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Treating an Ingrowing Toenail - Non-Surgical Options

Ingrowing toenails are boring. Not boring in an uninteresting way, boring in a they-stop-you-doing-what-you-really-want-to-be-doing kind of way. You can't wear the shoes you want to wear. Every step can be excruciating. It can affect your ability to partake in sport and exercise. It can be embarrassing; not just the appearance, but the fact that you can't rectify it yourself. Or your home ministrations have made it worse. Cringe. And course after course of antibiotics? Well if you've seen anything about the microbiome online, you'll know this isn't good news.

Yet I'm always amazed at how long it takes a person to visit me. Do folks not realise there is a quick answer to their problems? Is it 'cos you don't think that's what a podiatrist does? Is it the cost? Is it misinformation by other healthcare professionals? My favourite lately was a practice nurse advising a patient to apply hydrocortisone cream to their ingrown nail. Yes that may help with hypergranulation (excess red soggy flesh at the side of an ingrown toenail) - of which there wasn't any in this case - but that ain't gonna solve an ingrowing toenail. A podiatrist will do that. What IS the barrier to pursuing treatment? Tell me! Pop a note in the comments below.


Anyway, you're on this website so you've realised you need to find a podiatrist; what next? A quick Google search will find your nearest specialist - and it is important that you find a podiatrist and not a foot health practitioner for this. A podiatrist can not only treat you effectively there and then, but advise you on next steps (pun intended). I will just spend a second elaborating on why I feel it's a better plan to see a podiatrist rather than a foot health practitioner. A podiatrist is trained in neurovascular assessment. The minute you slip your shoes and socks off we're taking note of what your skin looks like, what colour is it, are there any hairs on it, are your toenails healthy... these quick observations give us a good impression as to your general foot health. Then most of us will palpate (check using our fingers) your pulses, or even whip out a Doppler (more on this here) to qualify our suspicions. For the average person attending my practice with an ingrowing toenail (hello young athletic boy), one can assume your circulation is good and you'll heal quickly. However, what about the 50 year old woman where everything looks tickety-boo on the surface, but her capillary refill time is 10 seconds. Am I going to trim a bit of nail out, make it bleed like thunder and then send her on her way? I am not. Ok so 10 seconds is a bit of an exaggeration, but it's something a foot health practitioner won't check as they are not trained in neurovascular assessment. Why does this matter? Well, I'm not going to put a wound* on your foot without knowing for sure that my treatment is not going to cause you a bigger problem. *Wound, in this instance, refers to the fact that when a bit of nail (the 'spike' of an ingrowing nail) has been removed, this typically reveals a breach to the skin - where the ingrowing nail has cut into the flesh of the toe, so there is a potential for infection (if there isn't one there already).


I digress. My point is if you want an ingrowing toenail to be treated appropriately you need to see a podiatrist. What To Expect At An Initial Appointment You will have been sent a medical history form. It may seem a bit OTT but I do need to know all this information in order to really understand how this ingrowing toenail has come about, and what are the best treatment options to offer you. As a rule of thumb, after discussing the options, I would typically cleanse the toe using Clinisept+, then use a very sharp pair of nippers in order to remove the ingrowing part of the nail. This is not a surgical procedure; the 'root' of the nail is not removed, and it will grow back - although whether it grows back ingrown or not varies hugely from case to case. For example, if ingrowing toenails are a family trait, then yes it will more than likely grow back.

Patients routinely tell me that this is painless and that they were expecting a lot worse. If there is an infection present, this procedure tends to be more uncomfortable and I'll typically apply a little EMLA (with consent from the patient) in advance of any treatment. What Next? Some people just need to be shown how to cut their toenails correctly - or told to cut their toenails full stop! The nails simply being too long coupled with activity (e.g. running) can be enough to cause nails to ingrow through repeated shear and friction in footwear. And If It Keeps Coming Back? - You can come back to the podiatrist every 6-12 weeks for regular maintenance (varies from person to person). - Nail surgery to permanently remove a sliver of nail (or the whole nail if it's a real mess) under the NHS or Privately; and there are different procedures available. A podiatrist will tend to offer a partial or total nail avulsion. I offer these procedures at my practice, and you can read more about that here. A podiatric or orthopaedic surgeon, or some extended scope podiatrists, can offer Zadik's or Winograd procedures. - Nail bracing... more on this below. What If I Don't Like Needles? Have I got news for YOU.

Nail bracing is a simple and effective treatment option for painful and involuted (curled-in) nails where toenail surgery isn't an option (e.g. impaired circulation, poorly controlled diabetes), or isn't desired for one reason or another.


Nail bracing requires no needles, no anaesthetic, no rest or down time and quick resumption to normal activities. It is comparable to the bracing of teeth used in dentistry; nail bracing is designed to restore the natural shape of a nail to prevent ingrowing and involuted toenails from recurring. Tell Me More, Tell Me More German-developed Onyfix® is a Class 1 Medical Device that is applied to your nail at its widest part. As your nail grows, it will retrain your nail back into a natural position and shape. The whole process takes several months to complete but is completely painless during application and while wearing the Onyfix® band. Instant relief can be achieved with Onyfix® without having to resort to nail surgery. Onyfix® is suitable for adults, children and diabetics.` The brace is small, discreet, and will not affect your footwear, activities or lifestyle.

PAIN FREE RAPID RESULTS DIABETES-FRIENDLY


For those of you thinking, "well, how the devil does that work then?' this concept is based on the principle of Davis' Law. Davis' Law states that soft tissue will heal according to the manner in which it is mechanically stressed. An Onyfix® nail brace will remain fixed to the nail plate and grow out with the natural growth of the nail. A big toenail takes roughly 9-12 months for the whole nail plate to grow out, with the lesser toenails taking around 6-9 months. If required, Onyfix® can be removed at any point by a podiatrist. Reviews are required every 3 months or so to check the brace is working as it should, and if the nail is particularly curled a second brace can be added alongside other conservative methods of treatment. Ok, so it looks like this is a long-term job - what if I'm going on holiday and I want my nail to look 'normal' in the meantime? Glad you asked. ToeFlex (hybrid gel nail reconstruction) can be applied to the toenail around (and over) the brace to disguise the brace and allow the nail to be painted, if desired. Where do I book? This treatment will be available at Raleigh Park Clinic from March 2024 and you can book online here. Choose either an Initial Appointment and pop 'toenail bracing' in the comments box, or select the Initial Appointment - Onyfix® Nail Brace option. If you've any questions or comments, please do be in touch!

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