Toe Nail Problems

 Ingrowing Toenails

Ingrowing toe nails refer to the penetration into soft tissue of a spike, shoulder or serrated edge of nail, often the big toe nail.

Ingrowing toenails may be caused by improperly trimmed toenails, very curved edges of nails, shoe pressure or repeated trauma to the feet from normal activities.

Frequently, the pain is due to a corn or callus in the groove (or sulcus) of the toenail. Most cases will require conservative treatment, while others may need a minor surgical correction, which can be conducted using a local anesthetic.


Podiatry treatment should always be conservative initially.

Minor nail surgery maybe required. This involves partial removal of the nail and use of chemicals to prevent regrowth.

Advice on nail cutting, footwear and Biomechanics is often necessary.

Omega (involuted) Nail

This condition sees an increased curvature of the nail causing pressure into the skin around the edges of the nail. The skin is seldom broken or infected.

Probable causes include constriction from poor foot-wear or osteoarthritis in the distal part of the toe.

There is sometimes a large amount of hard skin under the edges of the nail .This can increase the pressure even more on the underlying skin and make the toes very painful.


This can include careful clipping and removal of the hard skin. Partial nail avulsion may be necessary.This removes the sides of the nail permanently so that the curved edges do not press into the skin.

Foot wear advice will be necessary together will Bio-mechanical assessment to prevent recurrence.

Thickened Nails

Toe nails can often present with an abnormal but uniform thickening of the nail plate.

This can occur following damage to the nail bed, either through physical trauma, infection, poor circulation or systemic disturbances (Dariers Disease for example).

Nail cutting can become more difficult and the thicker the nail becomes, the more likely it is that trauma will occur under the nail.


This can be very difficult, making prevention more important.

The podiatrist, using either a drill or nail file physically reduces your nail plate.

The source of trauma is established to remove the cause of thickened nails.

Footwear is examined to reduce likelihood of pain and further trauma.

Self-care needs to be undertaken to keep the nail as thin as possible. However if the initial cause is skin related such as Eczema then excellent improvement can be made with the correct podiatry treatment.

Fungal Infections

 Fungal nail infections are characterised by thickening, discoloration and separation of the front of the nail from the nail bed. In some cases the nail crumbles.

These infections tend to remain in the nail if they are not treated, and can infect the nail bed.


This will often involve reduction of affected nails and advice on appropriate antifungal medications.

Podiatry treatment should be in conjunction with any visible athletes foot.

Topical medications are used subsequent to the nail being cleared and thickness reduced.


Ram’s Horn Nails

This describes an uneven thickening of the nail plate which can develop into a deformity of the nail resembling a curved ‘ram’s horn’ shape. The nail will often also be a dark brown or yellow colour and have ridges along or across.

This condition is most common in the great toe as it is this area which is most prone to injury. The most common cause is a single major trauma such as stubbing the toe.

Trauma to one side of the nail bed can result in uneven production of cells which as the nail grows out causes it to curve.

However neglect and constant pressure from ill fitting shoes can also be a factor.


The podiatrist will reduce your nail manually with a drill or file which provides immediate relief.

Patient education is important as it is essential to keep the nail plate as short and thin as possible.

Footwear should be assessed to remove possible causative factors.



Older people and nail problems

Older people with poor circulation are prone to fragile or brittle nails. Many older people do not have the strength, flexibility, or eyesight to trim their nails, especially if the nails are deformed.

Warning signs

Any sudden changes in colour or shape of the nail, sign of infection, development of a freckle under the nail, or pain should be discussed with your podiatrist. Your podiatrist can diagnose the problem and then recommend an appropriate treatment.

Your podiatrist

Regular visits to your podiatrist can help prevent foot problems, alleviate pain, and keep you on your feet and mobile.