Closing In On Ingrown Toenails

Ingrown toenails — a condition in which the edge of the toenail cuts into the flesh — generally occur more frequently during the fall and winter months, when out come the closed-toed shoes squeezing toes and causing ingrown toenails.

According to Johanna Youner, D.P.M., ingrowns can also be hereditary. “Sometimes you just inherit a nail shape from your parents where the sides are curving under,” explains Dr. Youner. “Sometimes it’s the shape of your foot — a worsening bunion deformity, for example, can force the nail into the toe and mold the nail into an ingrown. Tight shoes or even closed-toe shoes put pressure on a thicker nail, so in the winter, a person who does not have any trouble with ingrowns in the summer may have a lot of trouble once she puts on closed-toe shoes.”

This condition occurs most frequently in the big toe and may affect one or both sides of the nail. Initially it may only cause a little discomfort but as the nail grows deeper into the flesh the toe usually becomes infected and very painful. The skin becomes irritated, red, shiny, and swollen with a throbbing pain and the toe is painful to touch.

Nail softeners can be used to help the nail from piercing the skin but for successful treatment of an ingrown toenail it is advisable to recommend your clients visit their local state-registered podiatrist.

Where Ingrowns Start

Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is usually the victim of this condition, but other toes can also become affected.

“Ingrown toenails generally develop when the nail is cut too short or on a curve,” explains Dr. Stuart Mogul, a podiatrist in private practice in New York. “If there is discharge, pain, swelling, or discoloration in the affected area, recommend your client to a specialist.”

You can be sure your client has an ingrown toenail if she complains of sensitivity to any pressure such as shoes, socks, even the weight of bedding, pain along the edge of the toenail, inflammation, swelling, redness and discoloration, or bleeding.

What Nail Techs Can Do

We’ve all heard the old wives’ tales related to handling ingrown toenails — you must cut the toenail straight across or risk causing an ingrown, or cut a “V” in the free edge of the toenail to prevent the formation of an ingrown nail. As anyone who has ever had an ingrown toenail can tell you, these trimming methods do not work. What does work is the proper trimming and rounding off of the corners of the plate so that they do not cut into the skin fold along the nail grooves.

“For a pedicurist, she should gently tease or trim out the side of the nail,” says Dr.Youner. “This requires training to clean the border smoothly yet not too deeply. The border must be smooth — when a bit of nail is left after trimming out an ingrown — this is when an infection develops because the nail grows up and the piece gets stuck in the flesh, acting like a foreign body.”

The signs and symptoms of an ingrown may be mild or severe, according to Charlene Handzel,D.P.M. at Southlake Family Foot Center in Southlake, Texas. “Mild presentations of pain or tenderness, local redness, and mild incurvation may be present over a prolonged period of time,” says Dr. Handzel. “This type of presentation may be treated by a nail tech. For clients presenting an infection characterized by inflammation of the skin around the site or those with systematic diseases, a referral to a medical professional should always be arranged.”

“Treatment for ingrown toenails depends on the severity of the case. For immediate relief from the pain and discomfort, soak the feet in salt water or soapy water and apply an antiseptic,” recommends Dr.Mogul. “Nail techs can also apply any product containing tannic acid to the affected area. The tannic acid will harden the nail and shrink the soft tissue around it, possibly allowing the nail to resume its normal position.”

[Sidebar]

INGROWN TOENAIL PROTOCOL FOR NAIL TECHS

Step 1:  Soak the feet in warm water with an antibacterial agent to soften the nails.

Step 2: Next, trim the toenail with nail clippers and file down the corners of the nail to round them out.

Step 3: Clean out underneath the nail with an ingrown toenail lifter or curette.

Step 4: Take a nipper and gently nip at the ingrown from an angle and slowly pull it out.

Step 5: Be sure to clean out the dead skin that’s built up underneath the nail and buff the sides.

Step 6: Soak a piece of cotton in alcohol and place it under the big toenail to demonstrate how it should be kept clean at home.

 

Svetlana Karimova of Michelle’s Nail Studio in Redondo Beach, Calif.,  recommends an at-home treatment to her clients. “I have them soak a piece of cotton in alcohol and place it under their big toenail and clean it from side to side each night,” she says.“This helps to keep an infection from forming.”

In many cases, proper nail trimming will prevent ingrown toenails and keep the client comfortable. How do you know a client needs only careful trimming?  First, look closely at the nail and nail groove. There should be no infection present. The edge of the nail should not be so deep in the nail groove that it cannot be easily observed. You must be able to see what you are trimming, and you must have the proper instruments to work with.

Dr. Alan Meyerberg, a podiatrist at Staten Island University Hospital in Staten Island, N.Y., recommends using a nail clipper with slender pointed cutting jaws that can be easily placed under the free edge of the nail.

“Don’t pick or tear at the nails because they will rip down into the corner where the nail meets the skin,” says Dr. Meyerberg. “Don’t make the nails too short because as the nail grows, the pointy ingrown part acts like a knife stabbing from the inside and soon an infection develops. An infected ingrown nail requires prompt professional attention.”

If your client refuses to seek medical attention, you can let her know that there are possible complications of an ingrown toenail and it should be treated immediately. Some of the possible complications are the spread of infection to the foot and leg, or into the blood stream, loss or deformity of the nail plate, or in a worst case scenario — it can become a small benign tumor.