen – but can definitely be felt when they continue to grow and pierce the nail
Rounding the nails when trimming – even when you do use nail tools to trim your nails, curving the nails down into the sides may encourage them to become ingrown. The better way to trim the nail is to cut them straight across in a straight line, and then gently round off the very edges using a nail file if needed
It’s hereditary – your genetics may simply make you predisposed to developing recurring ingrown toenails. This is particularly true for those that have naturally curved or pinched (‘involuted’) toenails, larger toenails, or more skin surrounding the nail
If I’ve trimmed the nail and removed the ingrown portion myself, why is my nail not healing?
The most common answer is that you still have a piece of nail piercing the skin. Even if you saw a large piece of nail come out when trimming back the ingrown nail, there definitely can be more – even as podiatrists we’re often surprised when we remove a big piece of ingrown nail, have a quick check to ensure we’ve gotten it all, and find yet another piece of nail lodged in deep. Unfortunately, without the right tools, it can be very difficult to know if you really have removed all of the ingrown nail or not, especially when the surrounding skin is swollen or the ingrown nail is deep. If you’re still getting toe pain and ingrown nail symptoms after you believe it has been treated, this is usually a sign the problem hasn’t been fully fixed.
What are the early signs of an ingrown toenail?
When an ingrown nail first starts, it means that a sharp edge or spicule from the nail has recently pierced and penetrated the skin next to the spicule – even just slightly. This means that when any pressure is put on the nail, whether from being squeezed, from footwear, or even the natural vibrations through the feet when we walk, we can feel pain or discomfort. As the nail spicule has only recently pierced the skin, the skin surrounding the nail may not be red or inflamed, like is typically pictured in images of ingrown nails.The location of the nail spicule may be deep down in the nail, or toward the top of the nail in the corner – this really depends on where the spicule or sharp edge developed. Often, the spicule is deep down the side of the nail, deeper than the eye can see, meaning at the early stages it’s barely noticeable. What may give an ingrown toenail away in the early stages in a build-up of callus down the side of the nail – this can indicate that the nail edge has been rubbing against the skin for some time, and has finally penetrated.All in all, an ingrown nail in the early stages may not look so different from an unaffected nail. You can still have an ingrown toenail without any bleeding, swelling, redness or any discharge from the toe. The key is the pain when pinching the toe – if you get sharp, localised pain when pinching the toe, it could be the start of an ingrown toenail.
I have toe pain but I’m not convinced that it’s an ingrown toenail. What else could it be?
While ingrown nails are usually distinctive and common, similar toe pain can also be caused by:
Callus build up on the toe, by the nail, but without the nail piercing the skin
A foreign body like a splinter piercing the skin at the toe
Damage to the nail and nail bed from trauma – like from stubbing your toe
Toe fracture, which affects the toe bone beneath
A cyst or a clogged sweat gland may be present in the area
What happens if I leave my ingrown toenail untreated? Will it eventually go away on its own?
Given that the hard nail sits on top of our toe, it’s easy to think that the painful ingrown area is along the surface of the nail too, and so will easily grow out in time, taking the pain away with it. In most of the cases we see, the reality is quite different. The ingrown portion of the nail, which we call the nail spicule, is usually located quite deep down the side of the nail – often much deeper beneath the swollen skin than you can visibly see. Waiting for your nail to grow out then means driving this nail spicule deeper into an already tender toe. Given that toenails grow much slower than fingernails at an average rate of 1.62mm per month, and you may have multiple centimetres of skin to go through, this can mean months of severe pain, difficulty wearing shoes – and the risk of infection.
Can babies get ingrown toenails?
Absolutely, we’ve treated ingrown nails in babies as young as six months old. We’ve shared one of these case reports here.
Do ingrown toenails only affect the big toes?
No, while they most commonly affect the big toes, they can affect any of the toes. Here is a patient story and photo example of ingrown nail pain in the second toe.
My toe is starting to feel a little numb, and it’s a bit red. Could this be an ingrown toenail?
Numbness is not on the ‘typical’ or ‘expected’ list for common symptoms associated with ingrown toenails, but it is possible. More often, we would expect feelings of pain, swelling, redness, bleeding, and even clear/yellow discharge if an infection is present, a piece of nail is currently piercing into your skin and these are all fairly normal responses from your body.
Have more questions? Let us know!
If you have more questions about ingrown toenails, let us know, and we’ll include them in part two of our ingrown nail FAQs in our next blog! If you’re concerned about an ingrown nail or have toe pain that has recently started, book an appointment with our team by giving us a call on 09 523 2333 or booking online. We’re located within the One Health Clinic in Remuera, inside Perform Podiatry.
