Ingrown Toenail

Ingrown toenails (onychocryptosis) are a common, painful condition that occur when 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. This condition is usually very painful and can be associated with infection of the toe. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Irritation, redness, incomfort and swelling can result from an ingrown toenail.

Causes

Ingrown toenails can develop for various reasons. Usually, the tendency to have this common disorder is inherited such as toenails that simply are too large. People with crooked toes, either congenitally or from diseases like arthritis, are prone to ingrown toenails. In other cases, an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.

Repeated trauma, such as the pounding to which runners typically subject their feet, also can cause ingrown nails.
Another common cause is cutting your toenails incorrectly, often leaving a spicole (edge of nail) in the skin. Cutting your nails too short encourages the skin next to the nail to fold over the nail. Tight hosiery or shoes with narrow toe boxes only make matters worse. If the skin is red, painful or swollen on the sides of the nail, an infection may be present.

When the nail penetrates the skin, it provides a convenient entry for germs that can cause infection. Untreated, the nail can go under the skin, causing a more severe infection. In either case, the infection needs to be cured with sterile instruments.

Treatment and Prevention

Ingrown toenails should be treated as soon as they are recognized. In many cases, people with uninfected ingrown toenails can obtain relief with the following simple regimen:

  1. Soak the feet in luke warm salt wate (1 tablespoon in 4 liters)
  2. Dry them thoroughly with a clean towel
  3. Apply a mild antiseptic solution to the area
  4. Bandage the toe
  5. Seek podiatric help.

If inflammation, swelling, pain or discharge is present you should see a podiatrist to be treated.

Cutting toe nails properly goes a long way toward the prevention of ingrown toenails. Using a safety nail clipper, cut the nails straight across, so that the nail corner is visible without tapering the corners.  However, this can be difficult if the nail is very curved down the side. In this case, DO NOT ‘dig’ down the sides – see a podiatrist to resolve your problem.  You can always file the edges. If you cut the nail too short, you are inviting the nail corner to grow into the skin. It is the natural tendency, when the edge of the nail starts to grow in, to cut down at an angle at the nail edge, to relieve the pain.  This does relieve the pain temporarily, but it also can start a downward spiral, training the nail to become more and more ingrown and curved.

Those with poor circulation or diabetes should not do any self-management of ingrown toenails but should see a Podiatrist.

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 that is causing the ingrown toenail is removed, the infection is likely to persist.

Ingrown toenails have a great tendency to be reccurent.  They happen in the first place because of a number of reasons – the most common of those reasons is the shape of the nail: generally, if it is curved down the side or too large.

If the ingrown nail is severe, or if it does not respond well to conservative care, then a minor surgical intervention is a good option.  It is a relatively simple procedure that is successful for long-term relief of the condition.

Generally, after the surgery you will need to keep your foot elevated for a few hours and rest is advisable.  The same day, you can return to work or school.  It is recommended not to take part in vigorous activities, such as running for 1 to 2 weeks after the surgery.