FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SHAPE OF NAIL GREATEST "RISK FACTOR" FOR INGROWN TOENAILS

Question: I am having trouble with an ingrown nail on the big toe of my left foot. When I had this trouble a few years ago, I had hurt my toe kicking a soccer ball. I don't remember doing anything to hurt my toe this time. Why do I keep having trouble with the same ingrown toenail?

Answer: There are several things that could be contributing to your recurring problem with an ingrown toenail. Here are a few possibilities:

a big toe that is twisted in and slightly under the second toe;

shoes which don't provide adequate room and thereby force the second toe to always step on the side of the big toe;

and the shape of your toenail.

The greatest of these risk factors is the last one the shape of your nail. If it curves deeply into the flesh of the toe instead of lying flat across the top of it, you'll be much more prone to ingrown toenails. Many times, people with this problem make matters worse by cutting their nails in a way that makes irritation and infection of the skin beside the nail the condition we call an ingrown toe nail more likely.

Two of these risk factors are within your control shoe fit and the way you cut your nails.

The simplest to correct is, obviously, shoe fit. The toe area of your shoes should provide enough space that you can wiggle your toes up and down and side-to-side while standing up. If you can't, you need wider shoes.

I'll try to help you understand why the way you cut your nails is so important. When you look down at your big toe, it may seem that the nail just lays flat across the end of the toe. However, the edge of the nail curls down toward the bottom of the foot. The skin folds up along the side of the nail's edge creating a small trench of skin. It is the edge of the nail which is down in the bottom of this "skin trench" that causes the trouble. Cutting the nail short so that the end of the nail is inside this "trench" produces a sharp edge that can push against the skin and puncture it. Bacteria invade the toe through this wound and cause swelling, redness and pain. Individuals who have a greater degree of this downward curve of the nail edge have more trouble with ingrown nails.

So, to prevent ingrown toenails I recommend that you trim your nails straight across and nearly at the end of the toe, not curved back on the sides like finger nails. This keeps the downward-curving portion of the nail smooth all along that skin trench without any sharp, cutting edges.

Question: What can I do for my ingrown toenail?

Answer: If the skin at the edge of the nail is just a little irritated and tender, you may be able to get relief by soaking your foot in warm soapy water for 15-20 minutes twice a day. This softens the skin in that "trench" and helps remove any pus produced by your body's defense against the infection. You must also be cautious about the way your shoes fit, and remember to trim your nails properly.

When soaking and protecting your toenail fails to clear up the infection, it is time to see your family doctor or podiatrist. He or she will probably have you continue with the foot soaks and start you on an antibiotic. An individual whose nail still does not improve with this treatment or whose toe is seriously infected will need to undergo minor surgery to remove the part of the nail that is down in the "trench." This is a simple operation which is done in the office. The toe is usually dramatically better within a day or two.

In some cases the offending edge of the nail is removed as before, but the corresponding portion of the nail matrix the area where the nail actually grows will also be destroyed. This prevents the possibility of another repeat episode by eliminating the part of the "nail growth region" that produced the portion of the nail that previously curved into the skin. All that remains is a nail that lays flat across the top of the toe. Then, you'll be able to kick soccer balls without worry.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.