Ingrown Toenails, and General Toenail Care.
Some notes from my experience: By Nurse Mark
Ingrown toenails are a common problem, affecting many Americans. At best they are painful, unsightly, and annoying, and at worst they can cause dangerous infections. Most commonly affected are the big toes.
Most problems can be prevented by careful trimming of the toenails themselves. Many people tend to trim toenails far too short. Commonly recommended toenail clippers make it easy to do this if they are not used with great care. I prefer to use a pair of large bandage scissors, as pictured here. (I have also had patients use EMT shears and even tinsnips with good success!) They are about 7 inches overall, and give great control when used for nail trimming. It is important to note that you should never try to cut hard, dry nails - they will splinter and break! Always soak nails to soften them before cutting, no matter what tool you use. A perfect time for nail trimming is immediately after a bath or soak in a spa or hot tub. (Which is a perfect reason for a nice, relaxing soak - in case you needed an "excuse" to pamper yourself!)
Toenails must always be trimmed straight across - never rounded to match the shape or curve of the end of the toe. To trim toenails with curved corners is an invitation to trouble! Here is a simple drawing to show what a healthy, nicely trimmed toenail might look like - notice that the corners are fairly square, and extend out nearly to the edge of the toe. They can be carefully filed a little bit round to keep them from being sharp and catching on things, and the toenail itself is just a little shorter than the edge of the toe, to keep it from wearing holes in socks.
Longer is better, in most cases. As you can see on this drawing, an end view of the toe, the nail should lie fairly flat on the toe - especially at the outer edges.
I often see toenails that have been trimmed 'way too short, and rounded - like this drawing: This is a toenail that is just begging to become ingrown - the corners are very round, and this nail is at great risk for curving downward into the toe, as shown in this end view drawing:
It is also trimmed back too far, and this makes the problem worse. This is likely to become a very painful toe!
So, what to do? How can painful ingrown toenails be corrected? Your podiatrist will likely want to have you coming in for visits and trimming frequently - that's how he stays in business! He may also recommend having the toenail removed, or surgically altered. This is a very serious business, and should only be considered as a very last resort - there are many potential complications to this procedure. It is possible to correct ingrown toenails yourself, at home. Once corrected, they are fairly easy to keep in good shape.
Start out by soaking your feet, in a solution of Epsom salts, for at least 15 to 20 minutes, or until the skin of your toes begins to "prune" and the nails have softened. This is a "must do" before any sort of care is done to toenails! Now, if a trimming is all that is needed, is the time to trim. If you are dealing with a toenail that has become ingrown, it should be soft enough to be flexible - this is the time to insert a small cotton "pledget" (this is just a small piece of cotton that has been rolled or twisted into a cylinder, about the size of a large grain of rice) under the corner or edge of the nail that is pressing into the flesh of your toe. This may be a little tender at first, but getting that nail up and out of there will soon have the toe feeling better! Here is what a toenail with cotton pledgets under both corners might look like and another drawing looking at the end of the toe to show how we want the corners to be elevated: This may take some time and patience to achieve, and you should probably plan on doing foot soaks and replacing the cotton at least twice or three times daily, especially at first, until the problem is corrected. This will persuade the toenail to grow straighter, and allow the tissues to heal where the ingrown portion has until now caused problems.
Now that you have the toenail elevated up and out of the flesh of your toe and feeling much better, it is time to concentrate on keeping this from happening again. The first thing to do is to let the toenail grow out! You want to be sure that you are trimming the toenail long, as is shown in this diagram: Note that the nail has been allowed to grow out to the very edge of the toe, which means that the corners simply cannot dig into the sides of the toe. This is the perfect length for "retraining" toenails to grow without curving into the toe. It is also, unfortunately, a perfect length for putting runs in stockings and holes in socks - so, why not go barefoot or in open-toe shoes or sandals as much as possible? Your feet will thank you for the "fresh air and sunshine treatment"! Once you have the toenail growing normally again, you will want to trim it back a little, as was shown in the first diagram. Just remember - longer is better - not too short, and keep those corners squared, not rounded. Never trim dry or hard toenails - soak them first to keep them from cracking or splintering! Besides, that foot soak just feels good doesn't it!
Now, what about some other common nail problems? Fungal growths can cause thickened, discolored, misshapen nails that can easily become ingrown. This can be corrected! Frequent foot soaks and careful trimming is a good start, keeping the feet dry and clean is imperative, and regular application of anti fungal and anti microbial Tea Tree Oil will quickly clear this unsightly problem up. Remember, if you must wear closed boots or shoes, there is fungus in them as well - you will re-introduce it each time you put on your footwear! Shoes and boots must be disinfected - there are sprays available for this, or you can simply leave your shoes and boots out in the fresh air and sunshine, opened up as completely as possible, and let Mother Nature disinfect them. Never wear the same pair of boots or shoes two days in a row! While you are at it, remember to spend as much time barefoot or in sandals as possible - fresh air and sunshine are the worst enemy of most fungus. Think now, where do mushrooms (fungus) grow? Where it is warm and moist and dark - just like the inside of your shoe!
If you have developed ingrown toenails and they have become infected - they will be reddened, painful and may discharge pus if they are infected - you will want to do your Epsom salts soaks 2 to 3 (or more) times daily, then dry the area with a clean cloth or tissue, and apply some 3% hydrogen peroxide (full strength). Let this bubble and work for a few minutes, dry well, and then apply Tea Tree Oil, which is antimicrobial. Then you can continue with the rest of the treatment to lift the offending part of the nail and reshape it, as outlined above. You may also want to take Garlic - it is nature's antibiotic - and of course, Bromelain is most useful in any infective process because it reduces pain, inflammation, and swelling and therefore promotes healing. Remember though, when used this way, Bromelain should be taken between meals. Taken with meals it functions as a digestive aid but is less effective as an anti-inflammatory analgesic.
Keeping your feet and nails in good shape also requires that the rest of you is in good shape - well nourished, and with a healthy immune system to allow you to resist infections by bacteria or fungus. Your program should include Maxi Multi multiple vitamins, Maxi Greens for phytonutrients and antioxidants, and if your immune system is compromised in any way, Dr. Myatt's immune formulas as set out in the Acute Immune Protocol. Regular exercise is important for maintaining good peripheral circulation, which is necessary for healthy nail growth. Some supplements to consider for improving circulation include Ginkgo Biloba and Niacin. Deficiencies of essential fatty acids can contribute to dry, hard nails - consider supplementing with Flax oil or Fish oil (Max-EPA) to ensure that you are getting enough Omega 3 EFA's in your diet. Consider also adding some gelatin to your diet - this can easily be added to your daily SuperShake and will help to strengthen nails as well as improving joint function.
Those of you who may be diabetic can benefit from all these recommendations as well - but you need to be extremely careful when working with your feet if you have any impairment to your circulation or to the sensation in your feet (this is know as "peripheral neuropathy" and can happen in poorly controlled diabetics.) In addition to the measures outlined in Dr. Myatt's discussion of Diabetes, you should strongly consider consulting with Dr. Myatt about your diabetes and how it may be affecting your feet and nails as well as your general health and other organ systems. Dr. Myatt has an enviable record of success in treating, and even curing diabetes.
Until next time,
Mark Ziemann RN