Stages of an Ingrown Toenail

There are several ways to develop the painful and uncomfortable condition known as an ingrown toenail. It occurs when the toenail grows into the skin on the side of the nail and may occur due to several different reasons. These may include trimming the toenails incorrectly, wearing shoes and socks that are too tight, or possibly enduring an injury to the toe. There may be options, which may provide moderate relief, including soaking the toe in warm water, wearing the correct footwear that has adequate room for the toes to move about in, or taking antibiotics for an ingrown toenail that becomes infected. Research has shown there are three stages that take place when this condition occurs. The first phase consists of swelling around the side of the nail. Possible drainage and increased pain may be present in phase two, and phase three will typically consist of chronic and recurring infections. If you have developed an ingrown toenail, it is advised to consult with a podiatrist as quickly as possible to discuss the best treatment for you.

Ingrown toenails may initially present themselves as a minor discomfort, but they may progress into an infection in the skin without proper treatment. For more information about ingrown toenails, contact Dr. Kennedy Legel of Advanced Foot & Ankle Care Specialists. Our doctor can provide the care you need to keep you pain-free and on your feet.

Ingrown Toenails

Ingrown toenails are caused when the corner or side of a toenail grows into the soft flesh surrounding it. They often result in redness, swelling, pain, and in some cases, infection. This condition typically affects the big toe and may recur if it is not treated properly.

Causes

• Improper toenail trimming
• Genetics
• Improper shoe fitting
• Injury from pedicures or nail picking
• Abnormal gait
• Poor hygiene

You are more likely to develop an ingrown toenail if you are obese, have diabetes, arthritis, or have any fungal infection in your nails. Additionally, people who have foot or toe deformities are at a higher risk of developing an ingrown toenail.

Symptoms

Some symptoms of ingrown toenails are redness, swelling, and pain. In rare cases, there may be a yellowish drainage coming from the nail.

Treatment

Ignoring an ingrown toenail can have serious complications. Infections of the nail border can progress to a deeper soft-tissue infection, which can then turn into a bone infection. You should always speak with your podiatrist if you suspect you have an ingrown toenail, especially if you have diabetes or poor circulation.

If you have any questions, please feel free to contact our office located in Dallas, TX . We offer the newest diagnostic and treatment technologies for all your foot care needs.

Read more about Ingrown Toenails

Causes, Symptoms and Treatment Options

Medically reviewed by Drugs.com. Last updated on Mar 10, 2022.

What is an Ingrown Toenail?

An ingrown toenail is a toenail with an edge that pushes into the skin and soft tissue at the side of the nail. This causes redness, swelling and pain, and can lead to infection. Symptoms can be worse when you are wearing a shoe, which puts pressure on the nail. The nail on the big toe becomes ingrown more often than other toenails.

Ingrown toenails can be caused by cutting toenails improperly, by wearing shoes that fit poorly or by injuring the nail bed. Ingrown toenails also can run in the family. 

Symptoms

The most common symptom of an ingrown toenail is pain, especially if the area becomes infected. The surrounding skin might be deep pink and release a discharge or pus, or it might appear raw with a red moist lump overlapping the nail edge. 

Diagnosis

Your doctor can diagnose an ingrown toenail by examining the area. 

Expected Duration

Ingrown toenails sometimes correct themselves as they grow out, but more advanced cases may need to be corrected with surgery.  

Prevention

You can do several things to prevent ingrown toenails from forming:  

• Cut your toenails straight across so that the corner of the nail is visible to you, not buried under skin at the side of your nail. If you are not able to see the corner of your nail as you trim it, your nail might have a jagged corner after it is trimmed, with a “forked” edge that can extend under your skin as it grows. Use clippers that are designed to cut toenails, or a nail file.  
• Wear shoes that are large enough that they don’t push your toes together.  

If you are elderly, have diabetes or have other conditions that affect your circulation, be especially careful about how you cut your toenails and manage your foot health. 

Treatment

In the early stages of an ingrown toenail, soak your foot in warm water containing antibacterial soap or a few tablespoons of salt. Dry your foot and apply an over-the-counter hydrocortisone or antibiotic ointment and a clean dressing for one to two weeks. Do not cut your nail. As much as possible, wear open-toed or loose-fitting shoes. When the nail grows out, cut it straight across. If you are not making any progress, your doctor can prescribe a stronger prescription strength corticosteroid ointment to apply to the nail fold.

More advanced ingrown toenails require the attention of a health care professional. If the nail is not deeply ingrown, the edge of the nail can be lifted from the skin edge that it is irritating. There are multiple ways to help stop the nail from growing into the nail fold. For example, a small piece of clean cotton can be used to prop the nail’s corner up and over the skin edge until the skin heals. Your doctor may cut open infected areas with a blade or a needle to allow the pus to drain.  

