practically active

Ingrown toenails a hazard for diabetics

It's a pleasant thing to be young, and have 10 toes.

-- Robert Louis Stevenson

After my last column ran I received an email that I wanted to share:

"Dear Rosemary,

"Recently I had a rather severe ingrown toenail that needed treatment. Because of articles about your experience with an infection in your foot I got somewhat concerned about the possibility of an infection in that toe. So I went to my regular doctor and I was surprised that all he did was look at my toe, prescribe some antibiotics, then refer me to a foot doctor, where they X-rayed my toe, said all was fine and took care of my [ingrown] toenail.

"I just wanted to thank you for sharing that story because it prompted me to get to a doctor sooner [than] I might have."

As you can imagine, it makes me feel good that my cautionary tales have made a difference. And thankfully, this person's story had a happy ending.

I have had three ingrown nails on my big toes -- twice on one foot and once on the other. Each time I saw a doctor, and each time the toenail was removed. I had to soak it in Epsom salts once a day, and a vinegar and water solution once a day for a couple of weeks.

But just what is an ingrown toenail?

University of Arkansas for Medical Sciences' Dr. Ruth Thomas, an orthopaedic surgeon and director of the UAMS Center for Foot and Ankle Surgery, says that an ingrown toenail happens when the nail plate edge digs into the adjacent nail fold (soft tissue around the border of a nail) causing pain, inflammation and sometimes infection.

Common causes include:

• Wearing shoes with a tight toe box that puts pressure against the nail and the nail fold.

• Improper trimming, such as cutting the nail too short along the edges.

• Nail deformities like excessive curving or brittleness.

Treatment is directed at alleviating the pressure of the plate against the fold. Often it helps to soak the toe until the skin becomes soft. Follow with gently teasing the nail edge away from the fold using a cuticle pusher or nail file, then place cotton between the edge of the nail and the fold. Repeat daily until the edge finally grows out beyond the fold.

Thomas says sometimes it is necessary to remove the nail edge to eliminate the pressure, then "train" the edge as it grows out by pushing the fold away from the edge after every bath, to make sure the problem does not recur.

If the nail matrix, the part that produces the nail plate, is damaged, the developing nail may be discolored, pitted or split. As long as the matrix is not removed, the nail will grow back.

For people with recurring ingrown toenails, the answer can be removing the nail matrix by cutting it out or dissolving it with chemicals.

To avoid ingrown toenails, it is important to trim the end of the nail so that the edges of the nail plate on both sides extend past the nail fold. And don't wear tight shoes.

Since many diabetic patients have decreased sensation in their feet and don't feel the pain, they may not be aware a serious situation is developing. But an ingrown toenail can be the first step in developing an infection that leads eventually to a need for amputation.

Thomas recommends that diabetics with loss of sensation in their feet get assistance in trimming their toenails.

I still miss my little toe that was amputated last year because of an infection. The loss makes me treasure the nine I have left.

The bottom line is that all of us -- diabetic or not -- need to pay attention to our feet. As a body part, they are extreme workhorses.

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ActiveStyle on 09/12/2016