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Tips for Dealing with Ingrown Nails

Ingrown toenails, also known as onychocryptosis, are very painful and cumbersome to deal with. Especially if you are professional athlete or maintain some sort of outdoor activity as a hobby.

“Ingrown toenails (onychocryptosis) are common worldwide; the condition usually develops in the second or third decade of life. Patient complaints include painful toes, purulent drainage, and pain when walking; the ability to work is seriously affected. Good treatment options should facilitate early recovery and be associated with low recurrence rates.

An ingrown toenail is also termed ‘unguis incarnates.’ The nail grows into the skin of the nail fold, thus aberrantly invading the skin. To solve this problem, we advocate that the nail-fold skin should be placed under the nail. The present prospective clinical trial was designed to explore this hypothesis using a new simple suturing technique developed by the senior author. The knot technique developed by Ince et al. also emphasizes the importance of laying the skin under the nail.

Various treatment procedures are employed for this condition. Although systemic antibiotics and topical wound care are usually ineffective in the later stages of the condition, conservative therapy is reasonable in patients with mild–moderate lesions who do not complain of significant pain, substantial erythema, or purulent drainage from the lateral nail edge. When the lesion is more severe or conservative treatment fails, an operative approach is recommended.”1

“The causes of onychocryptosis are multifactorial. It seems to affect individuals of varying ages and has no predilection to gender. Trauma appears to play a major role. This can be in the form of improper pedicures, poorly fitting shoes, cutting the nail too close to the nail folds and general trauma such as stubbing the toe or having the toe injured in sport activities. Improper cutting of the nail borders can lead to a spiculated nail. This is where a portion of the nail deep to the nail fold is imbedded into the nail groove. The nail continues to grow deep in the groove and can penetrate the distal pulp of the toe. Onychocryptosis can also occur in infants and young children. Treatment before the age of 1 year should involve symptomatic relief by simple debridement. Removal of the nail border will usually resolve the local infection. Once the infant is ambulatory or after 1 year of age, a chemical as well as sharp surgical partial matrixectomy can successfully be performed.”2

Ingrown nails occur more frequently on the first toe. If it has been infected, the signs that indicate it are inflammation, redness, pain and suppuration of white, yellow or greenish color.

“Causes and Risk Factors Based on clinical experience, ingrown toenails are thought to be caused by improper nail trimming or tearing nails off.

 

Examples of improper and proper toenail trimming
Fig 1. Examples of improper and proper toenail trimming. Toenails should be cut straight across, and the corners should not be rounded off. Reprinted from “Management of the ingrown toenail.” American family physician, 79(4). By Heidelbaugh, J. J., & Lee, H. (2009).

 

Because of poor visualization or instrumentation, a barb is created that anchors itself in the soft periungual tissues and penetrates deeply as the nail plate grows distally. Force during ambulation, pressure from constricting footwear, and obesity (if present) drive the nail barb penetration and worsens its severity. Risk factors predisposing to development of ingrown toenails include anatomic and behavioral mechanisms. Some experts suggest that wider nail folds and thinner, flatter nails increase the risk of ingrown toenails, but this remains unproven. A case-control study with patients found no difference in the anatomic shape of toenails in patients with and without ingrown toenails. Repetitive trauma (e.g., running, kicking) or inadvertent trauma (e.g., stubbing the toe) may be inciting factors. Without any strict evidence basis, it is thought that a genetic predisposition and family history, hyperhidrosis, and poor foot hygiene increase the likelihood of ingrown toenails. Diabetes, obesity, and thyroid, cardiac, and renal disorders that may predispose to lower extremity edema can also increase the likelihood. In adolescence, feet perspire more often, causing the skin and nails to become soft, resulting in easy splitting. This produces nail spicules that can pierce the lateral skin. In older persons, spicule formation can become a chronic problem caused by their reduced ability to care for their nails secondary to reduced mobility or impaired vision. In addition, the natural aging process causes toenails to thicken, making them more difficult to cut and more inclined to exert pressure on the lateral skin at the sides of the nail plate, often becoming ingrown, painful, and infected.”3

Although at first the ingrown nail is not serious, it is important to go to the podiatrist as soon as the first symptom is detected. This way, we will achieve a faster recovery. Otherwise, the risk of worsening the situation increases with the passing of days. If the proper treatment is not applied sooner than later, infection might occur and pain will become more intense and bothersome.

“Predisposing Factors

Although an ingrown toenail can affect any age group, teenagers are usually most prone to the development of this abnormality. In adolescence, increased perspiration causing the nail fold to become soft and participation in sports result in the production of nail spicules, which can pierce the lateral skin fold of the nail apparatus. In older persons, spicule formation can be caused by reduced ability to care for their nails secondary to reduced mobility or impaired vision. In addition, the natural aging process causes toenails to thicken, making them more difficult to cut and more inclined to exert pressure on the lateral skin at the sides of the nail plate, often becoming ingrown, painful, and infected. Particular nail shapes may be at greater risk of developing this problem. The condition is unilateral in 80% of cases and mostly affects the hallux. Usually males are more commonly affected.

