What are the main causes of ingrown toenails. How can you recognize the symptoms of an ingrown toenail. What are the most effective treatment options for ingrown toenails, both at home and from a doctor. How can you prevent ingrown toenails from developing in the future.

Understanding Ingrown Toenails: A Common and Painful Condition

An ingrown toenail occurs when the edge of the nail grows into the surrounding skin, causing pain, swelling, and potential infection. While this condition can affect any toe, it most commonly impacts the big toe. Understanding the causes, symptoms, and treatment options for ingrown toenails is crucial for maintaining foot health and preventing complications.

What exactly is an ingrown toenail?

An ingrown toenail develops when the corner or side of a toenail grows into the soft flesh surrounding it. This can happen due to various factors, including improper nail trimming, tight footwear, or trauma to the toe. As the nail penetrates the skin, it can lead to inflammation, pain, and in some cases, infection.

Common Causes of Ingrown Toenails: From Nail Trimming to Footwear

Several factors can contribute to the development of ingrown toenails. By understanding these causes, individuals can take steps to prevent this painful condition:

• Improper nail trimming techniques
• Wearing shoes that are too tight or short
• Trauma to the toe, such as stubbing or having it stepped on
• Genetic predisposition (congenital nail shape)
• Repetitive pressure on the toes (e.g., from certain sports or activities)
• Poor foot hygiene

Is improper nail trimming really a major cause of ingrown toenails?

Yes, improper nail trimming is indeed a significant contributor to ingrown toenails. Many people make the mistake of cutting their toenails too short or rounding the edges to match the curve of their toe. This technique can encourage the nail to grow into the surrounding skin. To prevent this, it’s essential to cut nails straight across and avoid tapering or rounding the corners.

Recognizing the Symptoms: From Discomfort to Infection

Identifying the symptoms of an ingrown toenail early can help prevent more serious complications. Common signs include:

1. Pain and tenderness along the side of the toenail
2. Redness and swelling around the affected area
3. Warmth in the toe
4. Possible drainage or pus if infection develops
5. Difficulty wearing shoes comfortably

Can an ingrown toenail lead to serious complications if left untreated?

Yes, if an ingrown toenail is left untreated, it can lead to more severe complications. The most common concern is infection, which can spread beyond the immediate area and potentially affect the underlying bone. This is particularly dangerous for individuals with compromised immune systems or conditions like diabetes that affect circulation and wound healing.

Home Remedies: Managing Ingrown Toenails Without Surgery

For mild cases of ingrown toenails, several home remedies can provide relief and promote healing:

• Soaking the affected foot in warm water with Epsom salt
• Gently massaging the side of the nail fold to reduce inflammation
• Carefully lifting the edge of the ingrown nail and inserting a small piece of cotton or dental floss
• Wearing open-toed shoes or sandals to reduce pressure on the toe
• Using over-the-counter pain relievers like ibuprofen or acetaminophen

How effective are home remedies for treating ingrown toenails?

Home remedies can be quite effective for mild cases of ingrown toenails, especially when caught early. These methods can help reduce pain and inflammation while allowing the nail to grow out properly. However, if symptoms persist or worsen after a few days of home treatment, it’s crucial to seek professional medical advice.

Professional Treatment Options: When to See a Doctor

In cases where home remedies are ineffective or the ingrown toenail is severe, professional medical treatment may be necessary. A healthcare provider may recommend:

1. Lifting the nail and placing cotton or a splint underneath
2. Partial nail avulsion (removing part of the nail)
3. Complete nail plate avulsion (removing the entire nail)
4. Matricectomy (removing part of the nail bed to prevent regrowth)
5. Prescribing antibiotics if an infection is present

What does the partial nail avulsion procedure involve?

Partial nail avulsion is a common surgical procedure for treating ingrown toenails. During this process, the doctor numbs the toe with a local anesthetic and then carefully cuts and removes the ingrown portion of the nail. This procedure provides immediate relief and allows the nail to regrow properly. In some cases, a chemical may be applied to prevent that portion of the nail from growing back, reducing the risk of recurrence.

Preventing Future Ingrown Toenails: Proper Foot Care Techniques

Taking preventive measures can significantly reduce the risk of developing ingrown toenails. Key strategies include:

• Trimming toenails straight across, avoiding rounded edges
• Wearing properly fitting shoes with adequate toe room
• Keeping feet clean and dry
• Protecting feet from injury
• Avoiding tight socks or hosiery
• Regularly inspecting feet for signs of problems

How important is proper footwear in preventing ingrown toenails?

Proper footwear plays a crucial role in preventing ingrown toenails. Shoes that are too tight or short can compress the toes, forcing the nails to grow abnormally. Choosing shoes with a wide toe box and adequate length allows toes to move freely and reduces pressure on the nails. This is especially important for individuals who engage in activities that put repetitive stress on the feet, such as running or dancing.