For a more deeply ingrown nail, your doctor may numb your toe with local anesthetic and then remove a vertical strip of nail from the affected side of your toe. After this piece of nail is removed, the nail has a chance to regrow without an ingrown edge. If you continue to get an ingrown toenail, your doctor might also treat the cuticle with a medicine called phenol. Phenol will prevent that area of your cuticle from producing new nail, so your toenail will be narrower than it was previously.  

When To Call a Professional

Contact your doctor or foot care specialist if ingrown nail symptoms do not go away on their own in a reasonable period, if you are in pain or if you notice an infection. If you have diabetes or another health problem that affects your circulation, contact your doctor for treatment of your ingrown nail even if your symptoms are mild. 

Prognosis

Once you learn the proper technique for cutting your nails, you may never have another ingrown toenail. If you need to have a vertical strip of your toenail removed, this side of your nail will take several months to replace itself. Usually, the new nail will not be an ingrown nail. 

American Podiatric Medical Association (APMA)

https://www. apma.org/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

I want to cure an ingrown toenail

Article: “I want to cure an ingrown toenail”

December 12, 2020 – Khakimova Z.A., specialist in podology

An ingrown nail causes severe discomfort while walking and does not look aesthetically pleasing. It becomes impossible to wear your favorite shoes with heels and open sandals. Let’s figure out what to do if a toenail has grown in, and how to avoid it.

Disease definition and mechanism of development

Onychocryptosis is a pathology in which the nail plate begins to grow into the lateral skin ridges. Most often, the disease develops on the big toes. The disease appears due to inflammation of the soft tissues, which swell and are pressed into the nail.

In this case, a pedicure is absolutely useless, because the nail will grow anyway and problems will begin again. Sensitive soft tissues of the periungual roller are constantly injured on a sharp nail plate, therefore they grow strongly and become inflamed.

Classification and stages of development of pathology

There are four degrees of onychocryptosis:

The first – the shape of the nail has not yet been deformed, but the side ridges swell slightly and turn red;

second – the nail thickens, becomes convex and grows at an angle of 15-30 degrees;

Third – the affected nail plate is deformed even more. Its thickness reaches 2.5 mm, and the ingrowth angle increases to 45 degrees;

Fourth – the nail looks like a claw, becomes thicker than 2.5 mm and grows at an angle of more than 45 degrees.

At the first stage of the disease, shooting pain is felt when pressing on the nail plate, and the skin roller swells. If you do not start treatment of onychocryptosis, the discomfort will increase. The skin around the nail on the finger will turn red and start to hurt excruciatingly, pus may appear. It becomes difficult to put on shoes and walk.

At the last stage, the skin roller grows even stronger, tumor growths appear, which hurt a lot. A strong infectious process begins. It becomes unbearably painful for a person to step on a finger.

Causes

There are four main causes of an ingrown toenail:

1. Improper care. Onychocryptosis develops due to wearing tight shoes or boots with a narrowed toe, squeezing the thumb with a cast or tight bandage, and also due to the lack of a regular pedicure or cutting the nail too deep into an oval shape.

2. Individual features. The cause of the disease is too large skin rollers or deformation of the bones of the feet.

3. Concomitant diseases. Ingrown begins due to a fungus, gout, endocrine pathologies, a severe bruise or fracture of the finger.

4. Excessive load on the legs. An ingrown toenail may be due to obesity or pregnancy.

Symptoms of disease

Onychocryptosis is manifested by the curvature of the ingrown nail, which presses on the side ridges and causes severe pain. Discomfort is felt at the slightest touch and is especially intensified while walking in street shoes. If you do not start treatment, the skin will turn red, swelling will appear and a purulent process may begin. The nail will thin and break into small pieces.

Possible complications

Lack of proper treatment of an ingrown toenail threatens with serious complications. The infection will pass to the bone and spread through the lymphatic system, purulent inflammation will begin and gangrene may develop. In the worst case, the phalanx of the finger will have to be amputated.

Ingrown nail plate is especially dangerous for older people with chronic endocrine diseases and malfunctions of the vascular system.

Diagnostics

Before treatment, the doctor conducts a diagnosis to identify the cause of the disease and tells what to do if the nail grows on the big toe. With onychocryptosis, a general blood test, a study of purulent contents and an x-ray are prescribed to exclude the transition of the inflammatory process to the bone.

Treatment

Conservative

Conservative treatment of an ingrown toenail is carried out at the initial stages of the disease. The following methods are common:

1. Fraser bracket. The wire construction is glued to the edges of the nail and lifts it up to reshape and relieve pressure on the soft tissues.

2. Plugging. Between the nail and soft tissues, a gasket impregnated with an anti-inflammatory agent is installed. It does not allow the edge of the nail plate to come into contact with the skin roller, so further ingrowth is excluded.

3. Correction plate. The design lifts the nail and prevents cutting into skin rollers. It is attached across the nail plate with glue and covered with medical varnish.

Installation of corrective systems is painless and takes no longer than 20 minutes. Medical constructions do not cause discomfort and are not felt while walking. But they will have to be worn for several months and periodically replaced with new ones in order to completely get rid of the disease.

