Ingrown Toenails

An ingrown toenail is something that most people will have to deal with at some point in their lives. In most cases, an ingrown toenail isn’t a serious condition, but it can develop into something debilitating if left alone. It’s also a condition that some patients, such as those with diabetes, have to monitor closely as it can threaten the entire limb if left untreated. But even if a patient isn’t at a high risk of serious complication, the constant pain, pressure and potential for infection may be enough to call for treatment. And if the ingrown nail does not respond to conservative treatment, more aggressive measures may be indicated, including surgery. In most cases, a primary care physician can perform the treatment.

What are ingrown toenails?

An ingrown toenail, also referred to as onychocryptosis, is one of the most common forms of nail disease, and most people will experience it at least once during their lifetime. Technically, an ingrown toenail is the result of the nail entering the nail bed, cutting into it and penetrating the flesh. However, most people also refer to ingrown toenails as instances of the skin growing over the nail. When this occurs, it is almost always due to an infection causing the body to form a granuloma, which the nail then penetrates.

In both cases, the condition is defined by pain and pressure, both of which can be excruciating if the condition develops without treatment. The pain is typically made worse by wearing shoes. Ingrown toenails, by their nature, represent a significant infection risk, so it’s not unusual for an ingrown toenail to result in repeated superficial infections. As such, redness, swelling and discharge are also common symptoms of an ingrown nail.

The reason ingrown toenails are so common is that it doesn’t take much to produce one. And the vast majority of cases are due to a handful of causes:

  1. Poorly fitted shoes – When the toes are crammed into footwear, the nail beds, and thus the nails, are forced into a bent position. This is usually the case when shoes are too narrow or too short. If worn regularly, the nails will grow in a curled pattern that will eventually press into the surrounding nail bed.
  2. Prolonged exposure to damp conditions – This is usually the case when someone has worn their shoes too long. Feet sweat, and the inside of footwear becomes damp. Extended exposure to this damp environment causes the nail bed to soften and swell, making it tough for the toenail to grow properly. The result is a nail that grows into the surrounding tissue.
  3. Poor toenail maintenance – Most cases of ingrown toenails are the result of mistakes made during nail maintenance. If the nail is peeled off instead of being precisely clipped off, it can tear at the edges and take some of the skin with it. This sets the stage for an ingrown toenail. However, when clipping a nail, people must be careful not to cut it too short. If the nail is shorter than the nail bed, for example, the nail can grow into the nail bed if any pressure is exerted on nail.
  4. Trauma to the nail – Both finger and toenails are susceptible to long term complications if they are damaged. Something as innocuous as a stubbed toe can be enough to do damage to the nail bed, resulting in a nail that doesn’t grow properly. In general, the worse the damage to the nail, the more likely an ingrown toenail will occur. If something is dropped on the toe, for example, it can split the nail open and render it incapable of normal growth. If a lot of nail is lost during an accident, it will be extremely tough for that nail to return to its previous state.
  5. An infection – Infections to the nailbed or to the tissue around the nail can cause swelling and prolonged inflammation. This can interfere with the way the nail grows, as there is no longer enough room to accommodate the nail.
  6. Genetic factors – Like with most other medical conditions, there are genetics in play as well. The underlying genetics that determine the foot’s physiology and structure may increase the chances of an individual suffering from ingrown toenails.

Although little can be done about genetic factors or the odd accident, it’s still possible to prevent most ingrown toenails by wearing comfortable footwear, practicing ideal grooming habits and promptly treating any infections around the toe.

Ingrown toenails can often be treated at home with warm water, Epsom salt and antibacterial ointments. However, some ingrown nails will prove to be stubborn and unresponsive to this conservative approach. When that approach doesn’t pay off, a healthcare provider will need to provide more intensive treatment.

Treating an ingrown toenail

Occasionally, an ingrown nail becomes more than just a nuisance. It can develop into something that’s too painful to manage, or something that results in too many infections. Patients with preexisting conditions like diabetes, which put the limbs at risk, have to pay close attention to any ingrown nail, because a resulting infection may threaten the entire foot.

Fortunately, there are more aggressive options available in treating an ingrown toenail. One of those options is surgery, which can be performed as an in-office procedure. During surgery, the affected side of the nailbed is accessed, and the part of the nail growing into the bed is cut out. It’s a procedure known as wedge resection, and it is more effective than conservative methods of treatment. If, however, the ingrown nail does not respond to this, then the physician can excise more of the nail or destroy parts of it with chemicals.

Alternatively, a physician can brace the nail so that it is trained to grow normally. Although this method takes longer and isn’t the first line in treatment, it is essential for patients who cannot tolerate surgery, such as diabetics.

Ingrown toenails may seem like a harmless, barely-worth-the-attention kind of condition, but in some cases, the pain and constant infections say otherwise. If the nail cannot be controlled with the use of home treatments, a healthcare provider can step in and ensure that the ingrown nail is dealt with effectively and permanently.