Many people experience discomfort and hardness to the outside of the little toenail, and assume it is because of an ingrown toenail or a hang nail. They trim the nail back at this side, and maybe even have their doctor remove the side of the nail, but the problem seems to keep coming back. Why does this keep happening, and what can be done to fix it?
The truth of the matter is that the little toe nail rarely develops what can be traditionally considered an ingrown toenail, and any treatment designed to treat an ingrown nail will fail because the underlying problem, in most cases, is something completely different. A common thread in these situations is the shape of the little toe itself. Most people in this situation have little toes that are either contracted (crooked), rotate outward toward the outer side of the foot, or are both. As the toe skin on the outer side of the toe is thinner than the skin on the bottom, any prominence of the side against one’s shoe or rotation of this side towards the bottom exposes the skin on the side of the toe and nail to pressure it otherwise would not have to withstand. As a result, the toe skin next to the nail develops a callus to protect itself from such pressure. Since callus and nail tissue are virtually the same, it can be hard to distinguish this callus from the side of the nail, and it often is erroneously assumed this tissue is part of an ingrown toenail.
When one has an ingrown toenail procedure to remove the outer side of the little toenail, the only result is that there is now a broader space for the callus to spread, fooling people into thinking the ‘ingrown’ toenail has returned. What needs to be done to treat this condition permanently is something a little more elaborate. Simple solutions to reduce the outer pressure can be helpful for some, and can include wider and deeper shoes, padding to the outside of the toe (gel and elastic sleeve padding works nicely), or gentle regular filing of the callus that forms. For long term relief, the abnormal position of the toe must be corrected to reduce the pressure. This comes in the form of minor surgery, in which the toe contracture needs to be corrected, and any rotation needs to be reversed to bring the little toe back into a straighter position. These procedures heal relatively quickly, within a few weeks, and result in reversal of the abnormal callus and the pain that follows it. Some people have a condition along with this called a Tailor’s bunion, in which the bone below the base of the little toe is prominent towards the outside of the foot. This prominence has an effect on the position of the little toe, and in some cases needs to be corrected at the same time. While this leads to a little longer of a recovery period, the results are typically far better than if just addressing the toe itself when a Tailor’s bunion is present.
Because this condition is often misdiagnosed as an ingrown toenail, it is important one see a foot specialist, who will be better trained to recognize the structural factors that lead to its development and can treat it properly while avoiding nail procedures that won’t actually fix the problem.
Scott R. Kilberg DPM 