Nail plate removal

In an advanced case, a partial removal of the ingrown toenail is carried out with the destruction of the growth zone. Surgical treatment is indicated only at the last stage of the disease, when severe inflammation began and an infection joined.

The doctor removes part of the thumbnail and coagulates the surrounding tissue with a laser or radio wave knife. With abundant growth of the skin, the periungual roller is cut out. Such an operation is more traumatic, but the risk of re-development of onychocryptosis decreases. Complete removal of the nail plate is indicated for pathological changes and the development of the fungus.

After the operation, you can lead a normal life. But during the rehabilitation period, it is necessary to regularly come for dressing and examination. The doctor may prescribe antibiotics and healing ointments to completely get rid of the inflammatory process. On the first day, it is recommended to walk around the house barefoot or in wide slippers, and then wear loose shoes.

Folk remedies

Only a specialist should decide what to do with an ingrown toenail. Self-treatment with ointments can only aggravate ingrowth.

Prophylaxis

The key to preventing ingrown toenails is proper foot care. Wash your feet regularly and wear only high-quality, comfortable shoes that you feel comfortable in. It should not put much pressure on the fingers and constantly rub the calluses. Wear shoes with a narrow toe with high heels for a maximum of 3-4 hours.

Once every 1-2 weeks, trim and file your nails in a straight line so that the corners do not round off. Treat fungal infections promptly and wear orthopedic insoles for flat feet.

Treatment of an ingrown nail in the Deka clinic in Moscow

A disease in which the nail plate grows into the skin is called onychocryptosis. The edge of the nail can grow into the side of the nail fold on one or both sides. Most often, onychocryptosis occurs on the big toes, but there are cases when the nail grows on other toes and hands.

Navigation:

An ingrown nail is caused by a change in the direction of growth of the nail plate, which can be caused by various factors:

The first signs of an ingrown toenail are reddening of the skin around the nail and pain when it is pressed. If you ignore the onset of the development of the disease, it will continue to “gain strength”: the skin around the nail will begin to swell, a purulent formation appears at the site of the ingrown nail, an increase in the finger with an ingrown nail, the release of serous and bloody fluid, wearing shoes brings unpleasant pain.

How to treat an ingrown nail

Treatment of an ingrown nail is necessary at the initial stage, until severe inflammation and suppuration occur. At home, steaming baths with potassium permanganate, soda, furacillin are recommended, followed by treatment of the area around the ingrown nail with antiseptic compounds. There are also special pharmacy products (for example, Uroderm, Nogtinorm, Nogtimitsin), which greatly facilitate the processing of the nail plate and contribute to the exit of its edges as it grows from under the periungual skin roller.

With the development of an inflammatory process, dressings with ointments or emulsions containing anti-inflammatory components or antibiotics (for example, levomethicin ointment, levomekol) are applied to the nail plate and periungual fold. The inflamed edge of the roller is carefully shifted with a cotton swab, a gauze flagellum is brought under it, which is impregnated with the desired composition.

For the gradual correction of an ingrown nail, the following method is used: the surface of the nail plate is regularly sawn off in the middle, retreating from the edges by 0. 5-0.8 mm. The thinning of the middle part of the nail causes a “reaction”: as it grows, the nail begins to seem to “tighten towards the middle” and thus it evens out over time and stops growing along the edges into the periungual roller.

Another very effective method of correcting an ingrown nail is orthonexia, that is, the installation of a special plate in the form of a bracket (Frezer’s bracket, Gorkievich’s bracket). In some ways, this method is similar to the installation of braces in dentistry. With the help of a staple, the corners of the nails are brought out and rigidly fixed, after which the nail begins to grow without ingrowth. The staple can be installed if there is no inflammation of the soft tissues around the nail plate, psoriasis, nail fungus.

Ingrown toenail surgery

Surgical removal of an ingrown nail is indicated only in advanced cases, when conservative treatment does not give a positive result, and also when there is a long-term inflammation of the soft tissues around the nail plate with the formation of suppuration and it is necessary to prevent suppuration of the bone tissue.

The operation involves a partial resection, that is, a part of the nail plate that grows into the skin, or a complete one, is removed. Partial resection will be relevant in cases where the roller is thickened. And if there is a serious suppuration, as a rule, we are talking about removing the entire nail plate.

After the operation, the patient regularly comes to the clinic for examination and dressing, and this requires patience. Because you will have to change the bandages until a new nail grows.

In DECA, an ingrown toenail is removed with a laser. During the procedure, the pathological part of the nail plate is removed, as well as damaged tissues of the periungual ridge. Under the radiation of a carbon dioxide laser, the pathogenic zone is literally evaporated, while healthy tissues are not damaged.

Laser removal of an ingrown nail is characterized by low trauma and good efficiency. After this procedure, the rehabilitation period is much shorter compared to traditional surgery.