Ingrown Toenail – OrthoInfo – AAOS

If you trim your toenails too short, particularly on the sides of your big toes, you may set the stage for an ingrown toenail. Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin. An ingrown toenail may also happen if you wear shoes that are too tight or too short.

An ingrown toenail.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may get red and infected, and feel very sore. Ingrown toenails are a common, painful condition—particularly among teenagers. Any of your toenails can become ingrown, but the problem more often affects the big toe. An ingrown nail occurs when the skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. Redness, pain and swelling at the corner of the nail may result and infection may soon follow. Sometimes a small amount of pus can be seen draining from the area.

Ingrown nails may develop for many reasons. Some cases are congenital—the nail is just too large for the toe. Trauma, such as stubbing the toe or having the toe stepped on, may also cause an ingrown nail. However, the most common cause is tight shoe wear or improper grooming and trimming of the nail.

The anatomy of a toenail.

Nonsurgical Treatment

Ingrown toenails should be treated as soon as they are recognized. If they are recognized early (before infection sets in), home care may prevent the need for further treatment:

• Soak the foot in warm water 3-4 times daily.
• Keep the foot dry during the rest of the day.
• Wear comfortable shoes with adequate room for the toes. Consider wearing sandals until the condition clears up.
• You may take ibuprofen or acetaminophen for pain relief.
• If there is no improvement in 2-3 days, or if the condition worsens, call your doctor.

You may need to gently lift the edge of the ingrown toenail from its embedded position and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day.

Surgical Treatment

If excessive inflammation, swelling, pain and discharge are present, the toenail is probably infected and should be treated by a physician (see left image below). You may need to take oral antibiotics and the nail may need to be partially or completely removed (see middle image below). The doctor can surgically remove a portion of the nail, a portion of the underlying nail bed, some of the adjacent soft tissues and even a part of the growth center (see right image below).

Possible treatment options for an ingrown toenail.

Surgery is effective in eliminating the nail edge from growing inward and cutting into the fleshy folds as the toenail grows forward. Permanent removal of the nail may be advised for children with chronic, recurrent infected ingrown toenails.

If you are in a lot of pain and/or the infection keeps coming back, your doctor may remove part of your ingrown toenail (partial nail avulsion). Your toe is injected with an anesthetic and your doctor uses scissors to cut away the ingrown part of the toenail, taking care not to disturb the nail bed. An exposed nail bed may be very painful. Removing your whole ingrown toenail (complete nail plate avulsion) increases the likelihood your toenail will come back deformed. It may take 3-4 months for your nail to regrow.

Unless the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and to wear shoes and hosiery (socks) with adequate room for the toes. Nails should be cut straight across with a clean, sharp nail trimmer without tapering or rounding the corners. Trim the nails no shorter than the edge of the toe. Keep the feet clean and dry at all times.

Proper and improper toenail trimming.

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Ingrown Toenails: Causes, Symptoms, and Diagnosis

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Ingrown toenails occur when the edges or corners of your nails grow into the skin next to the nail. Your big toe is most likely to get an ingrown toenail.

If a toenail grows back into the skin around the nail bed, it’s known as an ingrown toenail. These can be painful and can become infected.

You can treat ingrown toenails at home. However, they can cause complications that might require medical treatment. Your risk of complications is higher if you have diabetes or other conditions that cause poor circulation.

Ingrown toenails occur in both men and women. According to the National Health Services (NHS), ingrown toenails may be more common in people with sweaty feet, such as teenagers. Older people may also be at higher risk because toenails thicken with age.

Many things can cause an ingrown toenail, including:

• cutting toenails incorrectly (Cut straight across, since angling the sides of the nail can encourage the nail to grow into the skin.)
• irregular, curved toenails
• footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for your feet
• toenail injury, including stubbing your toe, dropping something heavy on your foot, or kicking a ball repeatedly
• poor posture
• improper foot hygiene, such as not keeping your feet clean or dry
• genetic predisposition

Using your feet extensively during athletic activities can make you especially prone to getting ingrown toenails. Activities in which you repeatedly kick an object or put pressure on your feet for long periods of time can cause toenail damage and increase your risk of ingrown toenails. These activities include:

• ballet
• football
• kickboxing
• soccer

Ingrown toenails can be painful, and they usually worsen in stages.

Early-stage symptoms include:

• skin next to the nail becoming tender, swollen, or hard
• pain when pressure is placed on the toe
• fluid building up around the toe

If your toe becomes infected, symptoms may include:

• red, swollen skin
• pain
• bleeding
• oozing pus
• overgrowth of skin around the toe

Treat your ingrown toenail as soon as possible to avoid worsening symptoms.

