Date :25-Oct-2021

An ingrown toenail (unguis incarnates, onychocryptosis) is a common condition and it happens when the edges or corners of the nail grow into the skin next to the nail and sever the skin. It can be painful, causing redness, swelling and sometimes infection. It generally affects the big toe, either on one or both sides of the toe. Though smaller in size, ingrown toenails can have great ramifications when considering the amount of pain they inflict and the frequency of the problem. 

When the pain due to ingrown toenails is severe or spreading, it will be necessary to see the doctor, to relieve symptoms and prevent complications. The breakage of ingrown toenail causes a break in the skin and cause an infection in the area, which is often marked by bleeding and pus with a foul odour.

Causes

Causes of ingrown toenails include:

• Heredity: This also plays a part in some persons. The tendency for ingrown toenails is inherited especially those associated with collagen abnormalities (e.g., nail-patella syndrome, Darier’s disease and pachyonychia congenita).
• Mycotic Infections and Trauma: Sometimes an ingrown toenail is the result of infections i.e. fungal infections. Traumatic incidents, such as large object falling on your toe, stubbing your toe or engaging in activities that involve repeated pressure on the toes, such as running or kicking.
• Occlusive footwear : Ingrown toenails can result from wearing improperly sized footwears.
• Improper trimming: This is the most common cause of ingrown nails. Trimming your nails too short encourages the skin adjacent to the nail to fold over the nail.
• Medical conditions: People with deprived circulation, such as those with peripheral vascular disease and also those who are diabetic, are more likely to have complications. Rheumatologic, Hematologic, endocrine, hepatic, renal, gastrointestinal disease and pulmonary diseases can also significantly change the shape, colour, thickness, texture or growth rate of nails.

Once symptoms appear, ingrown toenails should be treated immediately particularly if the person has diabetes, poor circulation in the foot or nerve damage in the foot or leg. Otherwise, complications can happen. Management of ingrown toenails may involve conservative measures or minor surgery depending on the extent of impingement and infection.

CONSERVATIVE TREATMENT

Prophylactic measures:

• Baggy stockings and shoes with a spacious toe box may decrease extrinsic pressure on the toenail.
• Correct toenail trimming may prevent impingement on adjacent soft tissue.

General measures: Inform patients to decrease activity for alleviating symptoms, such as running and other sports, as this may reduce inflammation.

Erythema is reduced by soaking the foot in lukewarm, soapy water 3 times daily. Massaging the inflamed area will promote drainage.
Use of a broad-spectrum, first-generation cephalosporin may counter an early infection.

SURGERY

Toenail avulsion: This is the most common surgical procedure performed on the nail unit. Removal of body of the nail plate from its normal attachments through surgery is called toenail avulsion. The edges of the toenail will be cut away, to make it narrower. Doctor may also take out the folds of skin on either side of the toenail. In most of the patients, they only need to remove a small section at one or both sides of the nail (partial nail avulsion). This is usually done under local anaesthetic.

The hypergranulation tissue is an overreaction to the irritation and / or infection of an ingrown toenail if it has been present for some time and there is often a build up of excess tissue that bleeds easily and looks red. This will also be removed during the operation. This is not usually very painful, and most people can get back to normal activity the same day. The advantages of complete/ partial avulsion is lesser discomfort, no episodes of infection and walking will be easier with easier shoe choice.

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