Toenail Physics and Treatment for Ingrown Toenails

17 May Toenail Physics and Treatment for Ingrown Toenails

The bottom line; the hallux nail (big toenail) is flatter than all the other toenails and fingernails. A big flat adhered plate has more forces acting on it to bend it out of shape.

I note this 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 “quick” and dodgy nail salons has also been known to break the skin next to the nail and let 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.

Conservative treatment:

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 nails 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.

Nail Bracing:

This option boasts the best patient satisfaction ratings of all the treatments on the market.  Without taking any nails away and narrowing the nail plate this also gives the best cosmetic outcome. The other great thing about it is NO NEEDLES! For 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 is 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 GPs. 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 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 anesthetic!). 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!