Having an ingrown toenail can be a very painful experience, that can make everyday activities like wearing any shoes, playing sports, or being just overall active extremely painful due to the toenail causing extreme pressure on the skin and tissue of your toe, or actually breaking the skin, and growing into your toe itself.
Even with ingrown toenail surgery being done, if certain things aren't taken into consideration by you and your foot doctor, the ingrown toenail could still come back. This obviously can be very frustrating, if you've gone through the process of having this procedure done, for it to not work. Here are 5 reasons why your ingrown toenail keeps coming back.
5 Reasons Why Your Ingrown Toenail Keeps Coming Back
1. You're trimming your nails incorrectly
Trimming your nails incorrectly is one reason why your ingrown toenail could be coming back. There is a proper way to trim your nails to lower the risk of getting an ingrown.
Your goal when trimming your nail is to trim either straight across with a nail clipper or with a very slight curve. File the corners with an emory board or glas file to smooth the edges.
Do not over round the corners of your nails, or trim your nails in a U or V shape. Also, do not trim your nails too short. These are surefire ways to set yourself up for an ingrown toenail.
2. Your shoes are too tight
Many types of shoes that are worn nowadays have a very narrow or tapered toebox, that comes to a point at the front. These styles of shoes cause pressure on your toenails and squeeze your toes against each other, and inside the shoe, which over time can increase your risk of developing an ingrown toenail.
To keep your ingrown toenail from coming back, take a good look at your shoes. Is the toe box narrow/tapered or rounded like your foot shape? Your shoes should have a rounded toebox in order for your toes to spread as they should when standing or walking.
3. You are picking at the skin around your toenails
Picking at the skin around your toenails, in an attempt to get rid of dry, rough, callused skin, or just as a habit will increase your risk of developing an ingrown toenail.
If you are dealing with dry, calloused, or rough skin around your toenails, using a pumice stone, or increasing how much you moisturize your feet can help with this.
4. If you had ingrown toenail surgery, the root of the nail wasn't burned
The medical term for ingrown toenail surgery is called partial nail avulsion or PNA. When the nail root is burned with a chemical during this procedure, this is known as a partial nail avulsion with matrixectomy.
The majority of the time when a partial nail avulsion or ingrown toenail surgery is done, the root is burned (matrixectomy) so that that corner never comes back. The nail looks normal, and within weeks this area will be covered with skin. Without a chemical being used, the majority of ingrown nails, even if removed surgically, will come back ingrown again.
As a foot doctor, for the majority of my patients, I recommend the chemical destruction or burning of the nail root. The only time I usually don't burn the nail root during a partial nail avulsion is if there is an infection. This is because if the ingrown toenail is infected, the chemical used in a matrixectomy to burn the root will not work properly, leading to the nail growing back in broken, jagged, and in pieces, and the procedure will have to be repeated anyway.
So for these patients, the first partial nail avulsion will be to remove the ingrown toenail and to control the infection. Once the infection is gone, I have the patient come back in several weeks to have a repeat procedure, but this time the chemical is used to burn the nail root and to prevent the ingrown nail from coming back.
5. If you had ingrown toenail surgery where Phenol was used, you could be resistant to it.
The two most common chemicals used for ingrown toenail surgery are Phenol and sodium hydroxide or NaOH. There is no "wrong" chemical to use for this procedure, but people can respond to each chemical differently depending on their age, any health issues, and other reasons.
Phenol typically is gentler on the surrounding skin when it comes to ingrown toenail surgery, and for this reason, phenol is more commonly used to burn the nail root and prevent an ingrown toenail from coming back. The healing process is typically easier with Phenol, there is less redness, swelling, drainage, and pain.
Even though Phenol in partial nail avulsion with chemical matrixectomy has many benefits, there are some downsides as well:
Phenol is light-sensitive
Phenol when exposed to light, weakens this chemical over time. When it is used in a partial nail avulsion, it will not work, and your ingrown toenail will keep coming back.
Phenol should always be stored in a dark container, in a cabinet, away from any light, and only exposed to light once it's ready to be used during this procedure
Some people are more resistant to Phenol
Even if the phenol is stored properly, and the partial nail avulsion is performed correctly, some people simply just do not respond to Phenol. This is another reason why your ingrown toenail keeps coming back.
If your ingrown toenail keeps coming back after surgery, it's worth it to have this procedure done again but with a different chemical, sodium hydroxide. Sodium Hydroxide or NaOH is a more aggressive chemical than Phenol. This can lead to a slightly longer healing and recovery period, but going to a doctor who uses sodium hydroxide in their ingrown toenail surgery lowers your risk of the ingrown coming back close to 0.
Sodium hydroxide is the chemical I use for ingrown toenail removal at my office, Direct Podiatry Arizona.
When your ingrown toenail keeps coming back, it can be very distressing. From changing how you are trimming your nails, changing your shoes, or repeating the surgery to get rid of the ingrown toenail for good, there are several options you have to deal with this and get rid of your ingrown toenail for good.
Schedule Your Appointment At Direct Podiatry Arizona
Are you looking for a doctor to perform ingrown toenail removal in Phoenix? My name is Dr. Tarr, and I own Direct Podiatry Arizona in Tempe. To view my available appointment times, click here.