Painful toe; an ingrown toenail.
What is an ingrown nail?
An ingrown toenail (medical term unguis incarnatus) is very painful and usually develops in the nail of the big toe. The (side) edge of the toenail grows into the skin instead of alongside it. This makes the nail fold extremely sensitive/painful because a wound is created. The toe is red and swollen (inflammation), pus may form, and in a later stage, granulation tissue may also develop.
This complaint affects both men and women in all age groups, but is strikingly common in young adults between the ages of 15 and 25.
How does an ingrown nail develop?
An ingrown toenail can have several causes, but almost always develops in combination with considerable pressure on the toe, for example due to tight shoes or pressure from the other toes. This pressure causes the nail to grow differently from the matrix and form more of a curve on the side. When combined with cutting the nail too round instead of straight, the nail grows deeper into the nail fold as it regrows. Especially if the nail corner is not rounded off properly and a sharp point is created.
Causes that can lead to an ingrown nail:
- considerable pressure on the toe, for example from tight footwear
- injury to the toe (trauma)
- abnormal position of the toes
- cutting the toenails round and deep
- soft nail environment due to sweaty feet, hormones or damp conditions
The amount of discomfort you experience from an ingrown nail can vary greatly. For some, it is merely a sensitive spot that flares up occasionally, while for others, the toe can tolerate almost nothing chronically.
The difference between an ingrowing and an ingrown nail
- An ingrowing nail (pseudo unguis incarnatus) presses the side of the nail into the skin. This can cause mild to severe pain. The nail environment may be swollen and red, but the nail fold is still intact and there is no inflammation present.
- An ingrown nail (unguis incarnatus) grows with the tip of the nail into the nail fold, creating a wound. This causes an inflammation with wound exudate or pus formation.
Ingrown toenails can be divided into 3 stages:
- first stage: swelling of the nail fold, oedema, redness and sensitivity to pressure. This is what we call an ingrowing nail
- second stage: first stage 1 with penetration of the skin by the nail, causing inflammation and pain when pressure is applied to the nail fold.
- third stage: second stage, but with chronic inflammation of the nail fold and pus formation, which can lead to the formation of granulation tissue.
What to do for an ingrown toenail?
An ingrown toenail will not go away on its own. As long as the nail continues to press into the nail fold, the pain will persist. There are several options for treating an ingrown toenail. Which is best for you depends on the stage and whether you want to try to remedy it yourself or prefer to seek professional help.
What can you do yourself for an ingrown toenail?
If there is inflammation or severe pain, always contact your GP and do not try to treat it yourself. It is not easy to treat an ingrowing nail yourself and requires some specific instruments, but the following tips can help prevent it from getting worse.
- It is often suggested to soak the toe with the ingrown nail in a bath with baking soda or Biotex. In itself, this cleanses any inflammation and softens the nail plate, temporarily relieving the pain. However, the skin of the affected nail fold also becomes softer and even more vulnerable. It is therefore not a good solution, but rather symptomatic treatment.
- What you can do yourself is to clean the nail environment thoroughly. Dirt often accumulates between the nail fold and the nail, and removing it can provide relief. The easiest way to do this is to moisten the nail environment and remove the dirt with an excavator. This instrument is a very small, narrow spoon with a convex and a sharp side, which can be used to scrape away dirt. Be careful to keep the convex side against the skin and ensure the sharp side does not cause wounds.
- You can also carefully file the side of the ingrowing nail smooth with a narrow nail file, so that there are no longer any sharp points or cracks that can prick the skin.
- Once the nail environment is clean and the sharp edges have been filed smooth, you can place a piece of copoline (or possibly a cotton ball) between the nail and the nail fold using a palpator. This temporarily protects the skin of the nail fold, allowing it to heal.
- Always disinfect the nail environment after you have treated the nail with an antiseptic or disinfectant alcohol. A small wound may have formed in the skin, and this will help prevent infection.
Professional help for an ingrown toenail
Do you regularly experience an ingrowing or ingrown nail, but without inflammation? Then make an appointment with a (medical) podiatrist.
A podiatrist can directly relieve the symptoms through treatment. The nail is disinfected, filed, and if necessary, thinned and freed, allowing the skin to heal. There are also several options for preventing ingrown nails in the future.
For example, a nail brace or splint can be applied to guide the nail into the correct shape. This can also be done by applying a layer of acrylic to the nail plate.
If you have inflammation or frequently suffer from an ingrown nail that causes severe discomfort, see your GP. The doctor can treat the inflammation and, if necessary, refer you to a surgeon who can surgically remove part of the nail.
How to prevent ingrown nails?
It often takes a long time before you no longer experience any discomfort from an ingrown nail. The best thing is to prevent nails from growing in!
Our tips:
- Cut nails straight and not too short. This prevents the skin from growing upwards over the area where the nail should be. Do not cut away the corners. Rounding off sharp corners with a file is not a problem.
- Make sure your shoes do not constrict your feet. Shoes with a narrow toe or high heels, in particular, put a lot of pressure on the nails. Of course, you can wear such shoes occasionally, but alternate them often. This prevents the pressure from falling on the same place every time.
- Take off your shoes as soon as possible. Without shoes, your toes have plenty of room and are not under pressure.