What’s the best way to banish ingrown toenails?

MY SON is 19 and has had six or seven procedures to remove ingrown toenails on the big toe of his left foot.

He’s had infections in that toenail more times than we can remember and has been in constant pain for at least ten years.

He’s so fed up that he wants the whole nail removed. Is that the best option? Amanda Chamberlain, Broadstairs, Kent.

THE experience your son has had is far from unusual. Ingrown toenails are most common in adolescents, though it’s not known why.

An ingrown toenail develops when the growing nail (usually on the big toe) digs into and pierces the skin and soft tissue surrounding it, often causing pain and infection as bacteria that otherwise live harmlessly on the skin get underneath.

If there is an infection, doctors may prescribe a course of antibiotics and drain away any pus.

But while this may resolve the immediate problem, clearing the infection and kickstarting the healing process, if the nail continues to cut into the flesh, the infection will soon return.

Removing the toenail — a procedure carried out under local anaesthetic — can help, though the issue may still recur a year or so down the line when the new nail has fully formed.

It is possible to stop a new nail from ever forming again, which involves destroying the growth plate in the nail bed.

Though this will inevitably change the appearance of the toe for good, there are no other risks or downsides.

One way of doing this is with a procedure called Zadek’s, where the nailbed is cut away surgically under local anaesthetic.

In recent years, another method has been used, with just as much success. It involves applying a chemical called phenol (carbolic acid) to the affected area.

Phenol cauterisation, as this is known, successfully destroys the tissue from which the nail grows.

In my opinion, this is the treatment of choice.

Your son’s GP could refer him to the local surgical or orthopaedic unit for it to be carried out on the NHS (chiropodists and podiatrists may offer the same procedure, but you may have to pay for it if you go down this route).

SINCE May, I have had nausea almost daily. All tests were normal, and I’ve had some improvement from following a low FODMAP diet.

It seems strange that things I consider healthy — yoghurt, cabbage, honey and rye bread — are banned, but white sourdough bread and butter are encouraged.

I’ve long followed a highprotein, low-carb diet to avoid weight gain. Was I wasting my time? I’m 77. Brigitte Wahla, London.

YOU have been thoroughly investigated, but no conclusion has been reached about what’s causing the nausea.

Your letter does not mention other symptoms that often accompany nausea, such as abdominal pain, bloating or a change of bowel habit, so I must assume you’re not also affected by these.

I wonder if the problem might be the medication you are taking — nonsteroidal antiinflammatory drugs, such as naproxen, or anti depressants, such as fluoxetine, can cause nausea, though I am sure your doctor will have considered this.

In your longer letter, you explain that you’ve also been diagnosed with an underactive thyroid gland and atrial fibrillation (a heart rhythm disorder).

Neither of these is associated with nausea.

However, an underactive thyroid is often preceded by a period in which the thyroid gland is overactive (though the typical symptoms of weight loss, racing heart, tremor and feelings of agitation may be minimal), and this can cause atrial fibrillation.

The nausea you are experiencing could be a symptom of general unwellness triggered at that time, though this is a long shot.

The low FODMAP diet you refer to is a treatment for a particular condition — some forms of irritable bowel syndrome (IBS) — and, in any event, it is not usually a prescription for life, but is often recommended for six to 12 weeks as a way of alleviating the symptoms.

FODMAP refers to fermentable oligosaccharides, disaccharides, monosaccharides and polyols — essentially different forms of sugar molecules found in a range of foods that include onions, garlic, apples, pears, honey and wheat.

Some people don’t absorb these properly in the small intestine, so they then pass into the large intestine, where they are fermented by gut bacteria, leading to the production of gas and potentially bloating, discomfort and diarrhoea. IBS can cause nausea, but you’d also have these other symptoms.

However, it’s encouraging that eliminating the foods high in FODMAPs already appears to be reducing your nausea.

I know it seems to be a paradox that apparently healthy foods are banned, but let me reassure you: this is not an unhealthy regimen, given that it is only ever temporary.

The idea is that it will allow your intestine to settle and, in due course, the banned foods can be reintroduced gradually.

As you start doing so, you may be able to identify the food groups that are particularly troublesome for you.

BEAR in mind that the science of these matters is not yet fully understood. The microbiome — the vast colony of microbes that inhabit the large intestine — is also part of the picture, in terms of whether or not a low FODMAP diet will help your nausea.

But I assure you that your lifetime commitment to a healthy diet has not been wasted and, over the longer term, you can only have benefited from it.

I hope that you have a dietitian or a doctor who is experienced and interested in irritable bowel syndrome and the FODMAP regimen to help you with reintroducing foods if and when your nausea has resolved.

CONTACT DR SCURR

WRITE to Dr Scurr at Good Health, Scottish Daily Mail, 20 Waterloo Street, Glasgow G2 6DB or email drmartin@dailymail.co.uk — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.