Special Considerations: Ingrown Toenails in High-Risk Populations

Certain groups of people may be at higher risk for complications from ingrown toenails and require special care:

• Diabetics
• Individuals with peripheral neuropathy
• Those with poor circulation
• People with compromised immune systems
• Athletes and dancers

Why are diabetics at higher risk for ingrown toenail complications?

Diabetics are at higher risk for complications from ingrown toenails due to several factors. First, diabetes can lead to reduced sensation in the feet (neuropathy), making it harder to detect early signs of an ingrown toenail. Additionally, poor circulation associated with diabetes can impair healing and increase the risk of infection. For these reasons, diabetics need to practice meticulous foot care and seek prompt medical attention for any foot-related issues, including ingrown toenails.

The Role of Podiatrists in Treating Chronic Ingrown Toenails

For individuals who experience recurrent ingrown toenails or have complex foot health issues, consulting a podiatrist can be beneficial. These foot specialists can provide:

1. Expert diagnosis and treatment of ingrown toenails
2. Customized preventive care plans
3. Advanced surgical techniques for severe cases
4. Comprehensive foot health assessments
5. Education on proper foot care and nail trimming techniques

When should someone consider seeing a podiatrist for ingrown toenails?

Individuals should consider seeing a podiatrist for ingrown toenails if they experience recurrent issues, have a medical condition that affects foot health (such as diabetes), or if home remedies and general practitioner treatments have been ineffective. Podiatrists can offer specialized care and may recommend permanent solutions for chronic ingrown toenails, such as partial matrixectomy, which prevents the problematic portion of the nail from regrowing.

Understanding the Anatomy of Toenails: Why Ingrown Nails Occur

To fully comprehend why ingrown toenails develop, it’s helpful to understand the basic anatomy of toenails:

• Nail plate: The visible part of the nail
• Nail bed: The skin beneath the nail plate
• Nail matrix: The area where nail growth originates
• Nail folds: The skin on the sides of the nail
• Lunula: The white, half-moon shape at the base of the nail

How does the shape of the nail matrix influence the likelihood of ingrown toenails?

The shape of the nail matrix plays a significant role in determining the natural curvature of the toenail. Some individuals are born with a nail matrix that produces nails with a more pronounced curve, increasing their susceptibility to ingrown toenails. This genetic predisposition, combined with environmental factors like tight shoes or improper trimming, can lead to recurrent ingrown toenail issues. Understanding one’s natural nail shape can help in developing an appropriate preventive care routine.

By comprehending the causes, symptoms, and treatment options for ingrown toenails, individuals can take proactive steps to maintain foot health and prevent this painful condition. Whether through proper nail care, appropriate footwear choices, or timely medical intervention, managing ingrown toenails is an essential aspect of overall foot care. Remember, while many cases can be treated at home, persistent or severe symptoms warrant professional medical attention to prevent complications and ensure proper healing.

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 Toenail Removal | AAFP

Am Fam Physician. 2002;65(12):2557-2558

What is an ingrown toenail?

An ingrown toenail occurs when the nail edge is damaged, and the nail no longer fits properly into the side groove. The nail curls downward and digs into the skin, causing pain, swelling, redness, and drainage. Sometimes a piece of nail (called a lateral pointing spicule) becomes embedded in the side tissue, and the tissue becomes heaped up (hypertrophied).

What causes an ingrown toenail?

There are many causes for ingrown nails, but the two most common causes are poorly fitting shoes and improperly trimmed nails. Tight shoes compress the side of the nail and alter the fit of the nail in the groove. When nails are peeled off or torn, the edge of the nail can extend down into the corner of the nail groove. A torn nail can irritate the skin next to the nail, producing inflammation (swelling, pain, and redness) and sometimes infection.

Can ingrown nails be prevented?

Proper trimming of the nails is the best way to prevent an ingrown nail. Nails should be cut straight across, with the corners of the nail protruding from the end of the toe. Children or teenagers who play with their toes in bed at night can wear socks to bed to keep them from peeling or picking at their toenails.

How can I treat my painful nail?

When an ingrown toenail is mildly inflamed (slightly red and sore), soaking the foot in warm water and placing a piece of dry cotton under the corner of the nail may be all that is needed. If the ingrown toenail gets worse, the inflammation (pain, swelling, and drainage) may increase. An antibiotic ointment can be tried at this stage. After you see your doctor for the problem, he or she may try oral antibiotics. Surgical removal of part of the nail is often needed if the problem becomes worse.

What is the recommended surgical procedure for ingrown nails?