If you’ve had an ingrown toenail arise out of seemingly nowhere, and other members of your family have had ingrown toenails in the past, you may be wondering if ingrown toenails are genetic and if you’re going to keep getting them for years to come. Here’s a look into how and why ingrown toenails can run in families, as well as potential causes of ingrown toenails, and what you can do today to relieve your pain and stop them from coming back for good – even if they are genetic.
Are Ingrown Nails Inherited?
Yes, the characteristics that increase the risk of a person developing an ingrown toenail can be passed down through families. These may include:
The shape of the nail. Nails that are naturally curved, pinched or involuted are more likely to become ingrown, and the trait for the shape of the nail can be genetic
The amount of skin surrounding the nail (or its volume). The more skin you have surrounding the nail that may get pushed against the nail, the more likely the nail is to grow into this skin, and this characteristic can be genetic
The shape of the toe itself makes it more susceptible to an ingrown toenail, which can also be inherited
This means that it’s not the ingrown nail that is passed down, but factors that make it more likely for the nail to naturally grow into the skin. With this said, it’s important to know that just because you may have some genetic risk factors, does not mean that you will definitely develop an ingrown toenail. For some people, their ingrown toenails are caused by something completely different, like one of the causes below. So even if your family members struggle with ingrown toenails, doesn’t mean you definitely will too.
What Else Causes Ingrown Nails?
Aside from the shape of the toe or the nail, other factors that increase your risk of an ingrown toenail include:
Damage to the nail can increase its likelihood to become ingrown. This may be nail thickening, changes in the shape of the nail following trauma (like something being dropped on the toe) or from fungal nail infections.
Tight footwear cancreate pressure on the sides of the toes that can push the nail into the surrounding skin.
Pulling or picking the nails. Pulling the top of the nail off, instead of cutting them in a straight line with a tool, can leave a spicule at the edge of the nail where it is ripped off, often deep down the side of the nail where it is not visible or felt – until it starts growing and pierces the skin.
An improper nail cutting technique. Nails should be cut in a straight, clean line with no fraying or split edges and no curves. Curving or ‘rounding’ the edges of the nail down the side can encourage the nail to grow curved down into the skin.
Fixing Your Ingrown Toenail For Good
Regardless of whether your ingrown toenail is genetic or caused by something else, you can prevent your ingrown toenails from coming back for good. This is done using a procedure called a partial nail avulsion (PNA), performed by our experienced, registered podiatrists in our Remuera clinic.A partial nail avulsion removes the small portion of the nail that has grown into the skin, which usually looks like a small sharp spicule. Once the nail is removed, the skin can finally close and heal, and your pain will resolve. What makes the procedure permanent is that after removing the portion of the nail with the spicule, we also apply a solution to destroy the nail-growing cells at the base of the nail, meaning that this very small portion of the nail will not regrow. It will just close and heal.A PNA is a professional, safe and effective solution and one of the most common procedures carried out in our clinic. The benefits of a PNA include:
The procedure is simple for you – just sit back and relax, there is no prep work required
It’s quick! The total appointment time is one hour, and the procedure time is often around 20 minutes
The procedure is performed under local anaesthetic so is pain-free
You do not need to take any additional time off work or school following the procedure and can go home immediately
You do not need any special boots or braces while the toe heals
The procedure causes very little discomfort afterwards, however, painkillers can be taken should discomfort arise
We dress your toe, provide you with a take-home dressing pack and re-dressing instructions
We monitor your progress to ensure it is healing well
Recovery time is anywhere from two weeks to two months barring any complications such as infection. We provide you with all the dressings, topical antibacterial solutions and ointments, the post-op shoe and aftercare instructions, all tailored individually to your needs
Ingrown Nail Solutions For The Whole Family
Ingrown toenails are painful and frustrating – but just because they run in your family, doesn’t mean you have to put up with them for the rest of your life. Come in for a consultation with Auckland’s leading podiatry team specialising in ingrown toenail treatment.Book your appointment with our experienced podiatrists by calling 09 523 2333 or book online here.
In this case, it wasn’t necessarily the Shellac on its own, but how the tough Shellac substance gripped firmly onto the nail and then pulled the surface layers of the nail off, peeling them away until it got down to the side of the nail. Here, it was hanging on, and our patient pulled it off – much like how many people choose to pull the nail as an alternative to using proper nail trimming instruments – a very common cause of ingrown nails.
