Involuted Nails

Here at the Footcare Clinic, we often  hear people complain of ingrown toenails. Sometimes they are ingrown, but more often they are 'involuted'.

Involuted nails can be very painful as the two sides of the nail curl towards each other pressing into the skin at the edges of the nail. Looking at the nail from the end of the toe, the nail has a profile similar to a staple, as in the picture below. Sometimes the curvature of the nail is so great that the tip of the nail curls in a circle causing the skin to be pinched. They usually they don't break the skin or become infected but they can become painful due to pressure.

It doesn't take a wild imagination to understand the problems that nails like this can cause. The nipping action of the nail makes them feel very tight and any added pressure on the top of the nail from footwear for example, can cause friction in the nail sulcus and lead to a build up of hard skin. As hard skin develops at the nail edges, the amount of pressure increases and this makes the toes more painful.  

Very often, the shape of the nail increases the total depth of the toe, necessitating a much deeper toebox in footwear. With insufficient room in the toebox, pressure on the nail causes the nail plate to thicken up, leading to increased pressure, more hard skin in the sulcus and even corns. So the circle of events continues.

Some  people with involuted nails never have any problems with them, but the liklihood of the nail pressing on the skin and becoming sore is much greater than in people with flatter nails.

The problems really occur when the pain causes people to cut their nails back in an attempt to gain relief. Sometimes this works, but only for a short period of time. Occasionally this 'self care' can leave small spikes of nail which can then penetrate the skin and  become embedded, causing an infection and an ingrown nail, ( onychocryptosis)

With involuted nails, it is important to cut them straight across the natural line of the nail. Cutting away at the sides often leads to other problems. It is also important to ensure there is sufficient depth in the toebox of a shoe, to prevent excessive downward force on the nail. Professional help is always advised.

If this becomes a long standing problem, then a simple procedure known as a Partial Nail Avulsion can help. This involves removing the side or sides of the offending nail permanently so that the nail that is left behind is flatter, easier to manage and has no curved bits to dig into the sides. 

Ingrown Toenails

The very thought of a true ingrown toenail is enough to my toes curl! (More on curly toes later!)  It is a very painful condition and by the time a patient seeks help, it is often very inflamed and even infected.

Some people are prone to ingrown toenails, due to the natural shape and condition of the nail plate. Others are unlucky enough to suffer trauma to the nail, which causes it to ingrow.

If your nails are very 'tight', almost like a staple, they are possibly 'involuted'.  This type of nail is often inherited and extremely difficult to cut.

 Attempts to cut these nails may leave small spikes down the sides and, unfortunately, they only become apparent when they start causing pain.  The spike of nail literally grows into the flesh at the side, in the sulcus. At first it is only a slight irritation, but very quickly it rubs, pierces the skin and sets up an inflammatory response. As there is a lot of bacteria present, both in and around the nail, it soon becomes infected.

The skin is an incredible organ and as we all know, makes every attempt to heal itself.  Ingrown toenails are no exception.  The inflammatory response encourages the body to repair the skin break, delivering more blood to the area.  The next stage of the healing process is granulation of the wound. This is when a matrix is laid down in the wound for new capillaries to grow.

With a spike of nail present, the wound can't heal.  The body reacts to this by trying to 'reject' the foreign object and produces more granulation tissue, until there is 'hypergranulation' tissue. 

This is a lump which rises above the level of the surrounding skin.  It isn't painful itself, but it does bleed very easily due to the number of blood vessels present.  This is the stage when people usually seek help as looks quite alarming in addition to the pain.

Your GP will often prescribe antibiotics for this, which will help if there is a bacterial infection present, but will not resolve the problem. The only way to 'cure' the ingrown toenail is to have the spike removed.

This is not as painful as it sounds, even if the toe is very sore. An experienced podiatrist can resolve the problem in a matter of minutes, once the location of the spike has been found.

Once the spike has been removed, relief is immediate. The hypergranulation tissue will usually shrink back within hours and the toe will heal completely within days. 

A very easy resolution to a very painful condition!

Incidentally, the medical term for an ingrown toenail is 'onychocryptosis'. A very suitable name for a condition which is crippling.

So, if you think you have left a spike of nail when trimming your nails or have knocked your nail and think it may have split, hot foot it to your podiatrist who will sort you out in no time :)