Ingrown / Fungal Toenails

  • Causes Of Toenail Fungus

    Fungi thrive in warm, moist, dark places such as close-toed shoes. This is one of the most common causes of toenail fungus, however it is not the only. Fungal infection is the most common cause of yellow toenails; however rarely some other disease conditions can also cause yellow toenails. Some of these conditions are psoriasis, jaundice, paronychia, lymphedema, bronchiectasis and tuberculosis. However, with these other conditions, usually there will be other symptoms also typically including the discoloration of the fingernails.

    If a fungus is the cause of your discolored or thick toenails you may notice have streaks of discoloration and the nail may appear more brittle. If you’re unable to scrape off the yellow color with a nail file, chances are you’ll dealing with a fungus. Some toenail polishes can turn nails yellow.

    If your feet are exposed to warm and moist public places such as locker rooms you are at higher risk for fungal nail infection. Fungi thrive in these warm, moist environments and even your footwear can cause this environment that fungi love. Your risk also increases when your feet are kept in damp sweaty socks or not properly drying your feet. Wearing tight fitting shoes can also cause your feet to sweat. This can create the environment for fungi to grow and create thick yellow fungal toenails.

    How to Treat Fungal Toenails

    Because people are often inclined to hide their yellow or “ugly toenails” they keep them confined. This can make the problem worse by sealing in the fungus. If the fungal infection is allowed to continue untreated, you may end up losing the entire toenail. Additionally, the infection can spread to other people if you share towels or footwear. The best solution is to see your doctor for treatment. There are oral medicines and topical medicines that have traditionally been used to treat this condition.

    Over the counter topical medicines may be effective in some cases, however require long-term consistent use and many people do not have success with this treatment. With other more advanced cases some doctors may prescribe an oral medication. Many people cannot, or do not want to attempt the use of, the oral anti-fungal because it can cause elevated liver enzymes. Sometimes combined systemic and topical anti-fungal medications may also be prescribed. Usually prolonged treatment for up to 1 year may be required to cure a fungal toenail infection. As a result, many people are choosing the latest laser technology as their treatment for this condition.

    Have your fungal toenail(s) evaluated by the doctors who specialize in effectively treating this condition today. They will evaluate your condition and design a treatment plan specifically tailored to your case. Read our section about Treatment Options for more details.

    Prevention of Fungal Toenails

    The fungi causing yellow toenails require warm, moist and dark environment to grow. Wearing closed shoes for prolonged duration provide this ideal environment for the fungi to grow. Moreover, inadequate personal hygiene also makes one more susceptible to develop toenail fungal infection. Poor blood circulation in the feet and increased sweating also predisposes to toenail fungal infection.

    Therefore, preventing measures involve regular washing of the feet with soap and water and allowing them to become completely dry. Wearing shoes for prolonged duration should be avoided as much as possible. Feet should be completely dried before wearing closed footwear. Moisture absorbing socks are better to keep feet relatively dry, especially if one sweats more than usual. Toenails should be adequately trimmed. Regular exercising (walking, running, etc.) helps to improve blood circulation in feet and reduces chances of toenail fungal infection.

    • Wear Clean Dry Socks
    • Wear Breathable Footwear
    • Avoid Going Barefoot in Public and Damp Areas
    • Avoid Sharing Towels, Bathmats and Clothes if Someone Else has a Fungal Infection.
    • Clean and Dry Your Feet and Toes Daily.
    • Maintain Proper Foot and Toenail Hygiene.
  • Causes Of Ingrown Toenails

    In addition to improper toenail trimming, ingrown toenails are also  caused by shoe pressure from ill-fitting shoes, injury, fungal infection, heredity, or your natural foot structure. Ingrown toenails occur when the corners or sides of the toenail grow into the skin, often leading to infection. A common ailment, ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender; and if untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.

    Heredity – Many people have simply inherited the tendency of ingrown toenails.

    Injury – Stubbing your toe, dropping objects on your toes or repetitive movement under high pressure. If your shoes are rather tight fitting in the toe box for your foot structure and running or other activities cause repetitive movement this can contribute to the development of ingrown toenails.

    Nail Trimming – Perhaps the most common cause of ingrown toenails is improper toenail trimming. If nails are cut too short there is an increased likelihood nails will grow into the skin that surrounds the nail. Skin around the nail is raised in comparison to the nail and if cut to short this skin may encroach the area where the nail will grow into. As a result, the nail will grow into the skin.

