An ingrown toenail occurs when one side at the top of a nail turns under and cuts into the skin that surrounds it, causing the area to become very sensitive to pressure from a shoe. The nail of the big toe is the one affected most often. If untreated, the tissue around the ingrown nail becomes swollen and inflamed. Continued pressure may also cause small, painful corns to develop in the groove of the nail. An ingrown toenail is usually the result of cutting the nail on a curve instead of straight across, or cutting it too short. Shoes that are too short or narrow can also contribute to the problem. Other precipitating factors include a foot injury or faulty foot structure that leads to an uneven distribution of body weight.
Other Causes of Ingrown Nails
A fungal infection can cause misshapen and ingrown nails.
Diagnostic Studies And Procedures
Ordinarily, an ingrown nail is immediately obvious and does not require any other diagnostic procedure. If there are complications, such as an abnormal gait, X-rays of the foot may be ordered.
When circulation is poor due to diabetes or some other chronic condition, it is important that an ingrown toenail be treated by a podiatrist or a medical doctor who specializes in foot disorders, especially if there are signs of infection. If the area is badly infected, an antibiotic should be administered. In severe cases, a portion of toenail may require surgical removal. This can be done as an outpatient procedure by a podiatrist or a general surgeon. The doctor first numbs the area with a local anesthetic, then removes the part of the nail that has grown inward. If some surrounding soft tissue has to be cut away, a few stitches may be necessary. If infection is severe, it is sometimes advisable to remove the nail itself and the matrix from which it grows. This is accomplished by making a small incision at the base of each side of the toenail. The flap of skin is pulled back so that the matrix is exposed.
The entire nail is removed and the matrix is destroyed by cauterizing (burning) it, or by applying an acid solution that disintegrates it. (If the matrix is not completely destroyed, the nail may grow back in the same distorted way. Once a matrix has been fully removed, the nail will never grow back.) After destroying the matrix, the doctor then reattaches the skin flap to the surrounding tissue with small stitches. Following this operation, the toe is wrapped in a soft dressing, and the patient wears a surgical shoe or uses crutches until the foot can bear full weight. Oral antibiotics are usually given, and medicated toe soaks may be advised. Two days after the operation, the toe is examined to check on healing. Stitches are removed in a week.
Healing progresses more quickly if the patient keeps the foot elevated whenever possible. The toe should be healed completely in six weeks. Sometimes laser surgery is an acceptable alternative, but its merits are open to debate. Proponents claim that laser surgery is faster and less painful than conventional methods. Its detractors believe that conventional surgery is more likely to produce a cure because laser surgery may leave behind a few matrix cells, thus allowing the regrowth of the ingrown nail.
Alternative therapies are of little value in treating an ingrown toenail.
If the problem is due to improper toenail cutting and involves only a small portion of the nail, cutting a notch in the middle of the nail may be sufficient. This redirects nail growth from the edge to the center. You can also cut out the ingrown portion. However, this approach is advisable only in the earliest stage of the condition and should not be attempted if the surrounding area is inflamed, marked swollen, or infected. To prevent ingrown toenails, cut nails straight across. Also, wear shoes that are comfortably wide and round-toed rather than narrow and pointed. Avoid wearing extremely tight socks.