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What is an ingrown toenail?
The nail plate grows into the skin surrounding it, causing an ingrown toenail. The medical term for this issue is onychocryptosis. It can affect individuals of various ages, including newborns, toddlers, and teenagers, with the big toes being the most commonly affected. Onychocryptosis is a fairly common diagnosis, with 20% of patients seeking medical attention for foot issues experiencing it.
Why do ingrown nails occur?
Soft skin surrounds every nail on the fingers or feet, and typically, the free edge of the nail or the unattached white strip grows over this skin. However, at times, the nail’s growth direction changes, causing it to move to the side, press against soft tissues, and grow into them. The primary cause of this issue is improper nail trimming, as many individuals use rounded-edge scissors during pedicures, resulting in the corners of the nail plate being cut. In my experience, this factor accounts for 95% of ingrown toenail cases.
Onychomycosis, also known as nail fungus, is the second most common cause. A fungal infection causes the nail plate to become brittle and fragmented, leading it to bend, grow into the nail bed, and harm the surrounding tissues. The third cause is frequently observed in teenagers during adolescence and is related to excessive sweating. Due to the moist environment, the nail bed becomes soft, and the edges of the nail plate injure it, causing discomfort. Additional potential causes include:
- Uncomfortable shoes that are too tight, especially in the toe area;
- Engaging in sports like ballet and dance that involve frequent tiptoe walking;
- Repeated toenail plate injuries;
- Inherited tendency to develop ingrown nails, which is more prevalent among people whose parents also had this issue;
- Insufficient foot hygiene;
- Medical conditions such as diabetes, obesity, and disorders of the thyroid gland, heart, and kidneys that increase the risk of lower limb swelling.
How ingrown nail manifests?
The ingrown nail always causes injury to the nail bed, and the symptoms become more painful and the treatment more challenging as the process advances. Onychocryptosis has three stages:
- In the first stage, applying pressure to the nail bed causes pain, and there may be slight swelling.
- In the second stage, inflammatory symptoms develop, such as redness and pain when walking. Wearing shoes can be difficult, and pus may start to discharge.
- In the third stage, the inflammatory process worsens, causing the soft tissues around the ingrown nail to enlarge. Painful tumor-like growths called “proud flesh” can appear, along with infection and suppuration. The pain can become so severe that it makes normal walking impossible and results in limping.
How are ingrown toenails treated?
For mild cases of onychocryptosis, it’s advisable to visit a podiatrist. Conservative treatment is recommended for the first two stages of the condition, as long as there is no severe pain or swelling. However, severe cases require surgery, and only a doctor can perform the procedure. According to a review of the Cochran database, surgical interventions are generally more effective than non-surgical ones in preventing the recurrence of ingrown nails. However, surgery can be traumatic and may not be necessary in mild cases. It’s crucial to avoid self-medicating for onychocryptosis. Even in the first stage of the condition, where the toenail doesn’t heal on its own, it’s better to seek medical attention from a podiatrist or surgeon. If there are already symptoms of the second stage, it’s essential to go to the doctor immediately, as the pain may become intolerable, and the situation could worsen.
Additionally, it’s important to follow these restrictions:
- Don’t wear synthetic socks or stockings, they don’t absorb sweat and increase the risk of infection.
- Don’t apply lemon juice, honey, vegetable oils, or other folk remedies to the sore area, as it may intensify irritation and inflammation.
- Don’t try to dig out, cut, or trim an ingrown toenail with manicure tools, so as not to further injure the toenail.
How to Remove an Ingrown Toenail Without Surgery?
In the first and second stages of an ingrown toenail, doctors typically use non-surgical methods. By following the protocol and using proper sports taping, the treatment can be virtually painless.
The taping technique involves placing a thin pad between the nail plate and the nail bed. In some cases, doctors may also apply medication with anti-inflammatory or antibacterial properties to the pad.
This taping technique helps to prevent the nail from making contact with the inflamed soft tissues of the lateral nail bed, thus preventing further ingrowth. The pad is comfortable to wear, and patients can swim and engage in sports activities with it. However, periodic replacements of the pad are necessary until the nail plate fully grows and takes on the proper shape.
Corrective systems with brackets
Corrective systems that use brackets are similar in appearance to braces on teeth after they are installed. These brackets can be attached to the edges of the nail plate or wrapped around the nail, with the loop located in the center.
The corrective system using brackets helps to lift the ingrown toenail and reduce pressure on the nail bed. This correction helps to improve the shape of the growing nail and reduce pain. The force of impact on the nail plate can be regulated by tightening the bracket.
Corrective plate
A strip that is a few millimeters wide is fixed across the nail with a special glue to form a corrective plate. Different materials are used to make the strip, which is chosen based on the nail’s thickness and softness to correct the bend of the nail plate.
The corrective plate pulls up the nail, lifting it and preventing it from getting caught in the side edges. The plate’s effectiveness decreases as the nail grows, necessitating periodic replacement.
Modern plates and clasps are comfortable to wear, do not cause discomfort while walking, and do not stick to clothing. The procedure for applying the clasps or plates is painless and only takes 20-30 minutes.
Clasps and plates are highly effective in treating an ingrown nail. The only drawbacks are the need for replacement and the duration of wear, which can range from a few weeks to 14 months.
Patients do not need to take any additional care of the corrective clasps and plates. It is sufficient to maintain cleanliness, avoid wearing tight shoes, attend correction appointments, and refrain from attempting to remove them on their own.
If left untreated, onychomycosis can cause infections, and in severe cases, even require finger amputation. Individuals with circulatory disorders in the lower extremities, such as arteriosclerosis of the legs or diabetic foot, are at greater risk of developing complications such as acute purulent inflammation of the finger tissue (paronychia), purulent involvement and osteomyelitis, and gangrene of the finger’s soft tissue, which can develop rapidly.
Here are some ways to prevent an ingrown toenail:
- Trim nails properly, don’t round corners, use straight-ended scissors, after cutting follow the nail’s natural growth line.
- Regular medical pedicure if serious foot problems like poor circulation in legs, tendency to fungal infections, flat feet, etc. Medical pedicure uses a special machine with different attachments and uses sterilized or disposable tools.
- Wear comfortable, loose footwear with a stable heel that doesn’t squeeze the toes. This will prevent not only ingrown toenails but also calluses and blisters. Also, consider orthopedic insoles if recommended by an orthopedist.
- Maintain foot hygiene. Wash feet daily, treat footwear with disinfectants. Don’t wear someone else’s shoes and don’t walk barefoot in public places, especially in swimming pools to avoid infections.
Remember
- Ingrown toenail – this is when the nail plate grows into the skin around it.
- Toenails often grow inwards because they are trimmed improperly. Also, ingrown nails can occur due to fungal infections, uncomfortable shoes, improper foot hygiene and other causes.
- If the toenail grows inwards and does not resolve on its own or if inflammation and pain become stronger, it is best to seek professional help.
- At the first and second stages of an ingrown toenail, it is possible to avoid surgical removal of the nail plate.
- To prevent ingrown toenails, it is important to wear comfortable shoes, trim the nail plate correctly, avoiding cutting the corners, and to wash your feet daily.
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