    Footwear – Your running shoes may be too tight and may be cramping your toes. Many people sacrifice comfortable footwear for the sake of fashion. As a result, shoes with a narrow toe box may cram your toes into narrow places, put added pressure on your toes and lead to ingrown toenails, among other issues.

    Adolescent boys in particular are more prone to developing  ingrown toenails. They are growing so fast their shoes can become tight fitting quickly. This shoe pressure is often a causative factor in ingrown toenails.

    For children we use a combination of topical anesthetic and gentle electrical stimulation. The patient controls electrical stimulation themselves to help keep the nerves “busy” and the local anesthetic injection is administered. Younger patients benefit from this special technique. They are often very apprehensive about an injection, however with our techniques, the patient and their parents are often pleasantly surprised at how well they do.

    Other Conditions – Injury or trauma which lead to toenail loss can create a situation for ingrown toenails when the nail grows back in. Also fungal infections that cause changes in the nail can cause ingrown toenails.

  • Home Treatments For Ingrown Toenails

    Beware, bathroom surgeries often lead to infection.

    Do not attempt to remove infected nails on your own. If you notice an increase of swelling, pain or any discharge is present; the toenail is likely infected and should be treated by a podiatrist.

    Contact us if you are experiencing painful ingrown toenails, especially if you believe the condition worsening or you have diabetes or circulation issues. Addressing this condition early will help in the prevention of infection and other complications. Ingrown toenails can be very painful and can be treated easily depending upon the severity.

  • Ingrown Toenail Prevention

    Here are a few tips from Dr. Brandon Nelson and Dr. Timothy Young from Issaquah Foot and Ankle Specialists:

    Choose appropriate footwear – If you are active and participate in sports select footwear designed for that specific type of activity. A toe box appropriate for your foot structure is important preventing ingrown toenails and other injuries. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for running should have plenty of room also, but not be too loose.

    Check your toes – Ingrown toenails can often be avoided if you take care of your feet. Take a moment to examine your feet and look for signs of ingrown toenails. If you notice any red, swollen and painful areas of your toes near your nail you should have it evaluated.

    527998-R1-17-18A_018 by mattzor, on FlickrPerfect your cuts – When trimming nails be conscious of how short and curved you trim your nails. The more skin exposed the greater the opportunity the nail has to regrow into the skin. Always use a clean, sharp nail trimmer. When trimming your toenails consider briefly soaking your foot in warm water to soften the nail. Trim toenails straight across the top, do not taper or round the corners or trim too short. Never pick at or tear your nails.
    False relief – Topical medications that are available can relieve temporarily relieve the pain associated with an ingrown toenail. However this only masks the pain and the issue will continue to worsen.
    Avoid bathroom surgery – visit our ingrown toenail home treatmentssection for more information about these complications.
  • Ingrown Toenail Surgery

    Ingrown toenail surgery is a simple out patient procedure that is fairly quick with minimal pain. Steps can be taken to minimize the pain and in our office some techniques provide virtually eliminate pain. We use a nerve stimulation device that the patient controls the electrical stimulation themselves to help keep the nerves “busy” and a local anesthetic injection is administered. Moments after the injection the area is numbed and patients typically report only dull pain if any during the procedure to remove the ingrown nail.

    Patients may experience some discomfort after the procedure however this will depend upon the severity of the condition. Many people report pain is not noticeable after the procedure unless there is direct contact with the area like stubbing their toe. The images on the left show a local injection of a numbing agent that can be used to dull the sensation of the procedure. A section of the nail is removed and the toe was bandaged to prevent infection and provide some cushioning. The final image is after the bandage was removed.


    Injecting the anesthesia. by TheGirlsNY, on Flickr Had unexpected toe surgery today. Owie! by TheGirlsNY, on Flickr

    Partial removal of the toenail may only temporarily cure the problem and the nail can grow back again.  To prevent regrowth of that section of nail that caused the issue, part of the nail bed is destroyed using a chemical agent to prevent regrowth. This procedure is called a partial matrixectomy. A section is excised and the nail matix for that section is treated so a small section of nail will not regrow in the same area of the original issue. The skin that once lay under the nail will appear raw until it changes to resemble the skin that lay next to the nail.

    The actual surgical procedure is relatively quick and numbing agents minimize discomfort. Recovery times will vary based on the extent of the condition and course of treatment. Most patients can resume their normal activities withing two to three days post surgery.