The ingrown toenail, also known as onychocryptosis, is a painful condition of the toes.It occurs when a sharp corner of the toenail digs into the skin at the end of or side of the toe. Pain and inflammation at the spot where the nail curls into the skin occurs first. Later, the inflamed area can begin to grow extra tissue or drain yellowish fluid.
- When left untreated, it can develop into an infection or even an abscess which may require surgical treatment. Osteomyelitis is a rare complication of an infected toe, in which the bone itself becomes infected.
- Ingrown toenails are common in adults and adolescents but uncommon in children and infants. They are more common in men than in women. Young adults are at greater risk.
- Any toenail can become ingrown, but the condition usually occurs in the big toe.
Causes of Ingrown Nail
- Tight-fitting shoes or high heels cause the toes to be compressed together and pressure the nail to grow abnormally.
- Improper trimming of toenails can cause the corners of the nail to dig into the skin. Nails should be trimmed straight across, not rounded.
- Disorders such as fungal infections of the nails can cause a thickened or widened toenail to develop.
- Either an acute injury near the nail or anything else that causes the nail to be damaged repetitively (such as playing football) can also cause an ingrown nail.
- If a family member has an ingrown nail, then it is more likely to occur in other members of the family, too. Some people’s nails are normally more rounded than others or the underlying bone can be more “upturned,” which increases the chance of developing ingrown nails.
Treatment
If no acute infection is found, then the nail will be elevated and then conservative treatment will be applied. This consists of warm soaks, proper shoes, and frequent cleaning of the nails.
Sometimes, your doctor may choose to use a splint. Several types of splints are available that protect the skin from the sharp corner of the nails. Some of the most common types of splints include cotton wicks, plastic strips, plastic tubes down the side of the nail, and various resins.
Occasionally, a doctor may try to file or cut the nail down the centre in order to change the shape of the nail as it grows. A piece of hard plastic can also be glued to the nail to help it grow out flatter and straight.
If any extra tissue has grown up around the inflammation, the doctor may choose to remove it to help it heal faster.
Surgery for Ingrown Nail
If an infection is present, then surgical removal of either part of the nail or the whole nail and drainage of the abscess will be required. The extent of the procedure will depend on the severity of the infection, any other medical problems, and if this is a recurring problem.
The doctor will remove part of the nail so as to treat the skin or the infection without any pressure from the nail.
The doctor may decide to destroy some of the cells that make the nail grow back by applying a chemical (phenol or sodium hydroxide) to the skin under the nail. Adding phenol at the end of the procedure decreases recurrence rates but can be associated with increased infections. Some alternative methods of ablating the cells include surgical excision, lasers, electrocautery, or cryotherapy. This is performed so that to avoid the regrowth of the edge of the nail that caused the problem, which is more likely with severe or recurring infections.
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