Ingrown Toenail Example

Ingrown Toenails

Ingrown Toenail or Onychocryptosis is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails.

Symptoms of an ingrown toenail include pain along the margins of the nail (caused by hypergranulation that occurs around the aforementioned region), worsening of pain when wearing shoes or other tight articles, and sensitivity to pressure of any kind, even the weight of bed sheets or a duvet. Bumping of an affected toe with objects can produce sharp, even excruciating, pain as the tissue is punctured further by the ingrown nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken to treat the condition early on and keep the area as clean as possible. Signs of infection include redness and swelling of the area around the nail, drainage of pus and watery discharge tinged with blood. The main symptom is swelling at the base of the nail on whichever side (if not both sides) the ingrowing nail is forming.

Ingrown Toenails Causes

The main cause for onychocryptosis or "ingrown nail" is improper footwear including shoes with inadequate toe-box room and tight stockings that apply top and or side pressures; next is the damp wet atmosphere toes are subjected to all day in enclosed shoes, softening the nail-plate and swelling the epidermis keratin, which eventually increases the convex arch permanently; next is genetics; and last are trauma and disease.

Improper cutting of any nail may cause the nail to cut into the side-fold skin from growth and impact, whether or not the nail is "ingrown" (onychocryptosis). The nail bends inwards or upwards depending on the angle with which it has been cut. Looking from the perspective of the owner, when cutting the nail, if the cutting tool, such as scissors, are in an attitude where the lower blade is closer to the toe than the upper blade then that will cause the toenail to start growing from its base upwards. Vice versa, when the lower blade is farther than the upper blade, the toenail will turn inwards. The process is visible along the nail as it grows, appearing as a warp that advances towards the end of the nail. The upper corners turn more easily than the center end of the nail. As people cut their nails by holding the tool always in the same angle, they induce these conditions by accident, while as the nail turns closer to the skin, it becomes harder to fit the lower blade in the right attitude under the nail. When cutting a nail, it is not just the right angle that is important, but also how short it is cut. A shorter cut will bend the nail more, unless the cut is even on both top and bottom of the nail.

Causes include:
  • Bad maintenance, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across.
  • Ill-fitting shoes, as those that are too narrow or too short can cause bunching of the toes in the developmental stages of the foot (frequently in those under 21), causing the nail to curl and dig into the skin Trauma to the nail plate or toe, which can occur by stubbing the toenail, dropping things on the toe or going through the end of the shoes (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh.
  • Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases, or a genetic susceptibility to nail problems like ingrowth.

Ingrown Toenail Prevention

The most common place for ingrown nails is in the big toe, but ingrowth can occur on any nail. Ingrown nails can be avoided by cutting nails straight across; nails should not be cut along a curve, nor should they be cut too short. In both cases, the important thing to avoid is cutting the nail shorter than the flesh around it. Footwear which is too small, either in size or width, or those with too shallow a 'toe box' will exacerbate any underlying problem with a toenail.

It may not be so critical that the nails be cut perfectly 'straight across' as this may imply that they be squared at the corners. Leaving sharp square corners may be uncomfortable and cause snagging on socks. The important thing to keep in mind is that you want to be able to see the corners. You should be able to see the side edge of the nail as it meets the front edge of the nail. This way, you can be sure there is no 'splinter' veering off to the side and growing into your toe. Careful filing of the corner is reasonable. For some people the nail curves down on the sides, in this case it would be difficult to ever see the side edge of the nail plate and this cutting method does not apply. Some nails require cutting of the corners far back to remove the edge that digs into the flesh, this may be done as a partial wedge resection at your podiatrist's office.

Ingrown Toenail Treatment

Treatment of ingrown nails ranges from soaking the afflicted area to surgery. The appropriate method is dictated by the severity of the condition. In nearly all cases, drainage of blood or watery discharge should mean a trip to the doctor, usually a podiatrist, a specialist trained explicitly to treat these conditions. Most practitioners agree that trying to outwait the condition is nearly always fruitless, as well as agonizing.