The ingrowing toenail

A common problem which I see regularly in my clinic is the ingrown toenail. A relatively small complaint but extraordinarily painful.

There are commonly two types of ingrown nail - one we see in children and adolescents and one we see in an older age group. I will deal with the two types separately.

Childhood and adolescent ingrowing toenails
In children and young adults, ingrown toenails are mostly caused by incorrect nail cutting or tearing of nails. It is relatively uncommon for a nail to be truly misshapen in this age group.

When a nail is cut too short or too far down the sides then it is common for bacteria to invade the nail edge and cause it to become swollen, red and tender all signs of inflammation.

This type of ingrown toenail can often be managed conservatively without the need for surgical correction.

Antibiotics are rarely required in this type of ingrown nail as the cause of the pain is inflammation rather than infection. Some of the ways we manage this type of ingrown toenail are:

  • Reshape the nail to remove sharp edges,
  • Reduce the bacterial infection by using antiseptic scrubs,
  • Pack soft foam under the nail edge to prevent the nail cutting into the skin,
  • Use soft toe plugs to reduce pressure on the painful nail when wearing shoes,
  • Patience growing out the nail to a longer length.

Ingrown toenails in children and adolescents will often resolve within a couple of months using the above techniques. Recurrent ingrown toenails can be prevented with good education on nail cutting technique.


Adult ingrowing toenails
In adulthood, ingrown toenails are more commonly due to the nail becoming misshapen and thickened.

Unlike fingernails, toenails are exposed to many stresses over a lifetime, mainly from shoes. Trauma and repetitive injury to the toenail will damage the nail bed beneath the nail where the nail grows from.

This can cause thickening, change of shape, ridging and discolouration. This type of ingrown toenail can be more difficult to treat conservatively and may require surgical correction to reshape the nail more permanently.

Surgical correction for ingrown toenails has come a long way over the years and is now a quick outpatient procedure performed under local anaesthetic.

The procedure takes 15 minutes and you can walk out of the clinic independently. Ingrown toenail surgery is most commonly offered by podiatrists who perform the procedure frequently and are highly skilled.

A well performed procedure is painless and results in a good cosmetic outcome.

One of the most common comments from my patients who have undergone the procedure is that they wish they had done it earlier. 

Many patients delay having the procedure performed due to fear that it will be painful and that they will be unable to wear shoes for weeks. This is not the case and the benefits of having the procedure performed are substantial.

If you or a family member are suffering from a painful ingrown toenail you may benefit from an opinion from your podiatrist.

- Contributed by Virginia Bower, St Johns Foot Clinic, principal podiatrist

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