Your doctor will most likely be able to diagnose your toe with a physical exam. If your toe seems infected, you might need an X-ray to show how deep the nail has grown into the skin. An X-ray can also reveal if your ingrown nail was caused by injury.

If you need help finding a primary care doctor or gastroenterologist, you can browse doctors in your area through the Healthline FindCare tool.

Ingrown toenails that aren’t infected can normally be treated at home. However, if your toenail has pierced the skin, or there is any sign of infection, seek medical treatment. Signs of infection include:

• warmth
• pus
• redness and swelling

Home treatment

To treat your ingrown toenail at home, try:

• soaking your feet in warm water for about 15 to 20 minutes three to four times per day (At other times, your shoes and feet should be kept dry.)
• pushing skin away from the toenail edge with a cotton ball soaked in olive oil
• using over-the-counter medicines, like acetaminophen (Tylenol), for the pain
• applying a topical antibiotic, such as polymyxin and neomycin (both present in Neosporin) or a steroid cream, to prevent infection

Try home treatments for a few days to a few weeks. If the pain worsens or you find it difficult to walk or perform other activities because of the nail, see your doctor.

If the toenail does not respond to home treatments or an infection occurs, you may need surgery. In cases of infection, stop all home treatments and see your doctor.

Surgical treatment

There are different types of surgical treatments for ingrown toenails. Partial nail removal only involves removing the piece of nail that is digging into your skin. Your doctor numbs your toe and then narrows the toenail. According to the NHS, partial nail removal is 98 percent effective for preventing future ingrown toenails.

During a partial nail removal, the sides of the nail are cut away so that the edges are completely straight. A piece of cotton is placed under the remaining portion of the nail to keep the ingrown toenail from recurring. Your doctor may also treat your toe with a compound called phenol, which keeps the nail from growing back.

Total nail removal may be used if your ingrown nail is caused by thickening. Your doctor will give you a local pain injection and then remove the entire nail in a procedure called a matrixectomy.

After surgery

After surgery, your doctor will send you home with your toe bandaged. You will probably need to keep your foot raised for the next one to two days and wear special footwear to allow your toe to heal properly.

Avoid movement as much as possible. Your bandage is usually removed two days after surgery. Your doctor will advise you to wear open-toe shoes and to do daily salt water soaks until your toe heals. You will also be prescribed pain relief medication and antibiotics to prevent infection.

Your toenail will likely grow back a few months after a partial nail removal surgery. If the entire nail is removed down to the base (the nail matrix under your skin), a toenail can take over a year to grow back.

If left untreated, an ingrown toenail infection can cause an infection in the bone in your toe. A toenail infection can also lead to foot ulcers, or open sores, and a loss of blood flow to the infected area. Tissue decay and tissue death at the site of infection are possible.

A foot infection can be more serious if you have diabetes. Even a small cut, scrape, or ingrown toenail may quickly become infected due to the lack of blood flow and nerve sensitivity. See your doctor right away if you have diabetes and are concerned about an ingrown toenail infection.

If you have a genetic predisposition to ingrown toenails, they may keep coming back or appear on multiple toes at once. Your quality of life may be affected by pain, infections, and other painful foot issues that require multiple treatments or surgeries. In this case, your doctor may recommend a partial or full matrixectomy to remove the toenails causing chronic pain. Read more about foot care and diabetes.

Ingrown toenails can be prevented by making several lifestyle changes:

• Trim your toenails straight across and make sure that the edges do not curve in.
• Avoid cutting toenails too short.
• Wear proper fitting shoes, socks, and tights.
• Wear steel-toe boots if you work in hazardous conditions.
• If your toenails are abnormally curved or thick, surgery may be necessary to prevent ingrown nails.

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Ingrown toenail: symptoms, causes, treatment

An ingrown toenail is a common ailment. It is the ingrowth of the edge of the nail plate into the human flesh. This usually occurs on one or both sides, but central ingrowth may also occur.

Main causes

In the vast majority of cases, pathology is formed on the legs, and one of the main reasons for this is the wrong choice of shoes. It puts pressure on the nail, and it moves towards the skin.

The most common causes of an ingrown toenail are:

• inability to properly trim nails;
• genetic facto;
• fungal disease: some types of fungi destroy the nail plate, causing it to change its shape;
• deformity of the foot (often as a result of wearing smaller shoes), flat feet;
• Injury to the finger that pierced the nail plate and prevented it from growing as it did before.

