Toenail problems and how to fix them

When cutting nails without any problems, cut the nail straight across with nail nippers and ensure you do not clip down the sides of the nail. Keeping the nails short before any activity stops the repeat impact of the toes at the front of the shoes which will ultimately go on to cause blood blisters under the nail and at the base of the nail. If they persist the nail may come off completely as the trauma to the nail bed is too severe for the nail to remain in place.

Ingrowing toenail

An ingrowing toenail is one that the nail pierces into the flesh of the toe, most commonly the big toe. It can feel as if you have a splinter in the toe and can be extremely painful or worse become infected. Pus and bleeding may also be present. There is a difference between ingrowing toenails and a nail that is curling (involuted or convoluted) but isn’t piercing the skin, it is just misshapen.

There are many genetic factors that can make you prone to ingrowing toenails including your posture (the way you stand), your gait (the way you walk) and any foot deformities. Foot deformities may include conditions such as a bunions or hammer toes. Your nails may have a natural tendency to splay or curl out instead of growing straight, this heightens the risk of your nail to grow into the flesh.

Tight footwear, hosiery and socks can also push your toe flesh onto the nail so that it pierces the skin. If you sweat excessively or don’t rotate your footwear, this makes the skin moist and weak, so that it is easily penetrated by the nail. If you naturally have brittle nails with sharp edges or are in the habit of breaking off bits of nail that are sticking out, you are also more likely to get an ingrowing toenail. In addition, the wearing of ill-fitting socks and footwear that squeezes the toes will also contribute to formation of ingrowing toenails.

The single most common cause of ingrowing toenails is simply not cutting your toenails properly and regularly. This includes cutting your nails too low down the sides in order to relieve the pressure and discomfort of an involuted nail. Less common causes are fungal infections or in some cases certain types of medication such as Isotretinoin.

Is it serious?

If left untreated the infection can spread to the rest of the toe and foot which can lead to surgery. As with most problems the quicker you treat it, the less pain you will be in.

Who gets it?

Active people are particularly prone as they sweat more along with people who pick their nails.

How do I know I have it?

The most common symptom is pain followed by some form of inflammation in the surrounding nail area.

However, not everyone identifies an ingrowing toenail correctly. In some cases they have a curled nail which has a lot of debris underneath it, or a corn or callus down the side of the nail.  If it’s a corn however, the pain tends to be throbbing as opposed to the sharp pain you get with an ingrowing toenail. If this is the case, your podiatrist will remove the corn and, if necessary, thin the nail.

How do I prevent it?

Firstly, learn to cut your nails properly. Nail cutters aren’t a good idea because the curved cutting edge can cut the flesh and nail scissors can slip. It’s best to use the nail nippers because they have a straighter cutting edge but a longer handle for greater stability. Cut your nails straight across making sure not to cut too low at the edge or down the side. It is important that the corner of the nail is visible above the skin. It also helps to cut them after a bath or shower as the nail is much softer.

Good hygiene can go a long way to preventing in growing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made synthetic, materials, when choosing socks and shoes, ensuring they fit properly. Keep your feet clean and dry, and in the summer wear open-toed sandals to let air get to your toes as much as possible.

If you have diabetes, are taking steroids, or are on anti-coagulants, don’t attempt to cut your nails yourself.

Visit a podiatrist if you experience any:

  • Persistent pain in your toe from the ingrowing nail.
  • Symptoms of infection, especially if you have diabetes or a poor immune system.
  • Conditions which affect the nerves and/or feeling in your foot.

If you experience any foot care issues which do not resolve themselves naturally, it is recommended to seek the help of a HCPC Podiatrist


What is a Fungal Nail infection?

Nail fungus, or Onychomycosis, is a condition that is caused by the presence of a fungus living in and under the nail bed of a finger or toe. This area is cool and protected which provides perfect growing conditions for the dermatophytes (fungi). This area also makes it difficult to reach and therefore difficult to treat. The fungus begins under the nail, lifting the nail plate off the nail bed, which causing the plate to turn yellow, cloudy or dark coloured. Nail infections are becoming increasingly common, now affecting up to 10% of the adult population.

If  not treated quickly, the fungus will spread, and the condition will worsen. This causes heavily affected nails either to thicken or to become brittle and then crumble apart. As the fungal nail increases in thickness it will take up more room in the shoe which will feel uncomfortable due to the increase of  pressure from the shoe. This can cause blisters to form under the nail if there is repeated trauma to the nail plate.

Once affected, nails must be treated for a significant period of time before all the fungus can be eliminated.

The suggested treatment time to kill all the fungus once the nails have been affected is 6-12 months, as this is how long a toe nail takes to grow from the nail bed to the end of the nail plate

Treatment of Fungal infected nails.

There are some tests that can be done to establish if you have a fungal infection of the nail, these can be done by a Podiatrist or by your GP..

Once established, a Podiatrist can recommend several treatment plans for the resolution of fungal infection:

  1. Oral tablets can be prescribed by the GP in conjunction with a Podiatrist who would be able to remove the fungal affected nail in anticipation of a clear nail coming through.
  2. application of antifungal liquids onto the affected nails and application of antifungals onto the skin of the foot which prevent cross infection from the skin into the nail again.
  3. Laser treatment is now being very successfully used in the treatment of fungal affected nails.

These treatment methods will all take months to fully complete purely due to the length  of time it takes for the nail to grow from the bed to the end of the toe.

Thick and damaged toenails

Thick nails are often the result of damage to the nail and the nail bed, often due to a one-off trauma or repeated smaller traumas. The nail usually looks yellow and is much thicker than the other nails. It is slower growing and can be quite painful underneath the nail, where the pressure from the footwear can cause blisters or corns under the nails itself.

A Podiatrist can painlessly reduce the thickness of the nail, which will then reduce the pressure on the nail and therefore the pain. Unfortunately the nail will always grow this way as the damage to the nail bed is permanent. A Podiatrist will be able to recommend how best to handle the long-term management of this condition, and advise on the possibility of permanent removal of the nail itself.

These nails are often mistaken for fungal infected nails and are treated as such. It is always best to consult a Podiatrist to confirm which one you may have. The nails on the smaller toes can often be quite painful but the nail can look normal. The cause of this is often a corn down the side of the nail, which is often referred to as a `false nail` as it looks like the nail has split into two but it is actually a corn. Podiatrists can easily remove them, establish the cause, and advise you on any preventative measures required