What is an Ingrown Toe Nail?
An ingrown toenail (onychocryptosis) occurs when an edge of the nail penetrates the skin. This often results in an infection. The nail can also apply pressure in the nail fold area beside the nail, without penetrating the skin – this can also be painful as a corn /callus can build up down beside the nail (in the nail sulcus).
The severity of symptoms will vary, from some where a nail appears deeply embedded down the side or sides of the nail and in others, the corner or a small spike of nail may penetrate the skin, just like a knife. This can result in an infection and in many cases, the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.
- Poor cutting of the nail is most commonly seen as the cause of an ingrown toe nail, but this is not always the case. The following factors are involved in the cause of ingrown toenails:
- Nail shape plays a major roll .A nail that is more curved from side to side rather than being flat is more likely to become symptomatic (involuted nails). Some nails curve down the side at an almost vertical angle along the length of the nail, these can particularly increase pressure on a calloused, thickened nail sulcus.
- The shape of the nail is usually inherited (congenital), but it can be influenced by trauma and/or shoe pressure.
- Poor cutting of these types of nails can leave a sharp corner a small spike that will initially cause symptoms by putting pressure on the skin and then later penetrate the skin. Trimming too far down the sides is a common cause of an ingrown toe nail, as very often the nail is cut right to the very edge and breaks away instead leaving a jagged side.
- Tighter shoes increases pressure and increase the risk of a nail ingrowing.
- Previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail.
- Pressure from the toe next to the nail that has ingrown can sometimes be a factor.
- Fleshier, fatter toes have greater skin folds increasing the risk of nail pressure, and nails ingrowing.
- Increased moisture/sweating, e.g. adolescents, makes the skin less able to withstand the pressure or shearing of a nail and can result in ingrown nails, especially in active and sporty people.
Initial treatment of the ingrown nail (onychocryptosis):
- Antibiotics are often needed to treat the infected ingrown toenail, but don’t forget that the cause of the infection (the ingrown nail) is still there, so there is not a lot of point in treating the infection while the cause remains. Sometimes antibiotics may be needed to help the infection clear following treatment, particularly in patients with impaired healing (e.g. diabetics, those with impaired immunity or circulation).
- A skilled Podiatrist can easily remove the corner or spike that has penetrated the skin, often with relatively little discomfort. If the ingrown nail is too painful, a local anesthetic may be needed to do this. Don’t forget that unless the offending piece of nail is removed, the infection is likely to persist.
- After this, daily saline cleansing and antiseptic dressings for a few days will generally clear up the infection. Especially if you are healthy and have no healing problems. Again antibiotics and/or prolonged period of dressings are needed, especially if there is a problem with wound healing or if the circulation is poor or if you have diabetes.
- Occasionally, if symptoms persist or flare up, it is best to check for another piece of nail deeper down, causing the ingrown toenail.
Ongoing treatment of the ingrown toenail (onychocryptosis):
- Ingrown toe nails have a great tendency to happen again. Regular treatment by a Podiatrist can often be needed, as a conservative approach to prevent the nail becoming a problem.
Surgical treatments of the ingrown toe nail (onychocryptosis):
- If the ingrown nail is severe and persistent and conservative care is difficult with poor response, then minor surgical intervention is a good option. Minor surgery is a relatively simple procedure and is very successful for long term relief that is permanent.
- A number of different minor surgical procedures can be used by a Podiatrist to treat an ingrown toe nail and are done in the clinic under a local anesthetic.
- The most common procedure is the permanent removal of a portion of the nail on the affected side of the toe nail that is causing the problem. In the worst case of a total nail which is curved; it may be necessary to remove the entire nail.
- After a nail or part of the nail is removed, it will grow back as the growing cells at the base of the nail are still there – unless something is done to remove them. A chemical application is used to destroy the Nail Matrix (growing cells) to prevent regrowth. Very rarely, some cells survive and a regrowth occurs.
It is recommended that, after the surgery you keep your foot elevated for a few hours and rest is advisable. The following day usual activities can be resumed. It is advisable not to take part in vigorous activities, such as running for 2 weeks after the surgery. The use of an open toe shoe, so that there is no pressure on the area also facilitates healing. Also the area must be kept dry and be redresses every 2-3 days by your Podiatrist to prevent infection and monitor healing to ensure a satisfactory outcome.
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