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Common Foot
Conditions
Ingrown
Nails
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.
Causes
Ingrown toenails can develop for many reasons. In some
cases, the toenails are simply too large. 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.
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
Uninfected ingrown toenails can be treated following
this regimen:
-
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 burned 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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