My Approach to Solving the Problem — “Ingrown Nail” or “Lateral Nail Fold Injury Caused by Nail Plate Deformation”
Updated: Sep 4
Many believe — and I've noticed this many times, not only among patients but also among quite a few of my colleagues — that to solve the problem of an ingrown nail once and for all, the nail must be completely removed from the growth zone, specifically at the edge of the lateral nail fold, exactly where it grows from.
Let me walk you through how I see this problem and the approach I offer my patients.
Before we get into the question of ingrown nail removal (I'm stating the problem so we don't lose our bearings):
First.
What do I look at?
The overall condition of the feet — starting with the toes: are there any deformities, do I find calluses on the toes or between them.
Then I move on to the sole — I'm interested in how the metatarsals function, whether there are protrusions of the metatarsal heads (this kind of deformity indicates that the front of the foot is constantly overloaded).
I also look for possible calluses on the heel and across the whole sole, because these areas of friction show how the foot works as a whole — that is, its biomechanical function.
Second.
The second stage doesn't always happen sequentially. Most often I carry it out in parallel with the first.
Taking the patient history — the most common question you'll hear in a podiatrist's office:
«What shoes do you wear most often?»
It's a worn-out question, honestly. I'm deeply convinced I won't get any constructive answer to it. So I buried the actual point of that question a long time ago.
If I need to find out where the foot “suffers” most — I approach it from a different angle.
What I'm interested in, first and foremost, is shoe size!
And this is where, for some reason, 90% of patients start to get confused. Why is that?
My conclusion from years of practice comes down to two things:
People genuinely have no idea how to choose shoes, or by what criteria.
People choose shoes based on style, trends, and fashion, and also by relying on “expert opinions” — bloggers, celebrities, and so on.
There's another option — dress code, but in that case, in my view, the person is knowingly trading away their health.
Although, honestly, that's plain hypocrisy: even with a dress code, you can get everything right with your clothing!
So when it comes to footwear — I only really engage with the two options listed above.
Footwear gives me an understanding of how the foot feels in motion.
Now, a series of key questions I ask when taking the patient history:
Have there been any injuries to the spine, hip, or ankle (sprains, bruises, ligament tears, fractures)?
The point is that any injury doesn't just bring changes to the foot's biomechanics — it directly affects the ankle joint, forcing the body to offload the injured leg and redistribute weight.
The person's overall state of health.
What conditions they have, how tissue nutrition and microcirculation in the feet are functioning, and what medications the person is taking.
This information matters because illnesses — especially bacterial and infectious ones — directly affect the nail's structure, growth, and deformation.
Everyday activity.
Type of work, hobbies — I need to understand how the feet are used day to day. The answers show what kind of load the nails are under and why they're deforming or growing in.
At-home care.
How the person cares for their nails, what tools they use, and how they trim the nail.
These answers give me the full picture — whether the care being given is correct or not.
Once all of the above has been established, my task is to convey the essence of the problem to the patient:
why it happened, and what processes will develop if nothing is done.
So that the patient trusts me, I explain the treatment plan — and why exactly I'll be working this way.
And so the patient understands everything, I say the plan out loud — honestly, more for myself. The patient just listens and asks questions, while I go through it as if explaining it “for them”.
So!
The important thing: getting the main point across to the patient.
The first appointment is always frightening — and rightly so!
The patient doesn't understand what's going to be done to them.
My job as a podiatrist is to reassure them. That's essentially what I do from morning to night.
In short: to remove the inflammation, you need to remove what's driving it.
In the case of an ingrown nail, that's the piece of nail injuring the lateral fold.
A nail with a gap under it, detached from the nail bed, undergoing lysis — it no longer has a connection to the skin.
That's the actual “splinter” that needs to be carefully cut away and removed.
That's how I explain it to the patient before I start working.
Imagine this: we've removed the source that was driving the inflammatory process.
At that moment the patient sighs with relief — not from the pain, but because it has finally let go.
That pain had been dragging on for weeks, months. It's constant pressure that wears on the mind and exhausts you.
The patient exhales, hoping this won't happen again.
And this is where it's important to make one thing clear: I've only removed the consequence — the splinter itself.
The cause remains — and it still needs to be dealt with.
Many people think that once the ingrown piece is removed, the toe is cured.
A big misconception!
At the first appointment, I explain that there are two problems:
Nail deformation.
The nail growing into the skin (the nail injuring the skin).
So the second stage addresses the nail deformation, in order to prevent it from growing in again.
This is where orthonyxia comes in — treating deformed nails with braces and correction plates.
This is the main stage — addressing the cause, changing the shape and growth direction of the nail.
The systems are fitted for one month at a time, since the nail keeps growing and the direction of growth and degree of lift need to be controlled.
I see that orthonyxia is offered in many beauty salons, advertised as:
«Treating ingrown nails with braces and plates.»
That's a misconception!
Braces and plates do not treat an ingrown nail!
The ingrown piece of nail is removed and discarded — it's already dead tissue! There's nothing to treat there!
So imagine: we've straightened the nail. What's next?
After that, I ask the patient not to fool themselves: if the nail deforms again or grows in again, that's not on me.
The podiatrist's job is to eliminate the injury and straighten the nail.
And most importantly — to explain and show what needs to be done for rehabilitation and to prevent it from growing in again.
But if the patient doesn't follow the recommendations, the problem can come back.
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