An ingrown toenail is a painful condition of the toe that occurs when the sides or corner of the toenail digs into the skin at the end or side of the toe. The condition mostly affects the outer edge of the big toe, although the nail on both sides of the toe, or nail on any toe can become ingrown.
An ingrown toenail is also known as onychocryptosis.
What causes ingrown toenails?
The causes for ingrown toenails are listed below, but the two most common causes are ill-fitting shoes and improperly trimmed nails.
Ill-fitting shoes such as tight shoes, high heels and pointed-toe shoes cause the toes to be compressed together so that the nail curls into the skin and cannot grow normally.
Improper trimming of toenails can cause the nail edge or corner to dig into the skin. Toenails should be trimmed straight across so that the top of the nail should make a straight line.
Injury near the nail such as a ripped nail or nail peeled off at the edge can cause an ingrown toenail.
Fungal infections of the nail can cause a thickened or widened toenail to develop.
Prescribed medications, particularly oral retinoids such as isotretinoin and acitretin.
Usually an ingrown toenail will be visibly obvious, but you may not realise you have an ingrowing toenail until it is too late.
Onychocryptosis symptoms include pain, swelling and redness around the nail. Speak to a podiatrist for a professional identification of the condition and treatment recommendations.
Onychocryptosis: surgery or other podiatric treatment
Podiatric management of an ingrown toenail depends on what presents and to what level the nail is ingrown.
There are many people that are happy to have conservative nail clipping and clearing to keep them comfortable.
There are those that do not have an option but to remove the sides of the nail with a nail wedge resection. Surgical removal may be necessary when conservative management fails to keep the nail in shape, or becomes too painful to manage.
Those that present with a swollen, red and hypergranulated toe may have no choice but to undergo the minor procedure as conservative care will be too painful.
The nail wedge resection with phenolisation is a specialised technique used by podiatrists that is 95% successful in clearing the problem with minimum trauma and pain during and after the procedure.
It can be done under local anaesthetic utilising a ring block of the toe.
Using local anaesthetic, a tourniquet, and specialised instruments the podiatrist can painlessly remove enough nail to leave the nail looking normal once healing has taken place. Healing depends on the health of the individual, but the average settling time of the wound is 10 -14 days, before closed shoes can be worn again.
Other treatment for ingrown toenails
Ingrown toenails may also be treated by a gutter splinter using slit plastic tubing to keep the nail and the lateral nail folds apart.
These are kept in place by using tape or acrylic adhesive. An artificial nail may be sculputured using formable acrylic solution.
Can ingrown toenails be prevented?
Adhering to the following simple rules can easily prevent ingrown toenails:
Clip toenails straight across – do not cut them too short and do not round off the edges.
Wear well-fitting shoes.
Keep the feet clean and dry.