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 nail – stages of the disease, methods of treatment

16.02.2021

There will be no doubt that this is a serious and not at all trifling problem only for those who know firsthand what excruciating pain occurs if the case is neglected.

Approximately 10% of the country’s population suffers from an ailment – an ingrown nail, in other words, onychocryptosis. Typically, the toenail grows into the soft surrounding tissue.

How does a nail work?

A horn formation (plate) is called a nail. The nail is located in the nail bed. At the root of the nail is a matrix – due to it, the nail grows. If the matrix is ​​damaged, then the nail will grow incorrectly or stop growing altogether. On the sides of the nail are skin folds, they are called the nail roller.

Causes of onychocryptosis

• genetic predisposition,
• overweight,
• wearing tight shoes,
• shoes with heels,
• incorrect pedicure,
• diabetes,
• vascular disease of the lower extremities,
• fungal diseases,
• non-observance of personal hygiene,
• injury

Most often, an ingrown toenail occurs in young people. They try, during a pedicure, to round off the corners of the nail plate as much as possible, thereby disrupting the natural growth of the plate, it begins to grow into the soft tissue.

Stages of the disease

• The first stage is redness around the nail, swelling and slight discomfort when walking.
• The second stage – part of the nail cuts into the skin, swelling occurs. A person experiences obvious pain and not only when walking.
• The third stage – in addition to pain in the focus of inflammation, purulent discharge appears. The nail thickens. The so-called “wild meat” appears – tissue grows.
• Fourth stage – soft tissue granulation occurs. The disease becomes chronic. Difficult to treat.

Consequences

If an ingrown toenail is not treated promptly, complications can occur. Inflammation can go to the bone (ostiomyelitis), up to gangrene and amputation of the toes.

At risk are people with diabetes, the elderly.

Prophylaxis

First of all, it is necessary to cut the nails correctly, the cut should be even (parallel to the nail roller), when carrying out a pedicure, it is necessary to hold the legs in a warm bath, and follow the rules of hygiene daily. Wear loose, comfortable shoes.

Conservative treatment

If the stage of the disease is first or second, then nail softeners are recommended. Orthopedic inserts, staples, springs, plates are also recommended. Devices are fixed on the nail in order to correct the deformation of the nail. The procedure is painless. Delivers a minimum of inconvenience. The use of cosmetic varnish is allowed. It is recommended to wear the devices for 3-4 months.

With fungal diseases, appropriate medications will help.

Laser treatment

Gentle, painless method. As a rule, the nail plate is not completely removed. Remove only the ingrown part of the nail. Also, the infected tissue is cleared by the laser, preventing the process of further inflammation.

Radio wave treatment

No less popular method than all the others. When using it, the immune properties of the skin and tissues increase. No bleeding, no scarring.

Surgical treatment

The most radical. The ingrown edge of the nail, the nail bed and part of the nail root dry out. Either a wedge-shaped resection of the nail plate or a selective resection of the nail matrix is ​​performed. In advanced cases, the nail is completely removed. The disadvantage of this procedure is that the nail plate is restored within six months.

ingrown nail

Ingrown nail – conservative and surgical treatment in Moscow

Ingrown nail is an inflammatory disease of the soft tissues surrounding the nail. The reason for it is often called incorrect cutting of the nail, tight shoes, minor trauma, etc., however, the essence of the problem lies in the anatomical disproportion associated with the fact that the periungual ridges “crawl” unnecessarily onto the nail plate. This condition is congenital, for a number of years it may not bring discomfort, however, the random circumstances listed above lead to the development of inflammation. The predisposition to the occurrence of this disease is often inherited.

The disease manifests itself as inflammation of the periungual fold. At the same time, the lateral edge of the nail plate loses normal contact with the nail bed and the periungual ridge, and acts in relation to them as a foreign body, which contributes to the development of inflammation and ulceration of soft tissues, followed by the development of granulations (earlier people called it “wild meat”) . The finger becomes edematous, the skin turns red, the lateral ridges are thickened, pain appears when walking. Ingrown both outer and inner edges of the nail plate are possible.

In children , this disease occurs, as a rule, at the age of 12-14 years, almost exclusively on the first toes. The doctor makes a diagnosis based on the examination. No additional examination methods are required.

Conservative treatment consists of antiseptic baths and medicinal dressings. They strive for the gauze dressing to act as a gasket between the nail and the periungual roller. Shoes and socks should be light and breathable. A short cut of the nails with the removal of part of the nail plate does not prevent ingrowth, the resulting sharp and uneven edge injures the periungual ridge. A number of other methods are also used (laser, cryotherapy, etc.), however, conservative treatment brings only a temporary effect, since it does not eliminate the root causes of the disease – imbalances in the nail and periungual fold. In order to be sure that the ingrown nail will never recur, it is necessary to resort to surgical treatment.

Surgical treatment is carried out in a surgical hospital, where the child is hospitalized after performing the necessary set of tests, or in a polyclinic. Operations are performed under anesthesia or under local anesthesia. A huge number of methods of surgical intervention have been proposed. There is no generally accepted view of which one is optimal, and the choice of treatment method is decided by each surgical school in accordance with its traditions. All types of surgical interventions can be divided into two groups: operations on the nail bed and on the periungual roller. The result of surgery involving the removal of part of the nail bed is difficult to predict, as it is extremely difficult to predict what the shape of the nail plate will be when it grows back. Operations on the periungual roller, performed in the acute period, on inflamed tissues, often result in suppuration and divergence of sutures. A common feature of the treatment of an ingrown nail is a high probability of recurrence (recurrence) of the disease.

Method N.P. Shastina (RF patent No. 2481794) differs in that in the acute period, when there are inflammatory phenomena, the intervention is minimal in terms of trauma – removal of the edge of the nail plate, which is introduced under the periungual roller. Manipulation is performed on an outpatient basis, under local anesthesia and takes 5-10 minutes. After 3-5 days, the inflammatory phenomena subside. However, if nothing else is done, after 4 to 5 months, after the nail grows back, the “ingrown” nail will most likely re-occur. Therefore, 3-4 weeks after resection of the edge of the nail plate, it is necessary to perform a radical surgical intervention. Since an ingrown nail is a disease, the cause of which often lies in the special structure of the periungual folds, the operation is often performed on both legs at once, in order to prevent the possibility of developing this disease in the future.