Ingrown Toenails

  • By Judith Sullivan
  • 31 Mar, 2017
05 Feb, 2016

Causes, symptoms, treatment

Our feet are incredibly important. We use them to get around and, when any painful condition strikes, our movement is hindered. Unfortunately many people neglect the health of their feet and can succumb to painful feet conditions.  One of these are ingrown nails.

Ingrown Nails – what are they?

Ingrown toenails are caused by increasing pressure of an in-growth of the nail’s edge onto the skin of the toe. The breakage of the nail through the skin produces inflammation and causes discomfort. This discomfort is mild initially; however it can quickly become extremely painful as the inflammation progresses into an infection. Many people suffer from ingrown nails on a regular basis, as it becomes a recurring problem.

C ommon Causes

There are multiple causes of ingrown nails including the simple fact that one is trimming their nails improperly.  Athletes and sports enthusiasts are particularly prone to ingrown nails as they use their feet heavily whilst participating in sporting activities.  Another common reason is that many of us are wearing improper/uncomfortable footwear that can cause disru ption to our foot structure and can press uncomfortably on the toenails, therefore increasing the likelihood of ingrown nails.

Tight footwear, tights/stockings and socks can also push your toe flesh onto the nail so that it pierces the skin.  Also, if you sweat excessively or don’t rotate your footwear, this makes the skin moist and weak so that it is easily penetrated by the nail.

If you have brittle nails with sharp edges or are in the habit of breaking off bits of nail that are sticking out, you are also more likely to get an ingrown toenail.

Poor foot hygiene can introduce unwanted bacteria into your feet that can initiate infections or agitate mild infections into more severe inflammation.  When our feet sweat, it creates the perfect moist environment for bacterial growth. In addition to this, many people suffer from foot deformities such as abnormally long toes or congenital toe deformities.

Symptoms to look out for

Ingrown toenails have various telltale signs include redness and pain and swelling around the site. If the infection has progressed then you may also observe discharge such as yellow pus. Symptoms also vary from person to person as the infection may cause a range of other symptoms.  Often the signs are very limited, and one may only feel slight tenderness at the nail border when pressure is applied. Mild infections may clear up without treatment; however if the infection is recurring or has progressed into severe infection, then it is important to go and visit a qualified podiatrist.

Treatment  

Visit a podiatrist if you experience any:

  • Persistent pain in your toe from the ingrown nails
  • Symptoms of infection, especially if you have Diabetes or a poor immune system
  • Conditions that affect the nerves and/or feeling in your foot.

For those particularly prone to ingrown toenails from underlying problems such as poor gait, partial nail avulsion (PNA) may be recommended along with finding a more permanent solution to the underlying condition. This procedure is done under a local anaesthetic where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it re-growing in the corners. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings.

If you experience ingrown toenails that do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of your GP to prescribe antibiotics. But if you need urgent attention, you should contact a private podiatrist such as Betafeet Podiatry.

For more information visit:

http://www.scpod.org/foot-health/common-foot-problems/ingrowing-toenail/

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By Judith Sullivan 18 Jul, 2017
Andre was an associate podiatrist at Betafeet for five months.  His contributions to the practice were considerable.  Sadly we lost him to a higher professional and personal calling.

After a stellar educational background and career, Andre joined babylon Healthcare Services, UK based, with a view to helping them set up and deliver the first digital healthcare pilot services to the NHS.   Digital healthcare is a cluster of new and emerging applications and technologies that exploit digital, mobile and cloud platforms for treating and supporting patients. Digital Healthcare is being applied to a  wide range of social and health problems, ranging from monitoring patients in intensive care, general wards, in convalescence or at home – to helping doctors make better and more accurate diagnoses, improving drugs prescription and referral decisions for clinical treatment.

Rwanda then beckoned.

Since joining babylon Rwanda in April 2016, Andre has been instrumental in successfully setting up and launching Africa's fastest growing digital healthcare service.  According to Lindsey McConaghy, babylon's PR manager, 'Rwanda has a population of around 12 million but doctor numbers are in the hundreds. There’s an imbalance between supply and demand'.  

Digital Healthcare is not without its sceptics nor controversies - at what point do you let an app do the diagnosis?  Will GPs embrace technology in this way?

Here is Andre's report about his experiences in Rwanda:  

Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.

This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.

As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.

Now you are probably wondering what this has to do with podiatry?

Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.

As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.

The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.

How did all this lead me to Africa, I hear you say?

In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.

This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.

Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care. 

'Footnote'

It is with this experience I now look to move on to my next adventure focusing on Aboriginals and the utilisation of technology in the prevention of major non communicable disease such as diabetes.

Final comment from Reggie Simpson and Betafeet Podiatry

 We wish Andre the very best in his future and thank him for this interesting blog account.  We look forward to his next blog focused on his work with the Aboriginal population.  

By Judith Sullivan 12 Jun, 2017
By Reggie Simpson
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