An ingrown toenail also referred to as onychocryptosis, is what happens when the edge of the toenail grows into the skin of the toe. It is a painful condition that is most seen in the distal-lateral edges (on the sides) of the big toe.
Diagnosing Ingrown Toenails
An Ingrown toenail can be diagnosed quickly with a physical exam. Occasionally an x-ray will be needed to assess the extent of the damage, but typically this is only necessary when trauma or injury is what caused the ingrown nail.
The perionychium is the tissue that borders the sides and base of the nail. Ingrown toenails are seen when the nail body (corpus unguis) grows into one of these nail folds instead of out into the open as it should. This generally results in paronychia which is the term used for the inflammation of one of these nail folds.
Types of Ingrown Toenails
- Neonatal- Occurs in newborn children generally as a result of the nail and surrounding tissue being so soft, these are typically easy to treat and require no more than a gentle cleaning and lifting of the nail away from the nail bed.
- Distal-lateral ingrown- This is the most common type of ingrown toenail, it happens when the nail body grows into one or both of the nail folds on the side of the toe
- Pincer nails- This happens when the nail is deformed causing it to grow with an excessive downward curve
- Swelling (paronychia)
- Difficulty walking
- Pain when wearing shoes
- Overgrown skin
The cause for an ingrown toenail can occasionally be congenital (meaning it is present from birth) though usually they result from trauma, like a stubbed or stepped on the toe, tight restrictive shoes, or improper nail clipping. Nails should be clipped straight across and without any curve on the sides. Sometimes poor hygiene can lead to an ingrown toenail as well.
If the ingrown toenail has not resulted in infection or is not too deeply embedded, then home remedies are often effective. At home you can:
- Soak the foot in warm water for around 15 min 3-4 times per day. This will help soften the nail and relieve some of the pain
- Gently massage the nail fold away from the nail
- Apply a topical antibiotic like Neosporin to help prevent infection and keep the nail soft in the affected area
- Gently lift the nail away from the nail fold if the ingrown has not yet pierced the skin
Surgery for Ingrown Toenails
If infection occurs, home remedies are not working, or the pain is unbearable then a minor surgery can be performed to remove the excess nail and skin. Partial nail removal is when only the invasive portion of the nail is removed. This is the most effective treatment option for severely ingrown nails and greatly reduces the risk of recurrence. Total nail removal is only necessary if the ingrown is caused by a thickening of the nail or some other complete deformity of the corpus unguis (nail body). The complete removal of a nail is called a matrixectomy. Surgery on an ingrown toenail is generally a quick procedure that only requires local anesthesia to numb the area being worked on. If an infection is present the doctor might prescribe antibiotics to help your body fight it off.
There are a couple of things you can do to stop an ingrown toenail from coming back or to prevent one in the first place.
- Trim your nails properly (straight across with no downward curve on the sides)
- Wear proper-fitting shoes that do not put pressure on the nail fold or nail body
- Wear protective footwear like steel-toed boots if you frequently participate in work or activities that can lead to trauma of the toe
- Do not trim your nail too short