What is an Ingrown Toenail?
Millions of people in America alone suffer from ingrown toenails. An ingrown toenail most commonly affects the big toe, known anatomically as the Hallux. When an ingrown toenail occurs, the nail grows abnormally into the skin and flesh of the toe. This leads to pain and the overgrowth of skin tissue at the side of the nail.
The nails on our feet are produced by the germinal matrix, which grows forward to the end of the toe. The germinal matrix is the tissue that creates a toenail. The area under the nail, called the sterile matrix, attaches the nail to the toe. On either side of the nail is the nail groove, where the skin of the toe meets the nail matrix and the edge of the toenail. Ideally, the toenail grows into the nail groove and can be trimmed across in a fairly straight line, angled slightly into the nail groove.
Sometimes the edge of the toenail pierces the skin outside of the nail groove, beginning to act as a foreign body. Sometimes a nail is ingrown not only at the corner of the nail plate, but all the way down. The first signs of either condition are pain and swelling. The area of penetration may bleed or become infected, producing pus.
Without treatment, more serious conditions such as osteomyelitis (inflammation of the bone) and systemic infection can result. Wearing shoes and walking can become painful and difficult.
Causes of an Ingrown Toenail
The condition is caused by any of several factors. The most common of which is probably improper nail trimming, cutting the nail too much, so that when it begins to grow back it grows out of the "nail groove" directly into the flesh of the toe. Other causal factors include:
- The nail grows inward instead of straight out
- Shoes that are too tight, compressing the nail against the flesh
- Thickened nail
- Trauma, such as a blow to the toe
- Self-treatment with over-the-counter medications. In general, these do not work.
- Fungal infections (toenail fungus)
In addition, some people are hereditarily predisposed to developing the condition.
Preventative measures include proper cutting of toenails, avoidance of shoes that are too tight, and once the condition begins to develop, keeping the foot clean to prevent infection. Toenails should not be cut off at the corners. Rather, they should be cut across, in a straight line. Cutting the corners off can lead to ingrown toenail. It is estimated that half of the cases of ingrown toenails are caused by the patients themselves, through improper cutting.
Symptoms of an Ingrown Toenail
Severe pain, infection, swelling, sometimes pus, are major symptoms of the condition. It is normally obvious with a visual inspection, which will show that the nail is in fact growing into the skin and flesh of the toe, and that an infection is present. No X-rays or tests are usually required, unless there is suspicion that infection may have spread to the bone.
Treatment for Ingrown Toenail
If you have an ingrown toenail, it is best to see your doctor for advice. Any toenail that is bleeding, excreting pus, or swollen should be examined by a doctor. Many people with ingrown toenails delay treatment, or make matters worse by resorting to home remedies that may be more painful than medical attention.
Besides pain, the risks of home treatment for ingrown toenail include:
- Incurring an infection that necessitates more extensive treatment
- Return of the ingrown nail
- People with circulatory problems risk serious complications such as infection, gangrene, and the threatened loss of the limb
In treating an ingrown toenail without surgery, your doctor will probably recommend:
- Softening the nail by soaking the toe in warm salt water
- Gently positioning a few thin lengths of absorbent cotton covered with an antibiotic ointment around and under the nail
- Reducing pressure on the toes by avoiding shoes or wearing open-toed sandals
- The use of oral antibiotics to treat infection
- Keeping the foot clean
A doctor may insert sterile cotton or other material under the nail to raise it from its embedded location, showing you how to use this procedure to apply an antibiotic ointment to the injured toenail for a recommended period of time. The doctor may also prescribe antibiotics and will advise you concerning the frequency of other procedures, such as soaking the toe in warm salt water.
If caught early, non-surgical treatment may be sufficient. Pressure on the toe should be reduced to a minimum with the use of sandals or by simply not wearing a shoe for several days. Avoid the temptation to trim off the corner of the toenail, as this can lead to a worse condition, known as a fishhook deformity, in which the nail grows deeper into the nail groove. Keep in mind that the goal of non-surgical treatment is to allow the toenail to grow out to the end of the toe beyond the nail groove and rest on top of normal soft skin.
