Ingrown Toenail and Runners

0

Ingrown toenails can be treated, don’t tolerate the pain and unwanted discomfort, read this article and take action.

Only runners are aware of the damage that some common running injuries can cause them during intensive training programs. Achilles tendon pain, plantar fasciitis, and IT-band issues are some common running injuries that can mess up with your overall program and running plans. While these are often the most popular and known ones, one major source of running injury is often ignored: the ingrown toenail or the jogger’s toe.

Runners who tend to overlook their toenails and its sensitivity may develop this painful condition. Just like any other serious running injury, an ingrown nail can also destroy your training plan and/or programs. Unfortunately, even runners are not aware of how severe this could become from running. It does not only have the capability of affecting your running ability but can end up in excruciating pain and can be a devastating experience. If not taken care of in time, you may need professional help for treatment.

In this injury guide, you will find all the details about ingrown toenail and how to treat and prevent it from reoccurring. We will also tell you about the symptoms, treatment, and other tips that would help you restart your running routine in no time.

Ingrown Toenails Defined

Also known as Onychocryptosis, an ingrown toenail is a common condition that most runners experience in their career. It is a painful condition in which the toenail grows and curls into the sides of the skin or when the skin on the sides of the toenail grows and covers the edge of the nail. In both cases, the nail is in direct contact with the skin on its sides. A runner in this situation feels excruciating pain and discomfort in walking.

The skin on the sides of the toenail is actually soft flesh. When the nail grows into that flesh, it leads to redness, pain, swelling, and discomfort in walking. Forget running! In worst cases where proper care is not taken, the condition could also turn into an infection. The ingrown nail condition is most common with the big toe.

While an ingrown nail is a common condition, fortunately, in most cases, you can take care of it on your own. The key is to keep an eye and observe it. If the pain tends to worsen or the condition continues to spread, you might want to visit a doctor and get it checked. A professional medical representative can follow a treatment method to help relieve your pain, discomfort, and can help you with further complications related to this condition.

In case you have other medical conditions, such as diabetes (that does not allow easy flow of blood to your toe), the complications may increase and the condition could become even worse. When the nail breaks into the soft flesh, it gives away to the bacteria to enter and cause infection. The symptoms that your condition is turning into an infection include:

Ingrown Toenail Affecting Younger Males

The condition is often painful because it does not only damage the soft tissues around the nail but also breaches the underlying skin. As a result, the damaged tissues lead to granulation tissue formation, inflammation, and as stated above, infection. Other than the runners, the condition is also common in younger males. In a report, it was declared that around 20 percent of the patients with an ingrown nail is between 15 and 40 years of age.

Various extrinsic and intrinsic factors have been pondered over to find out the association between this age group and the toenail condition. However, the exact reason remains a debatable topic. The lack of research and quality evidence to support the mechanism behind this connection does not allow the researchers to reach a certain conclusion.

To date, there’s an ongoing debate about factors that are responsible for the development of this condition – with regards to the bacteria involved, the shape, size, and surrounding of the nail.

Ingrown Nail Symptoms

It’s not easy for a condition like this to go unnoticed. While the skin condition can be seen, the pain is enough to tell you something is wrong. However, in order to ensure you really have an ingrown toenail condition, the following symptoms can help you identify:

  • Tenderness
  • Pain in your toe along with the surrounding skin
  • Swelling of the skin surrounding your toenail
  • Visible redness in the outer skin
  • Tissue infection around the nail area

If you are experiencing all these symptoms, it is a clear sign that you have developed an ingrown, black toenail or a hammer toe.

Is It the Right Time to See a Doctor?

Now that you have identified the condition, the next question is if you should see a doctor immediately. There are home care treatments available for this condition. In case the symptoms are not severe and there is no other medical condition you are going through simultaneously, you might want to consider treating it at home first.

However, you should see a doctor for your ingrown toenail if:

  • You have a challenge or championship for running coming up and you do not have enough time to take care of it at home and wants to get it fixed as soon as possible. The doctor would guide you according to the severity of your condition and will treat it accordingly.
  • You are experiencing severe discomfort in walking and the condition seems to be spreading with time. The key is to keep a check and see if the condition is improving with time or not. In case it’s getting worse (you are noticing an increase in swelling, pain, and redness), then you might want to get it checked by a doctor.
  • You have other medical issues – such as diabetes. In such a case, conditions, even as minor as an ingrown toenail, can take a disastrous shift and can lead to a serious infection or sore foot.
  • You can see a weird curve in your nails that is growing towards the soft flesh on the sides of the nail. This is the alarming point where you can control the situation before it gets out of hand. This requires inspecting your nail when you feel any sort of discomfort.

