Ingrown toenail

An ingrown toenail, medically termed as onychocryptosis or unguis incarnatus, represents a frequently encountered foot ailment wherein the toenail, most commonly of the big toe, grows into the adjacent skin, leading to symptoms that range from mild discomfort to severe pain and potential infections. This condition often arises due to a combination of genetic predisposition, improper footwear, and incorrect nail-trimming techniques.

Toe nail (in grown)

Etiology and Pathogenesis

Several factors contribute to the development of an ingrown toenail:

Ingrown nail postop

• Footwear: Shoes that are too tight or narrow at the toes can press the nail into the surrounding tissue.
• Nail Trimming: Cutting toenails too short or not straight across might promote nail ingrowth.
• Trauma: Injury to the toenail, either through direct trauma or repetitive pressure (like long-distance running), can predispose to ingrown toenails.
• Anatomy: Some people have naturally curved toenails that tend to grow into the skin.
• Fungal Infections: These can thicken or widen the toenail.

Clinical Presentation

Patients with ingrown toenails often present with:

• Pain and tenderness along the nail borders.
• Swelling and redness.
• Warmth.
• Purulent discharge, indicating a bacterial infection.
• Overgrowth of skin around the nail (known as granulation tissue).

Diagnosis

The diagnosis of an ingrown toenail is primarily clinical, based on the physical appearance of the toe. If infection is suspected, a sample of the pus may be sent to the lab for culture and sensitivity testing.

Management

Treatment modalities are determined based on the severity of the condition:

• Conservative Treatment: For mild cases, soaking the foot in warm salt water, using over-the-counter pain relief, and wearing open-toed shoes might suffice.
• Surgical Treatment: For recurrent or severe cases, partial or total nail removal might be necessary.
• Partial nail avulsion: Removes a section of the toenail, usually performed under local anesthesia.
• Complete nail plate avulsion: The entire toenail is removed.
• Antibiotics: If there's an associated bacterial infection, oral or topical antibiotics may be prescribed.

Prevention

Prevention strategies include:

• Proper toenail trimming: Straight across and not too short.
• Wearing comfortable, well-fitted shoes.
• Inspecting feet regularly, especially in diabetic individuals.

Complications

If not addressed, an ingrown toenail can lead to:

• Cellulitis: A skin infection.
• Abscess: A pocket of pus.
• Osteomyelitis: A bone infection, in severe, untreated cases.

References

Heidelbaugh, J.J., Lee, H. (2009). Management of the ingrown toenail. American Family Physician, 79(4), 303-308. Haneke, E. (2012). Controversies in the treatment of ingrown nails. Dermatology Research and Practice, 2012.

See Also

• Foot disorders
• Nail diseases
• Cellulitis
• Osteomyelitis

By understanding the causes, presentation, and management of ingrown toenails, medical practitioners can effectively treat and guide patients in the prevention of this common and painful condition.

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