 

The main factors implicated in the development of an ingrown toenail are as follows:

  1. Poorly fitting shoes: Extrinsic compression of the great toe by tight footwear and narrow shoes places constant pressure directly on the medial nail wall and indirectly on the lateral wall as the great toe is pushed against the second toe.
  2. Improperly trimmed toenails: The toenails should be cut straight across, instead of rounded. Cutting the nail too short will allow more bulging of soft tissue leading to an inflammatory reaction and pressure necrosis.
  3. Excessive sweating: Excessive sweating and maceration causes the skin of the nail folds to become soft that can be easily penetrated by the nail.
  4. Nail infections: In tinea unguium or onychomycotic nails, the nail plate becomes brittle resulting in easy breaking off of nail spicules, making it easier for the nail to pierce the surrounding skin.
  5. Nail apparatus abnormalities: Improper shape of the nail plate, thick nail folds, medial rotation of the hallux (eversion) and reduced nail thickness can play a role in the development of the ingrown toenail. A nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail. The most severe type is called a ‘pincer nail’.
  6. Others: Congenital onychocryptosis is an infrequent form of presentation, believed to be due to intrauterine trauma or hereditary transmission. Kinds of ingrown toenails during infancy include hypertrophy of the lateral nail folds, distal-lateral nail embedding, congenital malalignment of the great toenails and overcurvature of the nail plate. In some cases a genetic predisposition has been noted and familial cases have been reported. Diabetic patients have been found to have a higher incidence of ingrown nails compared with nondiabetic patients. Ingrown toenail and paronychia have been reported secondary to drugs, such as indinavir and indinavir/ritonavir combination. Excess nail fold granulation tissue and ingrown toenail have also been reported with retinoids, docetaxel, cyclosporine and oral antifungal treatment. Subungual neoplasms may cause ingrown toenails due to compression of the nail plate against the nail fold.”4

Some recommended tips are:

 – Soak your foot in warm water 3 to 4 times a day if possible, for about 20-30 minutes. Afterwards, keep the toe dry.

– Apply a gentle massage to inflamed skin.

– Place a small piece of cotton or dental floss under the nail. Wet the cotton with water or antiseptic.

– Use a clean sharp nail clipper when cutting your nails.

– Trim the toenails straight along the edge. Do not try to cut the buried part of your nail, as this will only make the problem worse. Its recommended to use a straight nail clipper and avoid cutting the nails in a round shape, because this increases the risk of causing an ingrown toenail.

– A local antibiotic can be used to relieve pain immediately and can be found in a pharmacy in the form of gel, cream or ointment.

– When dealing with ingrown toe nails, it is best to wear open footwear so that the nail does not rub against the edge of the shoe and has the added advantage of allowing the feet to breathe. Therefore, you should also avoid wearing socks.

– Always keep feet clean and dry.

– Do not rummage or tear your nails with your fingers.

– Long shoes will allow your toes and fingers to move easily, providing comfort.

A buried nail is characterized by intense pain (of one or both sides) in the lateral areas of the finger. The discomfort increases with the pressure created by inflammation and is accompanied by redness and high temperature.

“People living urban region with low socioeconomically status cannot reach the medical support all the time. For this reason conservative treatments with more recurrences of ingrowing nail which limits the physical activities is a great problem for them. Also having the risk factors made them more susceptible to ingrowing nails. The aim of this study is to evaluate the risk factors and treatment results of ingrowing nails of patients living in urban region.”5

Remember, this problem shouldn’t go untreated as there may be risks of developing an infection, so the best thing to do is to visit a professional.

 

 References:

(1) Uygur, E., Çarkçi, E., Şenel, A., Kemah, B., & Turhan, Y. (2016). A new and simple suturing technique applied after surgery to correct ingrown toenails may improve clinical outcomes: A randomized controlled trial. International Journal of Surgery, 34, 1-5.Available online at https://www.sciencedirect.com/science/article/pii/S174391911630293X

(2) Al Kline, D. P. M. (2008). Onychocryptosis: a simple classification system. Foot Ankle J, 1(5), 6. Available online at http://faoj.org/wp-content/uploads/2008/04/onychocryptosis-a-simple-classification-system.pdf

(3) Heidelbaugh, J. J., & Lee, H. (2009). Management of the ingrown toenail. American family physician, 79(4). Available online at http://unmfm.pbworks.com/w/file/fetch/63484529/Management%20of%20the%20Ingrown%20Toenail_AAFP.pdf

(4) Khunger, N., & Kandhari, R. (2012). Ingrown toenails. Indian Journal of Dermatology, Venereology, and Leprology, 78(3), 279. Available online at http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=3;spage=279;epage=289;aulast=Khunger

(5) Yılmaz, T. U. Surgery for ingrowing nail is an effective treatment choice in an urban region. Journal of Clinical and Experimental Investigations, 5(1), 45-47. Available online at http://dergipark.gov.tr/download/article-file/104046

 

Robert Velasquez
13 October, 2018

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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