Causes of Ingrown Nail

There are a number of causes that may lead to this condition. Some of them are more common than the others. One of the most evident reasons for developing this condition is the wrong footwear. It’s usually because of choosing ill-fitted shoes as a runner. Running by wearing ill-fitted shoes results in a situation where the sides and the top part around the nail remains under pressure.

The enclosed and damp atmosphere within the shoes can also lead to the condition. The dampness around the feet for long hours can soften the plate of the nail. As a result, the nail is turned towards the sides of the flesh. Consequently, you will notice an increase in both its impact and growth. Once the condition prevails, the nail continues to grow in a permanent convex arch that causes bacteria and infection.

Cutting nail in an improper way may also lead to the wrong growth of the nail. If the nail changes its growth angle, i.e. upwards or inwards depending on the cut, the nail could get in direct contact with the skin and may eventually rupture it. The effects of these may not be visible immediately but get more evident as the nail begins to grow. Therefore, it is important to cut and trim nails carefully, especially when using a sharp nail cutting tool.

There are a number of other reasons why one may experience the pain of onychocryptosis. Read on and find out if you are susceptible to any of these causes of the ingrown toenail condition.

  • Heredity – As unusual as it may sound, some people may only develop this condition because they have the tendency for it. They inherit such conditions and may face it at some point in their lives.
  • Picking up the wrong, ill-fitted pair of shoes. There are a number of problems that a wrong shoe could cause to your feet. Wearing the wrong type of shoe during the development stage can cause ingrown nail and other foot problems. If the nail is permanently curled because of the shoe, it is likely to dig into the skin as it continues to grow. Whether the shoe is too short or too narrow, a toed shoe that doesn’t fit well is definitely a major reason for an ingrown nail.
  • Lack of nail care is very common in our society. We hardly pay attention to the health and cleanliness of our nails. In addition to the incorrect trimming patterns, poor nail care can also lead to ingrown toenail problems. Moreover, breaking your toenail in a wrong pattern can also cause a change in its shape.
  • Trauma caused to your toe or the nail plate is another major reason you may experience this condition. This could happen if the toenail is stubbed or if anything heavy is dropped on your toe. What seems like a black toenail, in the beginning, may end up with an ingrown toenail symptom. For runners, specifically, this is a major cause of touching their toe or toenail to the end of the shoe may also cause the nail to curl and dig into the soft flesh. This is very common during vigorous activities, sports, and especially running. In the long run, this could damage the flesh and injure it. This may also cause the nail to grow irregularly and continuously pressed into the flesh.
  • A bacterial infection could also lead to this condition. When a nail is constantly affected by bacteria, it could change its patterns of growth as well as the quality of the nail. As a result, it could start growing sideways and interrupt with the flesh in the surroundings.
  • Predisposition, genetic susceptibility, and other nail deformities may also increase your chances of developing this toenail condition. Predisposition could be anything from nail beds that are naturally abnormally shaped toe nails growing in a weird direction for no reason. Any of these reasons could lead to ingrown toenail without any external pressure from a shoe.
  • To your surprise, obesity and diabetes are two common reasons that can cause you toenail These medical conditions are known for messing up the natural mechanism and hormonal control of the body. When the body undergoes such changes, it could also have an impact on your nail health.
  • Similarly, renal disorders, cardiac, and thyroid can also cause ingrown toenails.
  • Certain medication (for other treatments) could also mess up the health of your nails and hair. Oral antifungals, retinoids, docetaxel, and ciclosporin are some medicines that have shown an adverse effect on the health of nails and hair.
  • Last but not the least, injuring your toenail can also cause you the toenail problem in the long run.

Risks/Complications Associated with this Condition

If left undetected or untreated, an ingrown toenail can cause serious infection and can even affect the bone. If it’s still ignored, the complications may increase and could infect the bone as well.

The complications tend to double if you have severe diabetes. The condition is known for affecting the blood flow in your body. Low blood flow to the feet can also damage the nerves. This suggests that even a minor foot injury – callus, corn, scrape, cut, or an ingrown nail – may get infected and worse and do not heal at all.

An open sore with very little chance of healing could require immediate medical attention and surgery for ingrown nail treatment. Surgery is carried out to save the foot from the death of tissue and decay.

In a case where you are experiencing complications and severity of the condition, it is best to see a doctor and not try to treat the condition on your own. Your doctors will diagnose the condition based on a physical examination as well as your symptoms and will suggest a treatment accordingly.

Ingrown Toenail Stages

Each stage of the ingrown toenail is associated with clinical features. So before we jump to the treatment for the condition, it is important that you are aware of these stages to find out if you need home-based treatment or if you need to seek help from a professional medical practitioner.

Stage 1 – Mild

Mild oedema, erythema, and pain. This is what you will experience as you start noticing the symptoms of the condition. The pain tends to get worse as more and more pressure is applied – especially while walking and running. The lateral nail fold may even lead to drainage or pus when under pressure.

