An ingrown toenail occurs when a portion of the nail plate embeds into the surrounding soft tissue of the toe. This usually occurs at the great toe for a variety of reasons, however, ingrown toenails can affect any of the digits of the feet. Once the nail embeds itself into soft tissue, the affected soft tissue becomes pinched resulting in significant pain. In most cases, the pain is worse with any contact to the area, such as from bed sheets or closed shoes. However, other times an ingrown nail can result in constant pain.
Ingrown nails can be caused by a variety of factors, including inherited nail types, trauma, improper nail trimming, shoe or sock pressure, toe deformities, high heels, and exercise activities. Many times, ingrown nails are common in certain families as a result of an inherited nail shape, width, or thickness. Ingrown nails can occur at any age. Children often develop ingrown nails with their high activity levels, and lack of knowledge regarding proper nail trimming techniques. In adults, curved nails often progress with time, and can place one at increased risk for ingrown nails.
Once a nail has become ingrown, it produces an ideal environment for infection. The embedded nail provides an ideal colonization site for bacteria, hidden beneath the outer skin. When infection occurs with an ingrown nail, it is common to see significant redness, swelling, and drainage at the affected nail borders. The pain generally increases with an infection as well. Oral antibiotics can usually control the infection for a period of time. However, the infection commonly returns as soon as the antibiotic is stopped, unless the portion of the nail that is embedded is removed.
Many times, ingrown nails can be prevented, even in nails that are substantially curved. Proper nail trimming is essential. Generally, toenails should be trimmed straight across, never cutting deeply into the corners of the nail edges. If the nails edges are cut too short, many times the nail cannot clear the skin of the nail fold as it grows, and buries itself deeper into the soft tissue. A straight edge toenail clipper can aid in proper nail trimming. Additionally, a nail should not be left too long, as a shoe can create back pressure on the nail against the soft tissues causing it to embed and inflame. Shoes should allow a finger width distance between the end of the longest toe and the end of the shoe, to prevent pressure against the toes. Tight pointed shoes are also more likely to cause an ingrown nail, and should be avoided. Daily cleansing of the feet is also recommended to reduce sources of infection.
People often avoid provide professional treatment of ingrown nails for a variety of reasons, and live with the condition for many years unnecessarily. Some have had bad experiences in the doctor’s office or emergency rooms previously, and are hesitant to seek treatment. Others are unaware that permanent correction is available with a simple office procedure. Many people attempt to painfully dig the nail edge out at home, which usually results in a return of pain upon nail regrowth, and places one at increased risk of infection and additional nail damage.
Fortunately, the treatment of ingrown nails has evolved over the years to a few simple office procedures that give predictable long-lasting results. In most instances, the non-painful base of the affected toe is pre-treated with cold spray to significantly reduce any brief injection pain. Once the toe is carefully anesthetized, the patient will not feel any pain during the procedure. The offending nail edge is then removed to the level of the nail root, which is then treated to prevent regrowth of the curved or embedded nail edge only. Antibiotic cream can then be applied to the area, followed by a light dressing. Post procedure home care generally requires simple daily cleansing, followed with antibiotic cream and a small bandage. Skin remodels at the nail edge over the next few weeks resulting in a normal appearing nail, which is unlikely to become ingrown again.
Other permanent treatments for ingrown nails are available in the office setting as well, and all can prevent many years of unnecessary pain. Therefore, early treatment is advisable. The most common comment during the follow-up visit is “I can’t believe I didn’t have this ingrown nail fixed sooner!”