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Ingrown Toenail – Causes, Symptoms and Treatment
An ingrown toenail occurs when the edge of the nail grows into the surrounding soft tissue, causing pain, redness, and inflammation.
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An ingrown toenail occurs when the edge of the nail grows into the surrounding soft tissue, causing pain, redness, and inflammation.
What Is an Ingrown Toenail?
An ingrown toenail, medically known as Unguis incarnatus, occurs when the lateral edge of the nail penetrates the adjacent skin. It most commonly affects the big toe and can cause significant discomfort. Without treatment, the affected area may become inflamed or infected.
Causes
Several factors can contribute to the development of an ingrown toenail:
- Improper nail trimming: Cutting the nail too short or rounding the corners is one of the most common causes.
- Tight or narrow footwear: Shoes that compress the toes can push the nail edge into the skin.
- Genetic predisposition: An inherited nail shape that tends to curve into the skin.
- Injuries: Trauma or stubbing of the toe can alter the direction of nail growth.
- Excessive sweating: Moist, softened skin provides less resistance to the growing nail.
Symptoms
The typical symptoms of an ingrown toenail often develop gradually:
- Pain and tenderness along the side of the nail
- Redness and swelling of the surrounding tissue
- Formation of granulation tissue (excessive, raw-looking tissue)
- Discharge or pus in the case of bacterial infection
- In severe cases: fever and swollen lymph nodes
Diagnosis
Diagnosis is typically made through a physical examination. A healthcare provider inspects the affected toe and assesses the degree of inflammation. In rare cases, such as when a deep infection (e.g., osteomyelitis, a bone infection) is suspected, imaging such as an X-ray may be needed.
Severity Grades
Ingrown toenails are often classified into three clinical stages:
- Grade I: Redness, mild swelling, and tenderness – no infection present
- Grade II: Increased swelling and pain, presence of pus
- Grade III: Chronic inflammation, granulation tissue, possible nail fold infection
Treatment
Conservative Therapy
For mild cases (Grade I), the following measures may help:
- Warm foot soaks to soften the skin and reduce inflammation
- Proper nail care: trim nails straight across without rounding the corners
- Wearing wide, comfortable footwear
- Placing a small piece of cotton or a special nail splint under the nail edge
Medication
If signs of bacterial infection are present, topical or systemic antibiotics may be prescribed. Anti-inflammatory ointments can also help relieve symptoms.
Surgical Treatment
For recurrent or severe cases (Grades II–III), a minor surgical procedure is often necessary:
- Partial nail avulsion (Emmert procedure): The ingrown nail portion and its corresponding nail matrix are removed to permanently prevent regrowth into the skin.
- Partial nail removal: Only the affected lateral strip of the nail is excised.
- The procedure is usually performed on an outpatient basis under local anaesthesia.
Prevention
An ingrown toenail can often be prevented with simple measures:
- Cut nails straight across and not too short
- Wear well-fitting shoes that do not crowd the toes
- Maintain good foot hygiene – wash and dry feet regularly
- People with diabetes mellitus or poor circulation should have regular podiatric check-ups
References
- Heidelbaugh, J.J. & Lee, H. (2009): Management of the ingrown toenail. American Family Physician, 79(4), 303–308. Available on PubMed.
- Mayeaux, E.J. et al. (2019): Ingrown Toenail Management. American Family Physician, 100(3), 158–164.
- DermNet NZ: Ingrown toenail (Onychocryptosis). www.dermnetnz.org
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