Symptoms of disease

The first manifestations of the disease are usually not paid too much attention, although it is quite easy to prevent complications at an early stage. The signs of an ingrown toenail are:

• first, the skin surrounding the nail turns red, then swelling forms in this area, pain appears when touching it;
• pus and blood begin to ooze from the damaged area, as the nail digs deeper into the skin, provoking an infection;
• if nothing is done, the ingrown part of the nail becomes denser, its deformation is almost irreversible; bone tissue is affected. At this stage, the disease becomes chronic. It is no longer possible to permanently fix the nail, but there is a chance to avoid a relapse with proper care.

Diagnosis of disease

Having discovered the symptoms of an ingrown nail, it is necessary to go for an examination to a specialist – a surgeon as soon as possible in order to prevent the possible development of the disease.

In the advanced stage, when there is a clear infection (severe redness and swelling speak of it), laboratory tests can be prescribed:

• complete blood count;
• blood sugar test (done to rule out diabetes).

In rare, especially advanced cases, an x-ray of the hand or foot is performed to exclude the fact of damage to the bone tissue.

Treatment features

Treatment of an ingrown nail begins with getting rid of acute symptoms, namely, with the surgical removal of the interfering edge of the nail plate, relieving inflammation.

Initial treatment

Further, the following options are possible to prevent a recurrence of the situation:

• Acrylic correction of ingrown toenails – carried out approximately once every 6 months. Contrary to popular belief, the generally accepted nail extension performs not only an aesthetic, but also a healing function. With its help, the nail plate acquires the correct shape without growing into the skin of the finger;
• hardware pedicure – can be cosmetic and performed by a pedicure master, as well as medical: with the fixation of special plates (performed by a specialist with a medical education).

However, both options are effective only in the initial stages of nail ingrowth into the skin. In the case when pus has formed or bone tissue has suffered, they are ineffective.

Advanced treatment

If an ingrown toenail is a serious concern, then you will most likely have to resort to more drastic measures.

• Correction of the nail with a plate. A special plate is applied to a part of the nail from the outside, which controls the degree of pressure on it. It gently aligns the nail from the edge, thereby giving it a different shape, harmless to the skin.
• Ingrown toenail laser correction – allows you to achieve a quick and effective result. The disadvantage of this procedure is its relative high cost. Does not completely remove the nail plate, gently removing only its excess part. The procedure is completely painless, however, if there is an inflammatory process on the nail, it must first be removed with anti-inflammatory drugs.
• Radio wave exposure – is the removal of the overgrown part of the nail with the help of radio waves. The procedure is fast, effective, painless and does not require additional preparatory steps. It implies the introduction of local anesthesia, the treatment of the nail with a scalpel, the necessary nozzles and an antiseptic.
• Surgical treatment of an ingrown toenail – used in advanced cases, when pus accumulates under the skin around. It is carried out under local anesthesia, requires separate preparation (preliminary diet, refusal of antibiotics and a number of other drugs). The whole operation takes about half an hour and requires some post-operative care (in particular, changing the dressing, washing the finger, applying an antibiotic ointment and a timely visit to the surgeon).

FAQ

Can an ingrown toenail be treated at home?

It is possible to correct the situation only at the very initial stage, but, unfortunately, in most cases, patients skip it, noticing the problem only when additional help is already required.

What does an ingrown toenail look like?

It is an overgrown nail plate, one edge of which digs into the skin. When pressed, it can cause pain.

What preventive measures should be taken to avoid the problem of an ingrown toenail?

You should purchase high-quality shoes that have the appropriate certificates, mainly from natural materials and always in size. Do not wear smaller shoes. If the shoes are crushing, they should be discarded. It is also necessary to properly trim the nails (use nail scissors or nippers) and periodically give the foot a break from wearing any shoes.

Ingrown toenail: which specialist should I contact?

The following specialists are involved in the treatment, depending on the stage of development of the disease: pedicure master, podologist, surgeon.

Ingrown nail. Causes. Treatment.

Ingrown toenail. Causes. Treatment.

January 15, 2020

Ingrown toenail is a very common disease that can occur in almost every person. From the studies of various authors, it is known that both male and female patients, of all ages, of any profession and occupation, are susceptible to an ingrown nail. Ingrown nails occur mainly on the first (rarely on the second) toe of the lower extremities and are more often detected on the right foot. On the inside of the nail, ingrowth occurs 7-8 times more often and is more severe than on the outside.

