17 May Toenail Physics and Treatment for Ingrown Toenails
Why have my nails started growing funny?! Why are they lifting? Are they ingrown? Why me?!
We are all too often blissfully unaware of our toes…until they start hurting! Anyone who has had an ingrown nail knows, it is hard to think when your toe is red, hot and swollen.
The delicate balancing act of a nail is between the stress of growth and adhesion to the underlying skin.
The nail is essentially a type of plate that can change its curvature. This plate is made of keratin, a protein found in the outer layer of human skin. The baby keratin cells form in a region inside the toe called the matrix, and as they multiply, they get pushed outward. Compacted layers of old cells form the hard, translucent nail plate. But the nail must be able to grow smoothly while also adhering to the skin of the toe. We can see on the top of our nail plates a series of tiny ridges that stretch from the base of the nail at the lunula (that half moon shaped white bit) toward the tip. The underside of the nail plate has a similar set of grooves/ridges so that the two fit together like a set of parallel rails on which the nail can slide and grow. The nail must grow at just the right speed. Too slow or too fast and the curvature of the nail has to change.
Things tend to speed up when we have a lot of growth hormones floating around in our system (think teenagers and pregnant women) which can lead to curling of the nail and those painful edges digging into the skin.
As we become more “mature”, we don’t just get wrinkles, grey hair and wisdom. Part of the package includes all sorts of chemical and cellular changes you might not like! Cell replication slows down and some of the materials the body uses for repair are second rate quality as we age. This can lead to …well…dodgy renovations. Slow growth can also cause change to the curvature of the nail. This as well as less elastic skin and thicker layers of keratin can lead to ingrown nails. Don’t forget just as your eye sight prescription changes as we get older, so does your “foot prescription”. So it is best to keep up with the times and adapt where necessary.
So why is the big toe the most common culprit? Two Physicist’s decided to put this to the test for The Physical Biology Journal back in 2014. The bottom line; the hallux nail (big toenail) is flatter than all the other toenails and finger nails. A big flat adhered plate has more forces acting on it to bend it out of shape.
I note these very clever gentleman only did the first principle equations to take into account the forces of growth. They did not include the forces caused by the silly shoes we sometimes squeeze our feet into. They also did not take into account the force of the bone underneath the nail plate. Bones can change (osteoarthritis, trauma) and cause an upward force from the inside of the toe up under the nail.
Sometimes ingrown toenails are just plain old human nature. It is just too easy to stub a toe, they get in the way! Picking/biting at the “quik” and dodgy nail salons have also been known to break the skin next to the nail and letting in a whole hoard of unwanted bacteria to a pus-filled party in the nail sulcus.
So what are the solutions you ask?
Today I will share with you the most common treatments for reducing pain, reducing the pathological curvature of the nail and also improving appearance.
This is where a podiatrist helps you with your nail care. They can try to tame the nail by reducing the thickness and using specialised tools to carefully remove nasty spikes of nail that are cutting into the skin. They can file down the edge and teach you how to keep the nail clean at home. Sometimes for one off cases after some kind of trauma to the nail, one consultation is all you will need. For those cursed with repeat ingrown and curly nails this just provides some short term relief. Appointments will need to be made regularly to keep the nails under control if this is your preferred method of treatment. For many people getting a professional opinion is a really good place to start.
This option boasts the best patient satisfaction ratings of all the treatments on the market. Without taking any nail away and narrowing the nail plate this also gives the best cosmetic outcome. The other great thing about it is NO NEEDLES! Anyone with a needle phobia this is the option for you. It is also safe to use on people with blood flow issues, children and sensitive skin. What is the downside you ask? Time. It takes 3-12 months to straighten the curvature of the nail. Just like braces that an orthodontist would use on teeth, some braces use small metal wires that are adjusted along either side of the free nail edge and changed every 4-6 weeks. Other braces use the same physics principles as a leaf spring- pressure v counter pressure. These braces are glued to the top of the nail. These gentle treatments require no time off work. You can wear the shoes that you want, continue with your normal activities and you can even go swimming with the brace on. If you are fashion conscious, you can paint your toenails with the brace on. Although this method is relatively new in Australia, it is very popular in Europe and has been used for over 30 years. It has been shown to be as successful as nail surgery for pincer nails and ingrowing nails. Not all podiatrists provide this treatment and we are delighted to be one of the few providers on the Sunshine Coast.
Partial Nail Avulsion (PNA):
This is the most common permanent surgical option used in Australia and is performed by most podiatrists and some confident GP’s. It is a very simple and safe procedure that involves first numbing the toe with local anesthetic (so you don’t feel a thing!). Then the side part of the nail that is growing into the sulci is removed all the way down to where the nail is formed at the root (or the nail matrix). The last of the nail cells are scraped away (still not feeling anything) and a chemical called Phenol is often (but not always) used to cauterize the area (i.e- a controlled chemical burn to stop the bleeding, kill off any remaining nail cells and any bacteria that might be hanging around). You will not feel any of this as your toe will be very numb (and sausage like! Thank goodness for local anaesthetic!). You are left with a little wound where the nail used to be that will need to be dressed daily until it is all healed in around 14 days. Most people experience a little discomfort in the first 24 hours and are encouraged to have a day of rest, keeping their foot up and pressure off the toe (no tight shoes). Salt water baths are great for keeping the toe clean and flushing out any gunk and antibacterial ointment and bandaids are the best way to dress the toe and allow it to heal. It is not a good idea to kick things for 2 weeks, or go swimming while the cut is still open. The biggest risks are infection or regrowth and both are not common. This is the quickest way to get rid of an ingrown toenail for good.
A podiatrist can help you find the best option for your nails and your lifestyle. If you have had a bad experience before and are a bit nervous about going forward, we understand. We are always here to talk you through any questions you might have. We are here to help after all!