Ingrown Toenail

Overview of ingrown toenail

A large percentage of the global population suffers from different types of foot problems. Poor hygiene conditions precipitate these diseases. A very common form of foot problem is “Ingrown Toenail”. It is common in people belonging to all age groups and genders. But young males have higher risks of developing ingrown toe-nails. In a study conducted by the Center for Disease Control and Prevention, nearly 75% of the population suffers from the problem of ingrown toe-nails in the United States alone. Ingrown toe-nail can give rise to a number of complications. Surgical excision becomes necessary in such cases.

What is an ingrown toenail?

Ingrown toenail is a medical condition in which the borders or the corners of the toenails curve downwards and dig into the toe-skin. It is also known as onychocryptosis or unguis incarnates. It causes pain, swelling and inflammation of the affected skin. In some cases, the ingrown toe-nail may create breaks in the skin. Granulation tissues are formed under such conditions. This may lead to bacterial or fungal infection in future. In more advanced stages, fluid-filled lesions may form accompanied by a foul smell from the affected toe. Ingrown toe-nail can occur in any of the toes. But it is commonly seen in the big toe. Incidences of ingrown toe-nails are more common in young males between the ages of 15-40. According to the reports of European Academy of Dermatology and Venereology, nearly 20% of the patients visiting the clinics for foot problems have ingrown toe-nails.

Common myths

There are a few myths related to ingrown toenails people need to be aware of-

• Cutting the toenail in the form of a V can prevent ingrown toenails
• Repeated trimming of the nail-borders can help prevent ingrown toenails
• Cotton placed below the nail-bed can lessen the pain due to ingrown toenails

None of the above facts have a valid basis. Therefore people should have knowledge on the actual causes and consequences of ingrown toe-nails.

What causes ingrown toenails?

Ingrown toenails are precipitated by a number of factors. The most important ones are listed below-

• The excess pressure created at the corners of the toe-nails due to poor-fitting footwear
• Improper shaping and trimming of toenails (Eg: cutting toenails very short)
• Thickening and abnormal growth of toenails due to existing foot problems like arthritis or nail-fungus
• Mechanical injury to the toe
• Repetitive trauma due to engagement in rigorous sports activities such as running or climbing on a regular basis (common in professional athletes)
• Loss of nails due to pas infections
• Excessive sweating of foot (Hyperhidrosis)
• Poor foot hygiene (not cleaning foot regularly)
• Occurrence of nail-fungus (Onychomycosis)
• Abnormal shapes of the nail-folds and the nail-plates (wider nail-folds and thin nail-plates)
• Familial history of ingrown toenails
• Diseases like Diabetes and obesity
• Diseases of the thyroid gland, renal tract or the cardiovascular system
• Over-the-counter drugs like ciclosporin, isotretinoin and docetaxel
• Using moist and dirty towels for cleaning foot
• Nail injuries left exposed and untreated for a long time
• Using harmful nail-cosmetics
• Doing manicure and pedicure in unhygienic places
• Repeating footwear for a long period of time

Symptoms of ingrown toenails

Ingrown toenails are manifested through the following signs and symptoms-

• Pointed edges of nails growing within the toe-skin
• Pain, inflammation, and swelling of the affected skin
• Yellowish or brownish nails
• Reddish discoloration of the affected toe-skin
• Itching and irritation of the toe
• Tenderness and warmth of the toenails
• Leathery texture of the adjoining toe-skin
• Infection of underlying tissues
• Formation of cracks in the adjoining skin
• Formation of fluid-filled lesions in and around the ingrown toe-nail
• Presence of yellowish or greenish pus below the nail or under the adjoining skin
• Persistent throbbing pain that radiates to adjoining areas
• Separation of nails from the nail-bed (rare)
• Permanent nail-deformities
• Presence of blood clots below the affected skin
• Occasional bleeding from the ingrown toenail
• Formation of rough and whitish flakes in and around the affected toe
• Difficulty in normal movements such as walking, running, climbing

Get rid of this painful condition with these easy and safe DIY remedies.

Stages of formation of ingrown toenails

Ingrown toenails develop progressively through a few distinct stages. These are described below-

• Stage I: This is the early stage wherein the ingrown toenail has not yet formed properly. Erythema and oedema of the adjoining skin occurs, accompanied by a mild stinging pain. The pain is more prominent when pressure is applied to the toe-nails.
• Stage II: Pain, oedema and erythema increase in intensity at this stage. Drainage of yellowish pus from the affected area is observed. This stage marks the beginning of Lateral nail-fold Hypertrophy.
• Stage III: This is the most severe stage. It is characterized by the formation of granulation tissues that leads to bacterial infections. Excess pus is formed under the nails. 

Types of ingrown toenail

Ingrown toe-nails are usually categorized into the following types-

• Distal nail embedding: In this type of ingrown toenail, the nail growth is restricted due to the presence of a band of tissue at the edge of the nail. This tissue is called the hyponychium. It is usually a type of congenital deformity. It may also occur due to complete avulsion of the nail in the past.
• Subcutaneous ingrown toenail: In this case, the toenail grows under the skin, causing pain and inflammation.
• Hypertrophy of lateral nail-fold: In this condition, the skin tissue grows abnormally over the affected toe. Hence the toenail does not get enough space to grow outward and starts growing within the skin.
• Pseudo ingrown toenail: This is usually observed in 2% of the new-borns. In this case, the nail plate is extremely short and seems to grow within the skin. This type is not painful.

Diagnosis

A culture of nail specimens may be recommended by a podiatrist. Punch biopsy and histology are also carried out in a few cases. The doctor will take into account your entire medical history before establishing the proper diagnosis and treatment method. In many cases, factors such as undiagnosed tumors or infections may be the reason. Trauma or injury could also be the reason.

Treatment and Prevention

There are a few home remedies that can help get relief from the symptoms. One of these includes soaking your feet in lukewarm water (with white vinegar and Epsom salt added to it).  Oral inflammatory medications may be prescribed by the doctor to treat the condition. It is important to keep the foot elevated. OTC anti-bacterial/ anti-fungal ointments are also helpful in getting rid of the infection caused due to an ingrown toenail. One can also get the nail trimmed with the help of a skilled podiatrist. In the most severe case, a surgery might be required.

In order to prevent ingrown toenails, one must always wear well-fitting and comfortable footwear. Make sure that your toes are not exposed to repetitive stress or trauma. Keep your feet clean and sanitized. Wear appropriate footwear for sports and physical exercises. Make sure you are not trimming your toenails in a curved manner, always trim them straight.

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