An ingrown toenail can appear due to various provoking factors. However, the main reasons should be highlighted:

· Wearing the wrong shoes. So wearing tight or narrow shoes due to pressure on the corners of the fingers can cause the nail to grow into the nail fold. In addition, sweating in such a situation becomes a favorable condition for the fungal process.

Hereditary causes. When diagnosing this pathology in the next of kin, it is necessary to monitor the condition of the fingers even more carefully, since a predisposition to the disease is inherited.

Incorrectly done manicure. Not everyone knows how to cut their nails correctly. Meanwhile, excessive trimming of the edges of the nail causes trauma to the skin.

· Congenital deformities of the feet can also cause the nail plate to grow into the skin.

· Injury to the foot is a provoking factor for crashing.

· Fungal infection of the feet causes an increase in the number of layers in the nail. Further, the thick nail plate quickly grows into the skin roller.

The main symptoms of an ingrown toenail:

· sensation of discomfort and pain in the area of ​​incision;

development of inflammatory changes in the skin in the affected area;

occurrence of an unpleasant odor from the lower extremities;

· at a later date, a purulent discharge may appear in the pathological area.

In order not to think about what an ingrown nail is, the treatment of this disease and its complications, it is enough to follow a few simple rules.

Wear only loose and comfortable footwear.

· Promptly treat orthopedic diseases.

· Do not start the development of the fungal process of the foot.

Use the correct nail clipping technique.

Since the initial manifestations of the disease are treated with conservative methods, it is necessary to seek the help of specialists at the first symptoms.

Conservative methods.

Their main goal is to combat purulent-inflammatory processes and reduce the intensity of pain in the affected area of ​​the finger, prevent its injury and create conditions for the unhindered growth of the nail plate.

For this, lotions with antiseptic solutions, hot foot baths with potassium permanganate or anti-inflammatory infusions of plant origin (calendula), Levomikol, antimicrobials, such as Baneocin in the form of an ointment or powder, are used. All this is combined with the displacement of inflamed soft tissues hanging as a result of edema, the application of gauze rollers or / and bringing under the sharp edge of the nail plate (if possible) gauze strips or thin rollers soaked in an ointment or solution containing antiseptic components. In the process of treatment, it is necessary to correctly periodically cut the nail in compliance with antiseptic measures and use loose shoes.

The use of conservative treatment is justified only at the initial stages of the disease, as well as in cases where the patient refuses more radical methods or is unable to use them for any reason.

Orthopedic techniques

They are characterized by great variety and have been used in different versions for a long time. The principle of their action is the gradual extension and increase in the radius of curvature of the nail plate by changing the direction of tension.

As a result of this, the edges of the ingrown nail are lifted and separated from the tissues of the nail fold, which helps to reduce pressure on them and reduce the degree of ingrown. Pre-rigid areas of the nail are treated with a softening compound.

Custom made metal springs or staples, identical to brackets, are used for orthopedic treatment. In recent years, correction of the ingrown nail with plates has been quite often used.

Flat leaf springs made of polymer materials are adapted to the curvature of the nail by means of a drill and glued to it with their entire surface using a special adhesive. On top of such plates, it is possible to apply nail polish. They are changed once a month. The whole process of treatment takes 3-4 months.

Recurrence of the disease is also possible after orthopedic treatment.

Surgical treatment.

Depending on the degree of nail plate ingrowth, the course of the disease (infection, discharge of pus, etc.), the first case of the disease or relapse, one of the methods of surgical treatment is selected.

· Resection (partial removal of the nail). Part of the nail plate that has grown into the skin is removed. The operation is performed under local infiltration anesthesia on an outpatient basis. There are two types of resection: marginal wedge resection and selective resection of the matrix (growth zone). Without removal of the matrix, relapses very often occur, repeated surgical interventions are necessary.

· Avulsion operation (complete removal of the nail). The operation consists in complete excision (tearing off) of the nail plate without damaging the soft tissues along the edge of the nail bed. Therefore, over time, the nail grows back. It is carried out most often with the development of an infectious-inflammatory process. This type of surgical treatment of onychocryptosis is traumatic, after which frequent relapses are noted.

· Vandenbos operation (removal of skin at the base of the nail). The operation is performed under local anesthesia, consists in removing the skin along the edge of the nail and does not affect the nail plate. After surgery, relapses are very rare. But such a surgical intervention is traumatic, after which the healing period is quite long.

Syme operation (complete removal of the nail matrix). This type of surgical intervention consists in the removal of the nail matrix, skin flap transplantation and partial osteotomy of the phalanx.