Stage 2 – Moderate

There’s an increase in the erythema, pain, and oedema. At this point, the pain could become worse and can definitely lead to yellow or while colored drainage and pus from the infected area. The nail fold in the lateral part also becomes more evident. It is also easy to see more swelling and redness around the nail border.

If you pay more attention to see the changes in your toenail, you can even see the curved nail tearing the flesh on the corner and infecting the area.

Usually, the pain gets worse at this stage.

Stage 3 – Severe

There is no way you can ignore this condition once it reaches this stage. In fact, it’s the ignorance that leads to the patient experiencing this severe stage of an ingrown nail. The erythema, pain, and oedema become severe and there’s an evident formation of the granulation tissue that could further lead to more infection and the formation of pus.

The drainage and pus could become severe too and the pain at this point becomes unbearable. The sidewalls of the toenail are evidently swollen and the redness speaks of the pain the patient is in. There are also marks of blood further making the condition prominent.

It becomes highly difficult to wear shoes – especially the closed ones as it leads to severe pain and drainage. This is the stage where treating the symptoms could become almost impossible. It is now time to see a doctor find out more about the recommended ingrown nail treatment.

Treatment

Fortunately, in most cases, an ingrown nail can be treated at home. However, we are referring to the initial treatment without any complications. The treatment can be safely carried out at home. However, in cases where complications are evident, it is strongly discouraged to perform any home-based treatment.

One should also avoid home-based treatment if there’s an infection or if you have other medical condition that makes you more susceptible to high risk.

Home-Based Treatment

If you are sure about taking care of your ingrown toenail at home, there are a few things you can do to relieve the pain and condition.

  1. First and foremost, keep up with the hygiene of your feet. Make sure they are clean at all times. Always wear clean socks and clean shoes that are not damp from inside. Also, make sure your shoes are not ill-fitted. Also, check if your shoes are not putting a pressure on your nail from inside.
  2. Heat water and soak your foot for 15-20 minutes. It might hurt in the beginning but will eventually help you feel better. Use a little cotton and transform it into a ball. Place it under the corner of the nail. Repeat this until you see improvement.
  3. Put an anti-septic cream around the infected area and massage gently using the tip of your fingers. This would help keep inflammation at bay.
  4. Do not trim your nail often. This is also referred to as ‘bathroom surgery. Constantly cutting your nail can worsen the condition with time.
  5. You can also try soaking your feet in water (at room temperature) with some ‘Epsom’s Salt’ if recommended by your doctor.

Keeping your feet clean and away from wrong shoes is like winning half the battle. If you can keep a check on your personal hygiene and repeat the steps mentioned above, you will see improvement in your condition in no time. In case there’s no improvement – or if the condition seems to get worse – see your doctor immediately.

Medical Treatment

First and foremost, a medical practitioner will first carry out a physical examination on your toe. It is ideal if you consult a specialist or an ankle surgeon for the treatment. After the examination has been carried out, the surgeon will advise you and suggest the most suitable treatment for you.

Initial treatment by the medical practitioner

  • Your doctor will initially prescribe you antibiotics for the condition. This is to control the symptoms and to give you some relief from the pain. However, the underlying cause of the condition still prevails. Thus, the antibiotics are the first step to clear the infection and provide the necessary relief to the toenail. This also helps in treating the infection so that the nail does not get worse after the surgery is carried out.
  • A specialized Podiatrist can help in removing the spike or the corner of the nail that has ruptured the skin. This procedure can be a little painful. In case the infected area is too painful, the procedure may become too difficult to handle. Therefore, a local anesthetic may be required for this. The ingrown nail is first removed so that further treatment can be carried out to remove the infection.
  • Once these two things are done, the doctor may suggest dressing your toe with antiseptic. This would further help with clearing up the infected area. The dressings are done together with the dosage of antibiotics to heal the problem from its root cause. Diabetic patients may be dealt differently by the doctors as all medicines are not suitable for their medical condition.
  • In some cases, the pain continues to persist even after all these procedures are carried out. This could be due to some other spike or an ingrown toenail that is located deeper. This would require further treatment.

Surgical Treatment by the Medical Practitioner

  • If the ingrown nail is severely infected, then oral treatments may not be effective enough. Moreover, sometimes even if the infection is not bad, conservative care is not enough for the condition. This is when the doctors suggest a surgical intervention, which is the requirement of the time. The surgery is minor and is relatively simpler. The results are also beneficial and offer permanent relief in most cases.
  • A podiatrist may suggest different surgical procedures to treat the ingrown nail. Since the patient is already going through a lot of pain, the procedure is carried out under the impact of local anesthesia.
  • In majority cases, the doctors carry out the procedure of removing the part of the nail that is the root cause of the problem. In worst cases, when the symptoms of an ingrown toenail are ignored, the surgery may remove the whole nail.
  • Whether the doctor removes a part or the entire nail, the flesh is soon covered by another nail as the growing cells are still present there. It is very rare that the doctors may feel the need to remove those cells too – if they are badly infected too. In case it’s the requirement of the surgery, an acid is used for damaging the growth cells permanently.
  • Once the surgery is complete, the patient may need to keep the foot elevated. The doctors also suggest rest for the healing period. You can continue to walk the following day. However, it is still not advisable to start running or participating in vigorous activities for at least two weeks. It is also recommended to use a shoe with an open toe so there’s no dampness or pressure applied to the affected area. This also helps with facilitating healing.

