INGROWN TOENAIL

Do the sides of your nails, especially the big toe, feel painful? Is there discomfort when wearing shoes? Are you fond of performing self-pedicure? Does wearing pointed shoes sound like a part of your daily routine? If you say yes to these questions, you might be experiencing or setting up the stage for ingrown toenail.

What is Ingrown Toenail?

Ingrown toenail is one of the most common nail conditions. It is also known as onychocryptosis or unguis incarnatus. The sides of the growing nail penetrate the skin, usually the lateral nailfold. The ingrown nail is recognized as a foreign material by the body that causes subsequent swelling and pain over the affected skin. Though it may sound like a benign condition, unguis incarnatus can be potentially devastating to patients with diabetes mellitus or spinal cord injuries (SCI). An infection or granulation tissue may develop secondary to the body’s immune response against onychocryptosis. This may lead to a non-healing wound, ulceration, and/or amputation if not addressed immediately with diabetic patients. SCI patients with high neurological levels of injury from T6 and above can experience autonomic dysreflexia due to ingrown toenail infection. Autonomic dysreflexia is a medical emergency where there is rapid elevation of blood pressure due to deranged adrenaline activity in the body.

What are the causes of Ingrown Toenail?

The following are the common causes, but not limited to, developing ingrown toenail:

• Performing self-pedicure

Cutting the sides of the nails incompletely may cause ingrown toenail development. The nail usually grows towards the lateral nailfold in this instance and causes pain.

• Tight shoes

Habitual wearing of tight shoes increase pressure to the toes. This forces the sides of the nails against the sides of the nailfolds and can eventually cause ingrowth. Pointed shoes cramp the toes and will cause ingrown toenail through the same mechanism.  

• Tight stockings

External compression caused by tight stockings will force the nails to cut into the nailfolds. Daily compression will promote ingrown toenail.

• Toe deformities

Digit defermoties such as bunions or hammer toes give excess internal pressure to the toes. This leads to pressing and growth of the nails into the skin.

Diagnosis of Ingrown Toenails

Seek consult if you notice pain or discomfort on the sides of the toes. X-ray is not needed for diagnosis unless there is suspicion of a fracture in the affected digit or presence of a bony deformity.

Treatment

• Trim nails appropriately

This may sound hilarious but most do not know how to trim the toenails properly. Cutting the nails straight across prevents ingrown nails from occurring. Using a nail file on the nail corners to follow the toe shape is another good practice.

• Foot hygiene

Washing the foot with clean, warm water twice a day helps prevent infection from setting in. Pat dry the affected toe to avoid adding pressure to the nail. Soaking the foot in warm water helps facilitate drainage for ingrown toenails with infection.

• Find the right shoe and stocking size

Shoes with wide toe boxes are preferred to avoid this condition. Wearing a shoe that is longer by a half inch than the big toe is the best length for most individuals. Make sure to also find the right stocking size for you.

• Pressure relief

 Putting a cotton pad or dental floss underneath the corner of the affected nail can cause pressure relief in mild cases. This technique works in some cases.

• Toe crests and bunion sleeves/relief

Toe crests and bunion sleeves/relief are composed of soft pads that provide pressure relief for cases of hammer toe and bunion, respectively. Relieving pressure off the affected nail and correction of anatomical deviation are important to avoid onychocryptosis.

• Surgical incision

For cases without response to the abovementioned techniques, surgery may be considered. There are three surgical options for ingrown toenails:

1. Simple removal of the affected side of the nail plate

Simply removing the nail cutting into the skin will provide pressure relief. Activity can be resumed immediately in most cases.

2. Removal of the overhanging nailfold

The skin where the nail grows into repeatedly is removed. “Shaving” the skin does this so that the big toe will resemble a thumb after the procedure. This procedure prevents recurrence of ingrown toenail while maintain toe function. Healing typically occurs in 10 to 14 days.

3. Nail ablation with carbon dioxide (CO2) laser

The CO2 laser destroys the affected nail with minimal damage of the surrounding tissues. The main advantage of this procedure is the laser’s ability to seal tissues immediately prevents bleeding. Patients with wound healing or bleeding disorders can have a safer ingrown toenail removal procedure.