By Paul M. Dake, M.D.
Q: I have an ingrown toenail on my big toe, which has required minor surgery three times over the last few years. Is there a way to keep this from coming back again?
A: About one-fifth of individuals with foot problems have an ingrown toenail. Risk factors for ingrown toenails include genetics (if a sibling or one or both of your parents have had this problem, it makes it much more likely that you will as well), improper trimming of the nails, repetitive trauma to the area (such as recurrent stubbing of the end of the toe), and poor foot hygiene (not washing the feet or trimming the nails – the latter causes them to get hooked on one’s socks, tearing the nail loose from the nail bed, resulting in infection). Also, footwear that is too narrow at the toe portion of the shoe, being obese, and having any medical condition that results in persistent swelling of the feet increases risk, due to persistent pressure on the sides of the toes.
The usual reason that a treated ingrown toenail comes back is that the matrix, that portion of the nail under the cuticle from which the nail grows, is not completely destroyed, with either a chemical or electrocautery, and the nail grows back over the following 6-12 months.
Ingrown toenails can often be prevented by using tweezers to push a small ball of cotton beneath the offending corner of the nail, pushing the flesh down so that the growing nail can pass over the skin there instead of puncturing it. This is best done early, before pain, swelling, redness and infection can begin. In addition, toenails should be trimmed straight across, so that both corners of the nail just project past the skin on the tip of the toe, not trimmed in an arc like most fingernails are trimmed.
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