Myths and Realities about the Treatment

As far as the home treatment is concerned, there are some myths and truths that you need to know to be able to make the most out of your home-based treatment. Keep reading!

  1. Cutting a “V” shaped notch in the nail will minimize the tendency for the nail to bend or curve in a downward direction.

Reality: It does not make any difference to the direction the nail grows in. In fact, chopping down the nail will further make the condition worse.

  1. Trimming the nail regularly is the best way to keep the borders in place. This would treat the ingrown toenail naturally.

Reality: Trimming is not right when you have the symptoms of an ingrown toenail. It can cause bacteria and the infection to spread if you continuously keep trimming the nail. Moreover, repeated nail trimming can even mess up the future growth of the nail and can make it worse.

  1. There are effective drugs available for treating the condition over the counter. You do not need doctor’s permission for treating something so minor.

Reality: Topical or oral medications available over the counter may offer relief from the pain on a temporary basis. They are never enough as a treatment or for addressing the root problem causing the condition.

Prevention and Nail Cutting Advice

As mentioned earlier, it is highly important to take care of your nail hygiene and ensure that the nails are trimmed properly to avoid ingrown nail. Therefore, it is important to learn the right way to trim the nails to avoid the consequences. Ingrown nail is often taken lightly whereas the symptoms – when they go worse – could even lead to situations where nothing but surgery would help treat the condition.

Nails should always be cut straight across. It is never a good idea to use a nail cutting tool to curve the nail. While it is important to keep up with the shape of the nail, cutting it using the tool in that particular shape is not recommended.

It is highly advised to:

  • Cut the nail across straight or if you really have to curve it, use a gentle one. Do not cut too deep or close to the side corners of the nail. It is also recommended to use podiatry grade clippers for cutting thick and rough nails.
  • To give the right shape to the nails, use a nail file instead of a cutter. Clean the debris once you are done filing your nails down.
  • Keep yourself clean at all times and take special care of your nails, their health, and hygiene.

Conclusion

What seems like a common and minor problem can turn nasty and big in no time if not taken care of in time. It is not easy for ingrown nail symptoms to go unnoticed due to the pain and the shape they take once the area is infected. It is best to take care of the treatment at home as soon as you notice the first symptom – when the condition is still in its initial stage.

In case you figure out after the area is infected, it is best to see a doctor for further help. While there are several treatment methods, it is recommended that you follow the one prescribed by your doctor. It is also important that you only consult a specialist in this regard. While you can get your infection examined by a physician at first, the treatment should only be carried out by a specialized doctor only.

Take multiple opinions before opting for surgery. It is always better to be safe than sorry. Keep up with the hygiene of your nails and make sure you observe their growth if you feel any sort of pain. Also, make sure you are using the right shoes that do not implement any sort of pressure on the nail bed.

Once you are done with the treatment, make sure you follow the doctor’s instructions and rest accordingly. As a runner, you are already more susceptible to the condition. Therefore, it is best that you do not participate in any vigorous activities or running until the condition is completely healed.

Always seek medical advice before trying any information. While citing credible references, each person is unique and may have special needs requiring a healthcare provider. Please use this information as only one source.

Sources

  1. American College of Foot & Angle Surgeons, Patient Education: Ingrown Toenail, Nov 17, 2018
  2. American College of Foot & Angle Surgeons, Ingrown Toenail, Nov 17, 2018
  3. California Correctional Health Care Services, Patient Education: Ingrown Toenail - Care & Prevention,
  4. The American College of Foot & Ankle Orthopedics & Medicine, Ingrown Toenail, Nov 17, 2018
  5. Jordan D. Metzl, Ingrown Toenails: How to Treat and Prevent Them, Apr 12, 2016
  6. Henry Chapeskie, Ingrown toenail or overgrown toe skin?, Nov 17, 2018
  7. NHS Choices, Ingrown toenail, Dec 01, 2016
  8. Web MD, Ingrown Toenail - Topic Overview, Nov 17, 2018
  9. Diana Rodriguez, 10 Ways to Treat Ingrown Toenails, Nov 17, 2018
  10. Jeff Herman, How to Cut Out an Ingrown Toenail Edge, Nov 17, 2018