Jennifer Wong, PA-C with Advanced Dermatology PC, with tips on preventing and treating ingrown toenails

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Healthy Toenails? They’re About the Cut, Not the Look

Jennifer Wong, PA-C

Pain, tenderness, redness, and swelling around a toe are indicators of an ingrown toenail that requires immediate attention.

Ingrown toenails? It’s sometimes all about the cut, says certified physician assistant Jennifer M. Wong PA-C, of New York- and New Jersey-based Advanced Dermatology PC and the Center for Laser and Cosmetic Surgery.

“The temptation, especially among women, is to make toenails appear aesthetically pleasing for the pool, the beach, or stylish open-toed shoes by trimming them to follow the contour of the toe rather than cutting straight across. Oblique nail cuts may cause a corner or side of the toenail to begin growing into the flesh of the toe, oftentimes leading to swelling, severe discomfort, and – potentially – infection,” Wong warns. “Equally concerning is excessive nail trimming to achieve a certain ‘look.’”

Experts concur. Researchers writing in the journal Physical Biology suggest that “cutting the [toe]nail in a straight way, namely removing the slight curvature, and maintaining this profile over time should…improve [and prevent] an ingrown nail condition.” They also cite “beauty fanatics” whose constant trimming of toenails risks development of serious nail problems.

Meanwhile, authors of a 2019 article in American Family Physician (AFP) indicate “nail care habits” are among “contributory factors” for ingrown toenails, which “account for approximately 20 percent of [all] foot problems in primary care” and most often involve the big toe.

Wong also cites constrictive shoes and tight socks that squeeze nails; excessive foot sweating; repetitive toe trauma, which can occur during running or other sports; and genes that determine the shape and thickness of nails, as factors for developing onychocryptosis – the medical term for ingrown toenails.

Pain, tenderness, redness, and swelling around a toe are indicators of an ingrown toenail that requires immediate attention, Wong says. “If ignored long enough, an ingrown toenail may lead eventually to a skin infection and, perhaps later, to an infection of the bone.”

Neglect of the condition can prove especially severe for patients with diabetes, a disease that inhibits blood flow to the feet. “For a diabetic foot, even a minor problem, such as an ingrown nail at its earliest stage, may fail to heal properly and cause an infectious, open sore that could require surgery,” Wong warns.

Wong points to a recent prospective study, appearing in a 2020 edition of Dermatologic Surgery, which concludes that ingrown toenails are “effectively treated with nail braces with excellent outcomes, favorable patient satisfaction, and low recurrence rates.” An earlier report – in Baylor University Medical Center Proceedings – indicates bracing for ingrown toenails is a “safe, simple, and inexpensive treatment option that avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and allows the practice of daily activities.”

Nail braces are “medical devices,” composed of wire, plastic bands, or adhesive materials that are placed over the nail’s surface and used to exert tension on the nail, creating positive changes to the toe’s affected tissue – much like dental braces for straightening teeth. The nail braces are even effective in children, patients with diabetes, and cases of moderate infection, Wong says.

Of course, much can be done at home before an ingrown toenail gets out of control. Wong advises anyone who is experiencing toe discomfort, slight redness, or sensitivity associated with an ingrown toenail to try the following steps at home:

  • Soak the affected foot several times daily in warm water to which a small amount of Epsom salts has been added.
  • If not too painful a process, use cotton or a strip of dental floss to lift the offending nail corner gently off the skin. Apply rubbing alcohol or other disinfectant underneath the nail.
  • Place a bit of gauze between the nail and the point where the nail pierces the skin.
  • Dab the toe with an antibiotic and bandage it so that socks or shoes do not continually rub and irritate it.
  • Wear open-toed shoes or sandals during healing.
  • Repeat the process daily.

“Should the problem fail to improve within a few days or should pain and swelling worsen and area of redness expand, contact a physician or other appropriate, certified dermatologic professional,” Wong states. “If you are a patient with diabetes, don’t try this at home. Seek immediate medical advice.”

Meanwhile, Wong emphasizes prevention.

  • Wear comfortable shoes – not tight or pointed ones.
  • Use protective footwear when engaged in sports or work-related activities that can potentially injure toes and feet.
  • Keep nails to a moderate length. The search for the perfect toenail “look” may just lead to an ugly-appearing – and potentially dangerous -- ingrown nail.

“And regularly check the overall condition of your feet. They are too often ignored even though they are a critical component of a quality daily life,” Wong says.

Bio: Jennifer M. Wong, PA-C Physician Assistant. Ms. Wong has comprehensive experience in medical and cosmetic dermatology for all ages.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.

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