Ingrown toenails are simply nails that grow back into the flesh of the toe, causing pain and discomfort. They often become infected, though there can be pain without infection or infection without pain. Symptoms of ingrown toenails include pain along the margin of the nail, sensitivity to any pressure at the affected area and any sign of infection, such as pus or
Uncorrected, an ingrown toenail can result in severe complications, progressing to simple inflammation, serious infection, ulceration and gangrene. Ingrown toenails are frequently at the inflammation or infection stage when treated by physicians or podiatrists. That is chiefly because anyone who suffers from it is seldom able to endure the pain and usually seeks aid before a more serious complication develops. Although an ingrown toenail can affect anyone, it occurs most often in persons between the ages of 10 and 30, perhaps because they do more walking than older folks, or disregard the early warnings that adults will heed.
Any toe might suffer from an ingrown nail, but the big toe, because of its prominence and length, is involved most often. The agents responsible are improper cutting of the nails, hereditary effects, and tight shoes and stockings. Short footwear can exert pressure upon the big toe, press directly on the toenail grooves, and force the outside edge of the nail into the flabby nail fold. In small children, an ingrown toenail might be traced to tight clothing, leotards, sleepers, or other bedclothes. The subtle but prolonged pressure that those articles of clothing exert on the toenails as the child thrusts his feet forward can lead to serious problems in adulthood. If a person has an inherited tendency towards nails with extreme curvature, the soft tissue of the fleshy folds might grow over the nail plate - and then the nail would grow inward. An overweight person who has chubby toes might also suffer from an ingrown nail that results from the fleshy folds covering the nail plate. The most frequent cause of ingrown nails, however, is injudicious cutting of the toenail using scissors or, worse, treating of the nail corner with one's fingers. A few days after such self-administered "surgery," inflammation can appear at the offended corner of the nail. At first, there is some discoloration, a mild swelling, and the escape of a little fluid. If these signs are disregarded, inflammation sets in. Pus forms and redness increases. Then, as the toe balloons, the pain starts. Sometimes, a bloody mass of material known as proud flesh appears at the lateral edge of the toenail between the nail plate and the nail groove. Proud flesh is acutely painful and, when irritated or injured, bleeds readily. At this point, most sufferers seek medical aid. If it goes untreated, a dangerous infection can spread and the infection can enter the bloodstream and proceed further up the leg.
Treatment of the ingrown toenail involves removing the offending portions of the toenail, reducing the inflammation, and controlling the infection. In severe cases, a foot doctor might administer or prescribe antibiotics. Various surgical procedures are used to eliminate ingrown toenails. The doctor can remove a portion of the nail, a portion of the underlying nail bed, some of the adjacent soft tissues and even a part of the growth center. Minimal-incision surgery is effective for permanently eliminating the corners of the matrix so that the nail edge growing inward do not cut into the fleshy folds as the toenail grows forward. Electrical cauterization, chemical cauterization, or surgical excision help the health professional remove the corners of the patient's nail growth permanently.
If excessive inflammation, swelling, pain, and discharge develops, the toenail probably is infected and should be treated by a physician. A podiatrist can trim or remove the infected nail with a minor in-office surgical procedure. A portion of the nail or overgrown skin is removed with a scalpel and the infection is treated.
If an ingrown toenail recurs, it may require a more permanent solution. A small portion of the nail and nail matrix (part of the nail that actually grows) is removed with a scalpel or burned with a concentrated chemical solution. This makes the nail narrower and prevents a portion of the nail from growing back, ensuring that it will not irritate the adjacent skin. The chemical treatment is a slightly less invasive procedure. It causes mild inflammation that lasts about a week. This procedure often cannot be used in severe infections because the chemical used (phenol) may be neutralized by the infection. In these cases, the physician must remove the infected nail with a scalpel.