Ingrown Toenail

A common foot problem, ingrown toenails or onychocryptosis can be very painful and need to be treated by a chiropodist. If a splinter or the whole nail exert pressure against the skin on any or both sides of the nail, it will result in an ingrown toenail. If this pressure is prolonged, it can cause swelling, infection, and irritation of the skin and pain. An injury to the toe can also cause acute ingrown toenails. In a chronic condition, it lasts for a long time. Though it is the large toe that is affected normally, the other toes are sometimes affected.

Ingrown toenail can be the result of an abnormality of the soft tissue on the side of the nail. It may also be a result of laxity of the skin due to certain rare diseases. Wearing tight fitting shoes normally leads to soft tissue abnormality. Overcrowding of the toes because of these shoes will result in pushing the soft tissue against the sides of the nail. Nail abnormalities is another widespread factor for ingrown toenails.

During the developmental stages of the foot, wearing shoes that are very narrow or short can lead to bunching of the toes that causes the nail to curl into the skin and cause ingrown toenails. If a person cuts the toenail short and curved, it may result in the edges turning in. Sometimes advancing age, poor blood circulation at the extremities due to blockage in blood vessels may also cause curved nails. Ingrown toenails can also be caused by bone spurs beneath the nail, or a direct hit on the nail, or due to multiple infections and certain drugs like Indinavir; but these are not very common.

Trauma that is caused by stubbing the toenail or dropping heavy objects on the toe will injure the flesh and this condition makes the nail to grow irregularly. This nail may also press into the flesh. For some people, there is a tendency of the nails to grow inwardly because they are genetically prone to nail problems and nail deformities. Ingrown toenails are categorized as three stages.

I Stage: Painful to the touch, the skin on both sides of the nail appears red due to inflammation or irritation. This condition may not be due to infection.

II Stage: The skin may bulge over the side of the nail and this may be due to infection. There may be oozing of a clear fluid or pus in the affected area.

III Stage: The infection may try to heal itself if the infection had been there for a prolonged time. By forming granulation tissue, the infection tries to heal, but that will add to the problem by making the tissues bleed easily. These tissues also move over the nail edge.

Clinically ingrown toenails can be diagnosed by looking at their appearance. The presence of pus indicates bacterial infection and should be determined by a culture test. Infections might have spread to the bone or joint space at times and with a x-ray, the physician can rule out this possibility which is rare. Diabetics are more prone to this condition and so should pay proper attention to their feet. These people lose sensation in their feet if they develop peripheral neuropathies.

The treatment of ingrown toenails depends upon its stage. Warm soaks, cutout shoe and elevation of the toenail with a cotton swab are some of the measures taken for stage one. Though the symptoms may improve soon, there will be complete cure only after a few weeks. Along with warm soaks, oral antibiotics are given for stage two ingrown toenails. Surgical options are there to remove a portion of the toenail if it is extremely painful.

If the condition has reached the third stage then partial or full toenail removal is the only way. This procedure is known as partial nail avulsion (PNA). This procedure involves removal of the section of the ingrown nail after injecting the toe with a local anesthetic. It will take 4-6 weeks for the site to heal after this surgery which is very common and painful.

How to prevent ingrown toenails?

1. Cut the nails straight across; do not cut the nails along a curve or very short.
2. Use foot wear that fits well. Shoes that are small in size or width will aggravate any problem that already exists with a toenail.
3. Prevent injuries to the toes by wearing shoes almost always during working or playing.
4. It is a myth that a V cut at the end of the ingrown nail will help the edge of the nail grows together. Only the growing area at the base of the toe determines the shape of the nail and it is not the end of the nail that determines it. It takes almost up to one year for a toenail to grow and this method will in no way hurry the growth.