Infected ingrown toenails can be painful and cause skin inflammation. Soaking feet in lukewarm water with Epsom salt may help draw out the ingrown toenail.

Ingrown Toenail

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

In medical literature, ingrown toenails are also called onychocryptosis or unguis incarnatus. They develop when the sides or corners of the nails advance into the skin adjacent to the nail and cut the skin. It is a fairly frequent type of nail disease. Tight-fitting shoes, extremely sweaty feet, or incorrect cutting of the toenails can increase the risk of ingrown toenails. 
&nbsp;

Ingrown toenails are frequently treatable on their own. However, if there&rsquo;s severe discomfort, the doctor can assist in alleviating the pain and preventing complications. Depending on the seriousness of the issue, treatments can range from home remedies to surgery. 
&nbsp;

Ingrown toenails commonly occur when individuals cut their toenails by narrowing the corner. If your toenail curves with the shape of your toe, it has the potential to grow into your skin. Ingrown toenails are common, but rarely cause harm to healthy people. An ingrown toenail can affect anyone, but adolescents, athletes, and those with the following conditions are at greater risk: 
&nbsp;

<ul>
	<li>Serious nerve damage in the leg or foot.</li>
	<li>Inadequate blood circulation.</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a>.</li>
	<li>An infection near the nail. 
	&nbsp;</li>
</ul>

Previous research found that the prevalence ranged from 2.5 to 5%<a href="#accordion">[1]</a>. The incidence rate is highest in teenagers and youngsters, with a clear male predominance (male:female ratio of about 2:1)<a href="#accordion">[1]</a>. 
&nbsp;

Signs and Symptoms

Ingrown toenails can be extremely painful, and they typically aggravate in stages. 
&nbsp;

Among the early-stage symptoms are:

<ul>
	<li>Tender, swollen, or hard skin adjacent to the nail.</li>
	<li>When pressure is applied to the toe, it causes pain.</li>
	<li>Fluid accumulates around the toe. 
	&nbsp;</li>
</ul>

Symptoms in later stages may include:

<ul>
	<li>Excessive skin growth around the toe. </li>
	<li>Red and swollen skin. </li>
	<li>Discomfort and tenderness. </li>
	<li>Seeping pus.</li>
	<li>Bleeding. </li>
	<li>Infection. 
	&nbsp;</li>
</ul>

Occasionally, new tissue begins to grow over the toenail. Doctors refer to this as a granuloma because the new tissue&#39;s surface resembles tiny granules. The inflamed area may ooze, bleed, or emit pus and produce an unpleasant smell, particularly if bacteria enter the wound.

To avoid aggravating signs and symptoms, treat your ingrown toenail immediately. 
&nbsp;

Causes

Ingrown toenails can develop in both males and females. They might be more frequent in individuals with extremely sweaty feet, like adolescents. Older people may also be more vulnerable because toenails thicken with age. Several factors can lead to an ingrown toenail, such as: 
&nbsp;

1. Incorrect Nail Trimming

The most frequent cause of ingrown toenails appears to be improper nail trimming, as it can result in a nail spike that traumatizes adjacent soft tissue. 
&nbsp;

2. Uneven, Curved Toenails

Irregular and curved toenails can cause an ingrown toenail to occur. 
&nbsp;

3. Wearing Shoes That Crowd The Toenails

Shoes that put too much pressure on the big toes, for example, overly tight socks and stockings or shoes that are very tight or narrow. 
&nbsp;

4. Injuring A Toenail

Toenail injury, such as accidentally striking your toe against something, dropping something bulky on your foot, or kicking a ball constantly, can also lead to an ingrown nail. 
&nbsp;

5. Improper Foot Hygiene

Improper foot hygiene, such as failing to keep your feet clean and dry, can lead to an ingrown toenail. 
&nbsp;

6. Additional Causes

The following are some additional causes:

<ul>
	<li>Bad posture. </li>
	<li>Inherited predisposition. </li>
	<li>Trimming toenails too short or not straight across. </li>
	<li>Infections of the nails. </li>
	<li>Specific medical issues. 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of an Ingrown toenail primarily depends on clinical features determined via a simple examination, with no laboratory or radiographic tests required. 
&nbsp;