Surgical removal of an ingrown nail involves removing a small portion of the side of the nail and destroying the nail bed beneath. The toe is injected with a numbing medicine, and the toenail is cut to create a new, straight nail edge. The cells underneath the nail will try to grow a new nail, so they must be destroyed, thereby creating a permanently thinner nail. If there is heaped up (hypertrophied) tissue on the side of the toe, it must be removed. The toe is then bandaged until it completely heals (a few weeks).

What is the recovery time from my surgery?

You should keep your foot elevated for a few hours and rest on the day of the surgery; the next day, you can return to work or school. You should refrain from running or vigorous exercise for 2 weeks after the surgery.

Following Ingrown Toenail Removal

1. Antibiotic ointment will be applied to the toe immediately after the procedure. The ointment is soothing and helps the toe to heal faster. You should apply the antibiotic ointment twice daily until the wound is completely healed. We like the over-the-counter (nonprescription) antibiotic ointment Mycitracin Plus because of the numbing medication mixed in with the antibiotic.

2. You may shower the day after the surgery. Gently dry the area and apply antibiotic ointment after showering. Avoid baths, swimming, or soaking the toe for the next 2 weeks. Try to keep the toe clean and dry.

3. Your bandage will help to pad and protect the wound, while absorbing drainage from the wound. You can replace the bandage if blood or fluid soaks the bandage. Please keep the wound bandaged for at least 1 week after the surgery.

4. You may experience some pain after the procedure. If you experience discomfort, you can take ibuprofen (brand names: Advil, Motrin, Nuprin), three 200-mg tablets 3 times a day with food, and acetaminophen (brand name: Tylenol), two 325-mg tablets every 4 hours.

5. You should wear loose-fitting shoes or sneakers for the first 2 weeks after the procedure. Please avoid wearing high-heeled or tight-fitting shoes in the future. You should avoid running, jumping, or strenuous activity for 2 weeks after the surgery. Teenagers should not participate in physical education activities for 1 to 2 weeks after the procedure.

6. Infection may develop in the toe during the first few weeks after the surgery. Call your doctor if you develop increasing pain, swelling, redness, or drainage from the toe.

7. Trimming the nails straight across the top of the nail is the best way to prevent another ingrown nail from developing. The nail must not be cut down into the corners, or picked at, or torn off. If you should develop another ingrown nail, see your doctor early, because early treatment may prevent the need for surgery.

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

Treatment of ingrown nail

The problem of an ingrown nail is familiar not only to women who are concerned about the beauty of their fingers, but also to men. Moreover, men are more likely to resort to procedures for the treatment of an ingrown toenail on the big toe.

Ingrown nail plate along the side of the nail, usually toes, brings a lot of anxiety to an adult and a child; causes severe pain, inflammation and abscesses, makes it difficult to walk and play sports. The reasons for this problem may be wearing uncomfortable shoes, fungal diseases, advanced inflammatory processes, hereditary predisposition.

Nowadays, there are many ways to cure an ingrown toenail without starting a problem. In the initial stages, the removal of the ingrowing part of the nail is carried out using conservative methods. With the development of the disease, most of the nail is removed and the affected part of the soft tissues is disinfected.

In our clinic, the surgeon Kazakov Mikhail Valerievich successfully performs the removal of an ingrown nail in the traditional way – surgical excision, as well as with the help of the COVIDIEN Force Triad electrosurgical high-frequency device.

The choice of treatment method depends on the condition of the disease and the speed of recovery after the procedure. In most cases, the operation is absolutely painless and does not bring discomfort to the patient.

Surgical removal of the ingrown toenail is the only method for ingrown toenails accompanied by suppuration of the surrounding soft tissues. The operation is performed under local anesthesia. The most commonly used partial removal of the nail plate (marginal resection). This intervention is more gentle compared to the complete removal of the nail plate, it is characterized by less postoperative discomfort and a quick recovery. Complete removal of the nail is prescribed if both sides of the nail plate grow in, with the spread of pus under the nail bed, as well as with severe fungal or dystrophic damage to the nail. The disadvantage of the method is the long healing process, during which the nail plate grows. This period is accompanied by unpleasant sensations and a feeling of discomfort. With repeated, recurrent, ingrown nail plate, methods of partial removal of the nail plate with plastic surgery of the nail bed and roller are used. This intervention allows you to completely eliminate the ingrown nail in the future, however, it is more traumatic and requires a longer recovery.

The electrosurgical procedure is performed using the COVIDIEN Force Triad Electrocoagulator. The method is based on the impact of high frequency current on the damaged area of ​​the skin and the nail plate. The advantages of this technology include high efficiency and no pain during the procedure. The electrosurgical method is characterized by a low degree of traumatism and a fairly quick rehabilitation. But there is a risk of relapses: with insufficient exposure power, it will not be possible to completely stop the disease.