What runners need to know about ingrown toenails

The summer after my daughter was born (2012), I had some really painful swelling in my big toes. I blamed it on pregnancy. And then a friend, who happens to be a nurse in a podiatrist office, stopped over to see the baby. One look and she said, “Ingrown toenails. Get ’em removed.”

Could it really be that easy? I was not convinced, but I made an appointment to have them looked at. The doctor took one look and said, “Ingrown toenails. We can take care of this for you.” 45 minutes later, I had less pain, less toenail, and was on my way! I was impressed with how quick the procedure was, and a few years later, still impressed that I’ve not experienced that sort of pain since.

 Lacing of the shoe properly is critical as well to prevent shifting of the shoe forward and again jamming the toes into the end of the shoe. Shoes should not be laced too tight nor should they be laced too loose. Even compression of every lace segment should be performed prior to the running/walking activity to allow for even and comfortable snugness from the toe area to the ankle. Tightening the top two segments of laces is not the correct way to tie a shoe.

Running form really has no significant influence on ingrown toenails. The inherent shape of the toe and hence the toenail can indeed be the source of the ingrown toenail and is the hereditary segment that is sometimes a factor in the cause of the ingrown nails. Trauma can also be a cause of changes to the nail shape or thickness.

Ingrown toenails, however are not always painful. Ingrown toenails by definition means that the borders of the nails curve inward placing the patient at risk of the ingrown toenail abscess which is most often what patients and primary care physicians refer to as an “ingrown toenail”. Many of my patients have ingrown toenails by definition but have no symptoms and never have had symptoms. Aging can cause changes to circulation which also then affect the growth areas of nails and can cause nails to become more ingrown, deviated or thicker.

Run Oregon: If someone suspects they might have an ingrown toenail, what will their consultation visit be like, and what types of treatments might be discussed?

Dr. Peterson: Initially, evaluation of the ingrown toenail, its shape, severity, infection versus no infection, patient’s circulatory status and history of previous encounters and lack of response to current treatment is performed.

Treatment requires removal of a segment of nail or the entire nail to eliminate the underlying irritation much like removing a splinter solves the problem of splinter pain. Rarely are ingrown nails truly infected and most often they are abscesses only as the pain is too intense causing the patient to seek treatment well before a true infection occurs.

Simple removal of the spicule, removal of the offending nail border back to the root (avulsion), or permanent removal of the offending nail border with destruction of the root are the 3 options that are generally discussed. Foot soaks and antibiotic therapy can be considered, however the antibiotics are rarely necessary as  true infections are rarely present. Generally foot soaks and other forms of topical treatment rarely resolve the problem as well without removal of the offending nail border causing the chronic irritation.

Run Oregon: In your experience, how many people with ingrown toenails benefit from partial or full toenail removal?Dr. Peterson: EVERYONE!  You must remove the offending nail that is causing the irritation much like you must remove the splinter to stop the pain from a splinter.

Run Oregon: In your experience, do a lot of people know what’s going on or are most people surprised that it’s an ingrown toenail?  

Dr. Peterson:  Most people realize it is an ingrown nail due to the redness, swelling and pain. There are a few patients, however, and a few nail conditions that are sometimes misinterpreted as a corn or second toenail due to the shape of the toe especially in some of the smaller toes. A podiatric professional however can easily determine this at the time of the evaluation.

Run Oregon: What is important to ask, or be aware of, before deciding whether or not you should have toenails removed?

Dr. Peterson: “Will the removal be permanent?”

In some cases “What will it look like?” (Mainly a question the female patients ask.)

Nails removed without destruction of the growth area will regrow and rarely if not ever do the nails change their shape when they return thereby returning in the same ingrown shape as they were prior to removal.

“Do I need my entire nail removed?” Many times only the ingrown border need be removed to solve condition. This is discussed with the patient prior to performance of the procedure and should be well explained and understood prior to performance of any “permanent” procedure as once the root is destroyed there is no going back.

Run Oregon: How do you determine if you should do a partial or full removal? 

Dr. Peterson: Partial or full removal is based on the severity of the nail itself.  If only a border or both borders are curved and the remaining portion of the nail is relatively flat, only the borders need to be removed. If however the nail is so thickened or is so horseshoe-shaped that removal of the ingrown borders to resolve the problem would leave such a very small segment of nail remaining then the entire toenail should be removed. The remaining small fragment many times may cause sufficient pain just because there is not enough nail remaining to stabilize against the nail bed. This is determined by the physician in consultation with the patient.  This goes back to the “what is important to ask or be aware of…” question.

Rarely do patients need all 10 nails removed. That doesn’t mean, however, that very thick and painful toenails can’t occur in any toe.  Ingrown nails can occur from the big toe to the little toe.