Ingrown toenails

Ingrown toenail (onychocryptosis) develops when a sharp corner of the toenail digs into the skin at the end of or side of the toe. Pain and inflammation at the spot where the nail curls into the skin occurs first. Later, the inflamed area can begin to grow extra tissue or drain yellowish fluid. Untreated, an ingrown toenail may develop an infection or even an abscess. Osteomyelitis is a rare complication of an infected toe, in which the bone itself becomes infected. Ingrown toenails are common in adults and adolescents. Any toenail can become ingrown, but the condition is most commonly seen in the big toe. 

Common ingrown toenail causes include:

  • Wearing shoes that crowd your toenails
  • Cutting your toenails too short or not straight across
  • Injuring your toenail
  • Having unusually curved toenails

 

ingrown toe nail

Ingrown toe nail

Management

Non-operative
This is the best approach for those without infection and/or mild symptoms.

  • The nail can be elevated and a splint placed under the nail to lift it off the underlying skin (Figure 1). The splint can be made of cotton wool/wicks or specially made plastic splint from chemist.

 

Ingrown toenailFigure 1

Figure 2 274pxFigure 2

  • Proper trimming of the nail is important. Trim your toenails straight across. Don’t curve your nails to match the shape of the front of your toe. (Figure 2)
  • Keep toenails at a moderate length. Trim toenails so they’re even with the tips of your toes. If you trim your toenails too short, the pressure from your shoes on your toes may direct a nail to grow into the tissue.
  • Wear sensible and fitting shoes

 

Operative/Surgical

  • This is usually recommended when repeated ingrown nails occur despite the conservative measures outline above, or when there is active and/or chronic infection as a result of the ingrown nail.
  • There are several surgical approaches that are used to treat troublesome ingrown toenails. All these procedures can be performed under local or if required, general anaesthesia
  • The most common surgery performed for ingrown toenails is wedge excision. A segment of the nail where it had been ingrown along with the underlying tissue, the nail bed (where the nail grows from) is removed. This will permanently stop that part of the nail from going back. The resultant nail will appear narrow following the procedure.
  • Alternatively, in patients with ingrown nail on both sides of the toe associated with deformity and/or fungal nail infection, total excision of the nail and nail bed (Zadik’s procedure) will be the preferred treatment. In this approach, the entire nail and nail bed are removed. The nail will not regrow again.

Lateral wedge excision

Lateral wedge excision