Involuted Nails

Lately in clinic, I have been hearing a lot of concerns regarding painful nails, sometimes accompanied by red, hot and swollen surrounding skin, OUCH! The type of nails that just don’t seem to know where to grow and patients are completely bewildered as to what they have done to deserve this?!

These types of nails are often referred to as involuted or if you’re experiencing the worst type, INGROWN.
Ingrown vs involuted is quite simple. Involuted refers to a nail shape that as it grows, changes shape encroaching on the surrounding skin causing pain. Involuted nails can have varying degrees of pain and curvature in the plates shape. 
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An ingrown nail is one that has surpassed this and is now cutting into the skin, commonly causing infection or the skin to hypertrophy (increase in size) and envelop the nail plate. These are incredibly painful and can stop you from doing what enjoy such as playing sport or performing the worm on the dance floor, pain free.
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​What causes this stubborn issue?!
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Usually there are multiple factors contributing to your nails misbehaving in this way. Until you discuss what you and your feet have been up to with your Podiatrist, it may be hard to put your finger (or toe) on it.

It is all good and well addressing symptoms of pain much like any other problem in the body, however, until you 'nail' the cause, this can stick with you for many new shoes, netball games, trail runs or whatever it's stopping  you from doing.

The main causes include (some more common than others)

• Genetic predisposition
• Trauma to the nail
• Posture of the foot
• Biomechanics of the foot in movement
• Foot deformity e.g. bunions and clawed toes
• Poor cutting technique or picking nails
• Poor fitting shoes and or hosiery
• Sweating
• Brittle/weak nails (this can be due to things like diet or arterial insufficiency)
• Fungal infection
• Medications e.g. beta blockers; Isotretinoin

Who experiences these pesty nails?

Any one can have involuted or ingrown nails. Usually seen from the age of wearing footwear and consistent weightbearing, onwards e.g. walking and running around.
Anyone that is exposed to one, many or any of the above-mentioned causes is vulnerable to involuted or ingrown toenails!

How do we tame these naughty nails?

Let’s talk involuted…

1. Figure out why the shape is changing and address the cause e.g. correct the position of the toe as result of a bunion with the help of a prefabricated or custom-made orthotic device; or look at purchasing shoes with a more appropriately fitting toe box.
2. ​Correct the cutting technique. This may mean you will need to frequent a podiatrist so they can gradually correct your nail shape and direct the growth away from the site of pain.
3. Depending on the severity of the curvature of the nail, conservative cutting techniques that are pain free may be completely fine. However, if the nail is particularly curly and has been left for too long a portion of the nail may need to be removed under local anesthetic. 

 And of course, the nasty ingrown…
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1. If the toe is infected, you will need visit your GP for possible prescription of antibiotics. In the meantime, keep the toe incredibly clean, cleansing it with warm salty water twice a day. You will need to keep this dressed in clean and new materials.​
2. Do not try and cut any of the nail away, immediately visit your Podiatrist to have this addressed properly, cleanly and safely in order to save yourself any further complications! No pliers or scissors PLEASE...​
3. Nail surgery to remove a part or the entire nail under local anesthetic is the most likely, effective treatment for this depending on the severity. This is something your podiatrist will discuss with you in detail. It’s a very quick procedure and depending on how tough your tummy is you can even watch! However, if you’re uncomfortable with the idea of blood or anything slightly invasive your Podiatrist will make sure you feel completely at ease and we can have you laying down talking about how much fun you’re going to have when you have your normal toe back!

Depending on whether this is your first one or you’ve had this recurring problem for years, the main message I want you to take away from this blog, is there is hope and your toe/s will be looking and feeling great again before you know it!

Image 1 - http://dubaipodiatry.com/ingrown-toenail-dubai-podiatry-centre/
Image 2 - https://www.palmettostatepodiatry.com/ways-to-prevent-smelly-feet/
Image 3 - http://www.yourpodiatrist.com.au/condition/ingrown-toenails/ 
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Written by Anneliese Ball
Podiatrist at Health Associates
Working Monday and fortnightly Saturday

Anneliese Ball
Podiatrist
Anneliese is at Health Associates as a podiatrist working Monday and fortnightly Saturday.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.

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