Some additional tests may however be required in case the doctor suspects an infection. 
&nbsp;

1.&nbsp;Physical Exam

Doctors examine the affected toe closely and inquire about the symptoms and potential causes. 
&nbsp;

2. X-Ray

If your toe appears infected, an X-ray may be required to determine how deeply the nail has advanced into the skin. An X-ray can also determine whether an injury caused your ingrown nail. 
&nbsp;

3. Additional Test

Additional tests, such as a blood test, may be required if the doctors believe the ingrown toenail has already caused complications, for example, cellulitis. 
&nbsp;

<h5>Stages Of Ingrown Toenails&nbsp;</h5>

Doctors classify ingrown toenails into three stages based on severity. These are given below: 
&nbsp;

Stage 1

The nail advances into the skin on the side. The skin is irritated, swollen, and hurting. 
&nbsp;

Stage 2

New, inflamed tissue (granuloma) develops at the corners of the ingrown toenail. The tissue tears and releases pus. 
&nbsp;

Stage 3

The skin around the toe is persistently inflamed and continues to ooze pus. Granuloma formation begins on the nail. 
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Treatment

Individuals with diabetes, nerve injury in the foot or leg, or substandard circulation in the foot should treat ingrown toenails immediately as the signs appear. Otherwise, complications, for example, infections, can develop.

The best treatment for an ingrown toenail will be determined by its severity. 
&nbsp;

There are three possible treatments: 
&nbsp;

<h5>1. Home Treatment</h5>

People can usually treat non-infected ingrown toenails at home.

Try these home remedies for ingrown toenails: 
&nbsp;

<ul>
	<li>Spend 15 to 20 minutes soaking your feet in warm water three or four times daily. Soaking will decrease inflammation and tenderness.</li>
	<li>Then, with a cotton bud, gently push the skin away from the nail.</li>
	<li>Repeat daily for a few weeks to allow the nail to grow.</li>
	<li>Insert a small piece of cotton wool or dental floss beneath the nail as it advances. This&nbsp; assists it in growing over the skin rather than into it. </li>
	<li>Each time you soak your foot, change the cotton wool or dental floss.</li>
	<li>Try to avoid picking at or removing the toenail yourself.</li>
	<li>For pain relief, use over-the-counter medications such as acetaminophen (Tylenol).</li>
	<li>To avoid infection, use a topical antibiotic, for example, polymyxin and neomycin or steroid cream. 
	&nbsp;</li>
</ul>

For some days to a few weeks, try at-home treatments. Consult your doctor if the pain aggravates or you cannot walk or do other activities due to the nail.

People may require surgery if home treatments do not work or if an infection develops. In cases of infection, discontinue all home remedies and consult your medical professional. 
&nbsp;

<h5>2. Conservative Treatment</h5>

In cases of mild to moderate lesions (first and second stages) of an ingrown toenail, conservative treatments (medical treatment to prevent invasive techniques to protect body parts) are normally advised. 

They are given below: 
&nbsp;

<ul>
	<li>&nbsp;Cotton-Wick Insertion Under The Edge Of The Nail</li>
</ul>

A nail elevator is used to place cotton wisp or pledget under the ingrown lateral groove edge. 
&nbsp;

<ul>
	<li>&nbsp;Dental Floss Method</li>
</ul>

The dental floss method is an alternative method to cotton wisps. A piece of dental floss is put beneath the ingrown nail to isolate it from the lateral fold. 
&nbsp;

<ul>
	<li>&nbsp;The Gutter Splint Or Sleeve Method </li>
</ul>

With this technique, your doctor numbs the toe and inserts a tiny slit tube beneath the embedded nail. This splint is worn until the nail grows above the skin&#39;s edge. This method also assists in relieving pain and discomfort associated with an ingrown nail. 
&nbsp;

