Death and an Ingrown Toenail

Ingrown Toenails: Myth or Fact?

Death and an ingrown toenail is a pretty alarming headline - toenails are part of a comedian's tool kit, yes? NO. This is a true story, and the moral of the tale is to treat an ingrown nail with respect as you would any wound. All wounds should not be considered minor.

The myths and facts surrounding ingrown toenails were perfectly encapsulated when actor Mark Wahlberg described his own experience on USA national TV with Ellen DeGeneres. This was obviously that sort of condition that was going to achieve a ‘high yuck factor’!

Wahlberg, who had flown in for the interview with his nail problem and was asked by DeGeneres,

‘Are you shot up with pain stuff?’

He responds, ‘It’s worn off now!’ ‘So now you are feeling it?’‘ I’m feeling it,’ he replies to an audience packed with excited ladies.‘The energy, however, is helping him, he explains to DeGeneres.

Publicity and the nail are bedfellows, often for the wrong reason—the blunt, if not misinformed, joke is a reference to disability.

Death and the Ingrown Toenail Story

Perhaps ingrown toenails share a similar comedic fate as bunions. However, I have had an ingrown toenail, albeit mild compared to many of my patients. I do know the inconvenience and discomfort are far from funny.

While training, I was informed by one lecturer that you could, in fact, die from an ingrowing toenail. This was stretching the truth by more than a mile. The only way you can die from such a condition is IF you develop a rapidly spreading infection through cellulitis and septicaemia. Sadly, this did, in fact, happen to a 17-year-old male when the local casualty officer in Australia failed to see that his patient had an ingrown toenail. The boy, barely into adulthood with much to live for, died.

Those with poor immunity are at the most significant risk and include patients being treated with powerful drugs to suppress cancer cells. We are reminded that immunity is about having sufficient specialist defence cells to ward off disease. Clinical experience and ignorance are also described in my link to CRPS – where the patient, this time in the UK, had an ingrown toenail and ended up with a leg amputation!

Naming the beast

The ingrown toenail has a number of names. Ingrown toenails are the most common and suggest that part of their origin is growing into the flesh. If you are playing Scrabble or want to impress others, you could say I have an onychocryptosis(on-ee-koh-kryp-toh-sis). IGTN for ingrowing toenails is the shorthand version we in the health care professions like to use.

The problem here is that IGTN has many appearances. Check out my article on IGTN on this site.

In the hands, we see the ‘Whitlow’; the skin on one or other side of the nail bed is inflamed and painful. A small amount of white discharge (pus) may be visible. I will leave the NHS website to explain the origins of Whitlow, which can form something similar, but also has other origins.

Paronychia refers to the inflamed skin around the nail (Fig.1), found on both the toe and finger, and Whitlow adds a name to provide further confusion.

Fig. 1. Pain from an ingrown toenail – classic presentation: sometimes, both edges appear red and will bleed.

Avoiding pain

You should not experience more pain than needed, as you would expect from dental treatment. If the clinician is unable to provide an anaesthetic, then ask to see someone who can provide this service.

Only registered people trained as podiatrists or medically qualified people can provide local anaesthetics. All registered podiatrists have been trained in using local anaesthetics since 1988.

Pain is the giveaway, tenderness to touch. The red, swollen component shows that it will not improve without treatment. A discharge implies the damage is increasing. The lack of healing is then demonstrated by the appearance of the cherry-red bulge. The more prominent the bulge, the greater the chronic state.

Chronic is our medical language, which means over time, nothing improves, and the conditions smoulder without improvement. The cherry-red bulge is known as hypergranulation.

Adolescent boys and girls experience similar occurrences, as both carry out similar activities and wear trainers a good deal of the time. Boys do have the additional unpleasant odour called bromidrosis or pongy feet more frequently than girls. The smell that arises comes from the bacteria living within the sweat and producing chemicals that form the smell. Fresh sweat on the skin does not smell.

Antibiotics do not cure ingrown nails, but provide a temporary fix if infected

At the first sign of inflammation, use a sterile plaster and cover the skin and nail for 24-48 hours. If inflammation spreads or the toe swells, seek help.

My book on foot health myths covers many such conditions as the one in this story. available from Amazon Books.

Thanks for reading ‘Can an Ingrown Toenail Kill’ by David R. Tollafield 

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