Ingrown Toe Nails

What is Ingrown Toenails / Ingrowing Toenails / Onychocryptosis?

An ingrown Toenail,or onychocryptosis, is a condition that commonly affects the big toenail although it can also occur in any of the other toes.

The specific causative factors of onychocryptosis are still unknown. However, it is known to be caused by pressure exerted by the in-growth of the Toenail edge into the toe's skin, resulting in inflammation.

Initially the condition causes discomfort which soon develops into an infection (cellulites) and then becomes a recurring problem. It is associated with toe injuries and is common among athletes,especially those participating in 'stop and start' sports such as tennis,soccer and basket ball.

Some of the common causes of ingrown Toenails include:

• Ill-fitting shoes
• Improper hygiene / lack of trimming of Toenails
• Toe injury
• Picking of Toenail
• Hereditary

Those who are obese, diabetic orarthritic and those who have an abnormal gait or toe deformities such as hammertoes or bunions are also likely to be at an increased risk of onychocryptosis. Also at risk are those who have fungal infections inthe toes or edema of the lower extremities.

Symptoms of Ingrown Toenails / Ingrowing Toenails

Symptoms of ingrown Toenails include the following:

• Redness
• Pain
• Swelling
• Pus discharge, in case of infection

Usually the condition resolves on its own.However, if it becomes infectious, or if it is persistent and recurrent, it has to be treated medically. Infections occur when the feet are kept warm or moist and caused by bacteria such as Staphylococcus or Pseudomonas or by the fungus Candida. If there is a break in the skin close to where the nail has ingrown these micro organisms enter and cause infection.

An unresolved toenail can lead to severe consequences such as:

• Paronychia - Localized infection of the nail
• Cellulitis - Paronychia can progress into infection of the deeper soft tissues or cellulitis
• Osteomyelitis - Bone infection
• Scarring of tissues surrounding the nails
• Onychodystrophy - Deformed Toenails
• Onychomycosis - Fungal toenails

Diagnosis of Ingrown Toenails / Ingrowing Toenails

The diagnosis ofonychocryptosis is rather simple and can be done with the help of the medical history of the patient, tracing the causative factors and by observing the symptoms.

A spicule or a nail growth may be detected along with pain, swelling and tenderness in the area. If infected, it may have pus drainage too. However, certain serious conditions such as tumors or even fungal infections can look like an inward growing toenail to an untrained person and hence the condition has to be carefully investigated.

Treatment for Ingrown Toenails / Ingrowing Toenails

Home Treatment for Ingrown Toenails:

1. Soak the feet for 15-20 min in lukewarm water containing any of the following:

• One part of white vinegar to four parts of water
• Two tbsp of Epsom salt in one quart of water

2. Clean feet, keep nails trimmed.

3. Take anti-inflammatory drugs (oral) to relieve pain

4. Change to comfortable footwear that do not apply too much pressure on the nails

If there is pain and if the symptoms persist for over a week, or if you have developed an infection, you must consult a podiatrist.Although GPs, dermatologists and many other types of medical practitioners can treat, podiatrists are specialists who are specifically qualified to manage this condition.

If the symptoms do not improve with home-treatments then surgery will have to be carried out to remove the problematic nail border. Surgical methods are based on two approaches:

• Narrowing or minimizing the nail plate
• Debulking the soft tissues

Some of the surgical techniques include:

• Avulsion - Detachment of nail.
• Partial matrixectomy - Elimination of the affected nail or the nail border.
• Permanent matrixectomy - Removal of cells from nail base (nail matrix). This is usually done for chronic and recurring conditions and can be done electrically, chemically or through dissection.

The choice of procedure depends on the degree to which the person is affected and also on the surgeon's discretion. All the techniques have a high cure rate and the outcome is dependent on the way it is carried out.

References:

1. Ingrown Toenail (Onychocryptosis) - (http://www.medicinenet.com/ingrown_toenail/article.htm)
2. Surgical management of ingrown toenails - an update overdue. Richert B. Dermatol Ther. 2012 Nov-Dec;25(6):498-509. doi: 10.1111/j.1529-8019.2012.01511.x.

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