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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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Things worth knowing about "Ingrown Toenail"

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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