Do you ever get pain in your toenail and wonder if it's an ingrown nail? And, if it is, why does it hurt so much?  Right now, our feet are still under cover. But soon, warm weather will be upon us, and our toes will come out to shine.  So let's make sure they're at their healthiest: and growing in the right direction! 

How Do I Know If I Have An Ingrown Nail?

Anyone, at any time, can develop an ingrown toenail. More often than not, the hallux nail (big toe) will be the one with the problem.  Ingrown toenails present in degrees of complication: sometimes, they're   just a nuisance, but other times they arrive with an all-out infection. 

Of course, this can make it harder to tell if you've got an ingrown nail, but here are some helpful guidelines: if the inner or outer fold of your toenail is in pain, you may have an ingrown nail. If you see a break in the skin at the nail border, swelling, or pus, you most probably have an ingrown nail. 

Keep in mind, your nail has two borders: the medial and the lateral.  The medial border is at the edge of your nail which is closest to the midline of your body. The lateral border is the one facing away from your midline, towards the outside end of your body.  You could develop an ingrown nail in either border, or in both at the same time! 

Why Do Ingrown Toenails Hurt and Get Infected?

Your toenails are meant to grow straight and outward towards the end of your toe.  But, for some people, the toenail grows into your skin, giving it a curved appearance. As the nail grows inward, it pushes into the adjoining skin--and that hurts, especially if you touch the nail. Now, if your nail keeps pushing into and through your skin, the skin will break, creating an open invitation for bacteria. And frequent washing won't help: the bacteria that is the usual culprit, Staph Aureus, is everywhere, and can enter your body through even the tiniest skin break. 


How Do I Know If My Ingrown Nail Is Infected? Pointy-toed shoes can increase your risk of developing ingrown toenails

If you see redness on the nail border, or if there is swelling, or drainage, your nail is probably infected.  And if you don't seek treatment, things will get worse. You may even develop a puss pocket! But let's talk drainage: what you see may be thick and yellowish. It could even smell bad.  You might notice the drainage on your sock or in your shoe.  So, you're thinking, how much worse will things get? If your condition progresses,  you may develop a granuloma, which is a soft tissue growth that looks like a red raspberry.  Now, it's not a cause for panic: it's simply your body’s reaction to the infection, compounded by inflammation due to the ingrown nail.  Still, at that point, it is definitely infected, and you need to get immediate attention. 

Why Did I Get an Ingrown Toenail? 

The shape of your nail is genetic.  So, if your parents or grandparents had incurvated nails...there's your answer.  But take heart: having an incurvated nail doesn't have to mean that you'll get an infected ingrown nail. Yes, the shape of your nail plays a role in this condition, but other factors must contribute.  For example, picking at your nails will up your risk. Getting pedicures at salons that dig into the edges of your nail ups your risk, because this may irritate your nail bed, inflame the nail borders and cause a vicious cycle of inflammation and ingrowth. Your footwear can also increase your risk: tight socks, tight shoes or even pointed shoes can hinder proper nail growth,  squeezing the toenail sides into your nail.  Even pregnancy can be a problem: because some pregnant women’s feet swell, their shoes get tight, and put too much pressure on the ends of the toes.  By the way, your nail infection can occur at the medial and lateral borders of the nail, but it can also pop up at the base of your nail.  If that happens, you'll see all the same symptoms as a border infection, but the redness may travel past your toe.  

How Do I Treat An Ingrown Nail?

The best option is to come and see me right away. But prior to your appointment,  you can  soak the affected foot in warm water, mixed with antibacterial soap,for a few minutes twice a day.  This will help draw out any drainage from an infected nail.   

Still, you'll need to come see us in the office.  If your skin isn't broken yet, I can use my instruments, and a very special technique, to cut away part of your nail border.  Very often, this results in immediate relief. But don't try this at home!!! This would only make you vulnerable to infection.

Now, if I see your nail is already infected, you may need a procedure called incision and drainage (I&D), to alleviate your pain.  I can do it right in our office procedure room, with a local anesthetic (lidocaine). And you will be able to walk out of the office, pain free! But, if I see a localized bacterial infection, I may also prescribe oral antibiotics to make sure all of your bacteria clears up.  I'll also fit you with a post-op kit to keep your nail healing properly. 

I'll also walk you through techniques to keep your ingrown nail from coming back! Our most important lesson: cut your nails straight across.  If you try to “dig” at the corners, they will only become irritated.  Plus, if you pick your nails, stop picking at them!  And make sure to examine your sock and shoes choices, with roomy comfort being your primary goal.

What If My Ingrown Toenail Returns?

First, don't panic. If recurring ingrown toenails plague you, we can perform an elective, in-office procedure called a matrixectomy.  This procedure, like the I&D described above, is done under local anesthesia.  It's purpose is to permanently remove your nail border, so only the edge of the nail that grows into your skin will be removed.  The whole nail is not removed, only the affected border--and it looks exactly the same, just a few millimeters more narrow.  To complete the procedure, I'll remove the border, which is no larger than a toothpick) then apply a chemical into the corner to keep any nail cells from regrowing.  Afterwards, I'll follow up with post-op wound care, just like after an I&D. But, this procedure's post op will be a little different:  you're like to have a little more drainage and irritation as your body adjusts to the lack of a nail border while healing. Plus, we'll schedule follow up visits to check your progress and examine the nail border until it's completely healed.

I know that was a lot of information, but if you take home just one message, I hope it will be this: if you have any concerns about your feet or nails, please call our office. Don't ignore an issue or try to deal with at home, on your own. At Prairie Path Foot & Ankle, we're here to heal your feet, as quickly and painlessly as possible. So help us help you, and come in at the first sign of discomfort!