It is important to discontinue the use of constrictive footwear. Many painful disorders of the feet are caused or intensified by ill-fitting shoes.
Surgery for an Ingrown Toenail
If the condition has resulted in permanent overgrowth of the tissue surrounding the nail margin, or in recurring infection, surgery may be required to treat the condition. Surgical treatment varies slightly depending on the particulars of each individual case.
In mild cases, removal of a portion of the tissue at the side of the nail groove may reduce pressure and irritation. In this procedure a wedge of tissue is removed and the healing process allows the groove to reform itself.
Sometimes surgery involves use of a local anesthetic and removal of a portion of the toenail and its root. Patients with recurrent ingrown nails may require the use of a medication known as liquid phenol, which permanently removes lateral portions of the nail matrix.
In cases of severe deformity, the entire nail may be removed and the germinal matrix removed as well. This is called a nail ablation. No new toenail will grow back, and because of the finality of this procedure, it should be done only as a last resort. Surgery for ingrown toenail is painless and easy to perform on an out-patient basis. Patients should be able to put weight on their feet immediately after surgery but walking is uncomfortable. In most cases, toenails grow normally after surgery without imbedding themselves into the skin.
It is important to carefully follow your surgeon's instructions before and after any surgical procedure, and to comply with his or recommendations for recovery. Changing the style of footwear, you use is very important. Other comfort measures may be considered for the long-term health of your feet — physical therapy, ultrasound treatment, whirlpool baths, heat, massage, and ice treatment can all be used to pamper and relieve the feet.
How to prevent Ingrown Toenails?
Like any other disorder of the foot, ingrown toenail needs to be considered on a case-by-case basis, in relation to the particular patient's lifestyle and general health. If the patient has a systemic disease like rheumatoid arthritis or gouty arthritis, it is important to seek appropriate medical treatment for the overall condition as well.
At a time when insurance companies are limiting covered surgical procedures, almost all policies pay for ingrown toenail treatment. This is because professional treatment reduces the risk of infection and often eliminates repeat office visits for complications that may result when ingrown toenails return.
To prevent ingrown toenails in the first place, or their recurrence, cut your toenails straight across with the end at a very slight angle. Avoid trimming too close and cutting into or damaging the skin at the corners of the nail. Always cut neatly with scissors or nail clippers. Ingrown toenails often recur, so preventative measures are important.
Many disorders of the feet are related in some way, and if left untreated they can have an adverse effect on your quality of life, affecting your gait and putting undue pressure on other weight-bearing joints as you attempt to compensate for the pain in the foot. Be sure that you do not stress your feet by wearing the wrong shoe for various activities. Anyone who hikes, speed walks, runs, or participates in sports should wear appropriate supportive footwear. Taking the time to review the ways you submit your feet to unnecessary stress, usually through the use of ill-fitting shoes, can go a long way towards eliminating a host of foot problems.
The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.
What are Deformities of the Toes?
The foot is a highly mechanical apparatus, made of many bones and other coordinated structures. The foot carries the entire weight of the body and propels us forward when we stand, walk, and run. Several common deformities of the toes—claw toe, hammer toe, and mallet toe —often cause pain and a loss of function in the use of the foot. Failure to treat these conditions may contribute to the development of serious and disabling changes in habitual ways of walking and carrying the body.
Claw toe, mallet toe, and hammer toe are all deformities of the toes. While they are somewhat similar in appearance, each has specific characteristics. Variations in the three conditions are caused by differences in the direction the joints of the affected toes bend, as well as in degrees of deformity.
Toe deformities are often congenital, occurring for example, in some people with muscular dystrophy. People with high arches, or those who have a tendency to rotate their feet inward while walking are susceptible to deformities of the toes, as are those with rheumatoid or osteoarthritis and people with diabetes.
Proper evaluation is the first step in understanding toe deformities and the problems they present. Seeking early evaluation for disorders of the toes and feet is always a good choice, and can make a significant difference in controlling the condition.