Ingrown Toenails

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Overview

Ingrown toenails are known to physicians as onychocryptosis. They are common, painful conditions that occur when the skin on the side of a toenail grows over the edge of the nail, or when the nail grows into the skin.

Ingrown Toenail Click on the image to view a larger version.

Causes

Ingrown toenails can develop for many reasons. In some cases, the toenails are simply too large or the condition develops as a result of genetically inherited tendencies. Persons whose toes curl (congenitally or from disease such as arthritis) are prone to onychocryptosis.

Trauma, such as stubbing a toe or having one stepped on can cause a piece of the nail to jam into the skin. Frequent running also can cause ingrown toenails. Ingrown nails can be caused by trimming them incorrectly, causing them to regrow into the skin, by excessively tight stockings, or by shoes with narrow toe boxes. Bedridden patients commonly develop ingrown toenails if the bedsheets are kept tucked-in tightly.

Fungal infections can also cause ingrown toenails. In some cases, the infection progresses toward and beneath the cuticle into the root of the nail, causing damage that results in an abnormal growth pattern.

Signs and Symptoms

Onychocryptosis should be treated as soon as it develops. If the skin is red, painful, or swollen on the sides of the nail, there may be an infection. The ingrown nail is in warm, often moist, and bacteria-rich environment and it provides a convenient entry for germs that can cause infection. At first, the skin around the nail may be mildly red or inflamed. Untreated, the nail can go under the skin, causing a severe infection. The infection must be cured using sterile instruments and antibiotics. People who attempt to fix an infected toenail themselves may worsen the problem.

Treatment

• soak the feet in warm soapy or salt water;
• dry them thoroughly with a clean towel;
• apply a mild antiseptic solution to the area; and
• bandage the toe.

Various over-the-counter preparations are available that can harden the skin and shrink the soft tissue along the edge of the nail so it grows normally. A soft, foam toecap can be worn while the ingrown nail heals.

If excessive inflammation, swelling, pain, and discharge develops, the toenail probably is infected and should be treated by a physician. A podiatrist can trim or remove the infected nail with a minor in-office surgical procedure. A portion of the nail or overgrown skin is removed with a scalpel and the infection is treated.

If an ingrown toenail recurs, it may require a more permanent solution. A small portion of the nail and nail matrix (part of the nail that actually grows) is removed with a scalpel or cauterized with a concentrated chemical solution. This makes the nail narrower and prevents a portion of the nail from growing back, ensuring that it will not irritate the adjacent skin. The chemical treatment is a slightly less invasive procedure. It causes mild inflammation that lasts about a week. This procedure often cannot be used in severe infections because the chemical used (phenol) may be neutralized by the infection. In these cases, the physician must remove the infected nail with a scalpel.

Prevention

Unless the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and wear shoes with adequate room for the toes. Nails should be trimmed straight across with clippers to a comfortable length.

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