<ul>
	<li>&nbsp;Taping Procedure</li>
</ul>

With this technique, your doctor uses tape to drag the skin away from the ingrown nail. The tape is wrapped around the toe, and one end is fixed against the side of the ingrown toenail. The goal is to drag the side of the nail crease away from the nail to alleviate pressure. Among conservative treatments, taping is the most secure and least painful procedure. 
&nbsp;

<ul>
	<li>&nbsp;Nail Wiring</li>
</ul>

Two holes are drilled along the nail&#39;s distal corner, and an elastic wire is put and twisted towards the front. The wire&#39;s elasticity may help rectify the abnormality of the ingrown toenail. 
&nbsp;

<ul>
	<li>&nbsp;Others</li>
</ul>

Other techniques include the following:

1. Slit tape-strap procedure. 

2. Nail braces.

3. Acrylic nails. 
&nbsp;

<h5>3. Surgical Treatment </h5>

Ingrown toenail surgery is done under local anaesthesia (LA). Any local anaesthetic (lidocaine, ropivacaine, mepivacaine, or prilocaine) can be used in concentrations ranging from 0.25% to 2%. Ingrown toenail surgery options include:<a href="#accordion">[3]</a> <a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>&nbsp;Spicule Excision and Partial Matricectomy</li>
</ul>

The concerned portion of the nail is cut out with a partial mechanical matricectomy. Matricectomy is the term used to describe the entire removal of the nail matrix, which causes permanent nail loss. 
&nbsp;

<ul>
	<li>&nbsp;Chemical Partial Matricectomy</li>
</ul>

Phenol is frequently used in chemical matricectomy. Chemical matricectomy is more successful and less excruciating than mechanical matricectomy. Its success is dependent on effective hemostasis. Other chemical agents, for example, sodium hydroxide and trichloroacetic acid may be used. 
&nbsp;

<ul>
	<li>&nbsp;Wedge Surgery Of The Toenail And Nail Fold</li>
</ul>

The method entails removing the affected portion of the nail plate, performing a partial matricectomy, and wedge surgery of the nail bed and the hypertrophic (excessively developed) nail fold. Normally, clinicians should avoid using this method. 
&nbsp;

<ul>
	<li>&nbsp;Removal Of The Concerned Nail And Total Matricectomy</li>
</ul>

It is a more thorough treatment for ingrown toenails that includes the removal of the affected nail, the nail bed, and a total matricectomy (chemical or mechanical). It is prescribed for: 
&nbsp;

1. Advanced stage ingrown toenails

2. Onychodystrophy (abnormal variations in the shape, texture, colour, and growth of the fingernails or toenails) 

3. Onychogryphosis (a condition that primarily affects the big toe, in which one set of toenails grows significantly more and faster than the other). 
&nbsp;

<ul>
	<li>&nbsp;Soft-Tissue Nail Fold Excision Technique</li>
</ul>

This technique does not touch the nail because it is based on the theory that the nail is not the cause of ingrown toenails. It entails a wide removal of soft tissue enveloping in an oval fashion. 
&nbsp;

<ul>
	<li>&nbsp;Other Techniques</li>
</ul>

Newer methods that have become the most recent forms of ingrown toenail treatment are given below:

1. Electrocautery

2. Radiofrequency ablation

3. Carbon dioxide laser ablation 
&nbsp;

There are several surgical treatment options for ingrown toenails, and there needs to be an agreement on the best technique. The ideal and appropriate procedure should result in the best functional and aesthetic result possible and a low reappearance rate. 
&nbsp;

<h5>Post-Surgery Care</h5>

Following surgery, your medical professional will allow you to go home with your toe bandaged. To let your toe heal appropriately, you must keep your foot elevated for the next few days and wear special shoes.

Typically, the bandage is removed two days following surgery. Your healthcare provider will tell you to wear open-toed shoes and soak your feet in salt water daily until your toe heals. You will also be given pain relievers and antibiotics to avoid infection. 
&nbsp;

After partial nail excision surgery, your toenail will most likely grow back in some months. A toenail can take up to 12 months to grow if the whole nail is excised down to the base (the nail matrix beneath your skin).

