Onychocryptosis, or ingrown toenail, is one of the more common conditions encountered by dermatologists. It might be hard to conceive how a single toenail can be the source of so much pain, yet pain is the main reason that patients suffering from ingrown toenails go to a dermatologist. The nail is a normal component of the anatomy of the toe, but once it breaks the skin, the body treats it as it would any foreign body; it revolts, it inflames, it swells, and it hurts. As an ingrown toenail can be a source of severe morbidity, it becomes important to know its cause, symptoms, and available treatment options.
The major reason for nails to penetrate the skin is mechanical trauma. Wearing shoes that exert pressure on the toes can push the nails into the surrounding skin. The reason why ingrown toenails are more likely to occur to younger people or athletes is because they wear shoes for a prolonged time and they sweat excessively in them. The constant pressure from the shoes pushes the nail into the skin, and the sweat makes the skin around the nail soft enough for the nail to pierce it. Cutting the nail too short or not trimming its edges properly facilitates its penetration of the skin as it is growing. In rare instances, a person can be born with an abnormal shape to the nails that leads to an ingrown toenail.
Symptoms of an Ingrown Toenail
The symptoms resulting from an ingrown nail depend on the degree of invasion of the nail and the presence or absence of an infection. Usually the big toe is the one affected (Heidelbaugh, 2009). Early symptoms consist of pain on walking and minor swelling and redness of the skin surrounding the nail. Touching the area is also painful, which makes attempts to trim or correct the shape of the nail unpleasant. The introduction of an infection leads to wound formation and pus discharge. When the wound has been present for some time, a bumpy, fleshy and moist growth is seen, which is termed “granulation tissue.” This is an attempt by the skin to heal itself in cases of chronic wounds.
Treatment is Key
Treatment of an ingrown toenail is necessary to restore normal functionality and the ability to walk and be active without pain. Treatment is also crucial for diabetics, who are more prone to serious complications such as bone infection or even toe amputation (Khunger, 2012).
Choosing an experienced physician is key, as the choices of treatment modalities are wide, and some offer a lower recurrence rate than others. It is best to ask the doctor of his or her preferred mode of treatment and its recurrence rate, then to read up on the treatment before making a final decision.
In mild cases, the aim of treatment is to fix the ingrown nail without resorting to surgery. Instruction is given on how to properly trim the nail and on appropriate footwear that does not compress the nail nor cause excessive sweating. Topical treatment may be given to reduce the inflammation and treat any infection. Several conservative outpatient techniques are available that require no anesthesia.
In more severe cases, surgical or chemical removal of the offending part of the nail can be employed (O’Brien, 2012). These procedures require local anesthesia of the affected toe, and a recovery period of at least a week. Any of these procedures carry a chance of recurrence, especially if proper care and trimming of the toenail are not maintained post operatively. Recurrence rates can range from five to seventy percent, depending on the chosen surgical or chemical method (Khunger ,2012).
Bottom Line
An ingrown toenail is a difficult and common problem, but it is fortunately treatable. This is good news for athletes and young adults, who suffer the most from ingrown toenails. Even though there is a chance of recurrence, with the correct choice of a treatment modality and with proper and diligent care, many patients never experience a recurrence ever again.
Interesting Fact: The medical terminology for an ingrown toenail is onychocryptosis (o – nee – ko – krip – to – sis). Let’s break that down! Onycho- is anything to do with nails. Crypt is “hidden” or “buried”. And –osis is the usual suffix for “a condition or a disease.” So onychocryptosis is “the condition of the hidden – or buried – nail.”
References:
Heidelbaugh, J.J., Lee, H., & Arbor, A. (2009, February). Management of the ingrown toenail. American Family Physician, 79 (4), 303-308.
Khunger, N., & Kandhari, R. (2012). Ingrown toenails. Indian Journal of Dermatology, Venereology and Leprology, 78 (3), 279-289.
O’Brien, T. (2012). Current techniques of toenail surgery. In Saxena, A. (Ed) International advances in foot and ankle surgery (pp. 125-132). London: Springer.