Avoid movement to the greatest extent. 
&nbsp;

If the ingrown nail becomes painful, delaying treatment will only make things worse. Ingrown nails that are left untreated can be concerning if you have pre-existing medical concerns.

You may experience complications if you suffer from an illness or require medication that impairs your immune system and capacity to fight infection. These ailments and prescription drugs consist of

<ul>
	<li>Autoimmune diseases</li>
	<li>Cancer</li>
	<li>Immune-suppressing drugs 
	&nbsp;</li>
</ul>

An ingrown nail might also become more problematic if the legs and feet don&#39;t have adequate blood flow. Early medical intervention is strongly advised when there is a high chance of problems. 
&nbsp;

Unmanaged ingrown toenail complications usually involve

<ul>
	<li>Cellulitis&mdash;infection of the surrounding skin</li>
	<li>Osteomyelitis&mdash;infection of the bone</li>
	<li>Skin sores 
	&nbsp;</li>
</ul>

Medical intervention is needed right away for these issues. Surgery may be necessary in extreme situations. 
&nbsp;

The following factors increase the risk of ingrown toenails: 
&nbsp;

<ul>
	<li>Being a teenager causes feet to sweat more, softening the nail and cuticle</li>
	<li>Cutting nails excessively short or reducing the corners are two nail care practises that promote the nail to penetrate into the skin tissue.</li>
	<li>Being less able to take care of your nails e.g. physical or mental limitation due to a disease</li>
	<li>Wearing footwear that limits your toes</li>
	<li>Engaging in motions that expose your toes to danger or harm, such as sprinting and kicking</li>
	<li>Having a disease that reduces blood flow, like diabetes. 
	&nbsp;</li>
</ul>

<ul>
	<li>Maintaining your feet might help you avoid issues like ingrown toenails. It&#39;s crucial to correctly trim your toenails (straight across, not at an angle or down the edges).</li>
	<li>Apply foot moisturiser after washing and thoroughly dry your feet every day. To remove tough or dead skin, you can also apply an exfoliating stone as well as a foot file.</li>
	<li>Your feet might stay healthy if you wear shoes that fit appropriately. Additionally, you must replace your socks (or tights) every day.</li>
	<li>If you start experiencing foot issues, see your doctor or a podiatrist as soon as you can. 
	&nbsp;</li>
</ul>

A Novel Approach To Pincer Nails&ndash;Ingrown Toenail Treatment

Many treatment options are available for ingrown toenails, including conservative treatments such as cotton insertion, Gutter treatment, elastic tape, and external devices etc. However, these methods can lead to cosmetic deformities and have a recurrence rate of 6.2% to 37%.<a href="#">[5]</a>

Recently, researchers presented a novel approach for complete nail and nail bed removal with a lower recurrence rate, minimal cosmetic deformity, and a low postoperative complication rate. The procedure is called &ldquo;modified terminal Symes amputation&rdquo;&nbsp; 
&nbsp;

As part of the operation, the surgeons shaved the dorsal part of the distal phalanx, removing only the nail bed without shortening the phalanx; thus, preserving the length of the toe. So far the operative method has been performed on 10 patients between the ages of&nbsp; 30 and 80. These patients suffered from persistent pincer nails and had failed both conservative and operative treatments.

According to the results, none of the patients reported a recurrence or faced any major cosmetic deformities. Moreover, the site of operation demonstrated good healing. Thus, the researchers believe that the novel operative method can lead to better postoperative results and improve patient satisfaction. 
&nbsp;

Key Points

<ul>
	<li>An ingrown toenail is a highly prevalent and very unpleasant issue. Tight-fitting footwear, poor nail care, or recurrent injuries can all lead to ingrown toenails.</li>
	<li>Wearing comfortable, supportive issues is essential to prevent ingrown toenails in both adults and children.</li>
	<li>Consult a podiatrist for guidance on the best course of action for your ingrown toenail.</li>
	<li>Individuals who have diabetes must examine their feet every day and visit a podiatrist minimum of once a year to get them examined. 
	&nbsp;</li>
</ul>