Ingrown Toenail: Symptoms, Causes, Diagnosis, and Treatment

An ingrown toenail, or onychocryptosis, occurs when the edge of a toenail grows into the surrounding skin. This common condition can lead to pain, redness, and swelling. It most often affects the big toe but can occur on any toe. Early intervention is essential to prevent infection or complications. In this comprehensive blog post, we will explore the symptoms, causes, diagnosis, and treatment of ingrown toenails, along with prevention tips.

Symptoms of an Ingrown Toenail

The symptoms of an ingrown toenail can vary depending on the severity and progression of the condition. The most common signs include:

1. Pain and Tenderness: The first noticeable symptom is usually pain or tenderness along the sides of the toenail, particularly when pressure is applied. Even simple activities like walking or wearing shoes can cause discomfort.
2. Redness and Swelling: The area around the ingrown nail becomes red and swollen as the nail digs into the surrounding skin. This inflammation is the body’s natural response to injury.
3. Infection: If left untreated, an ingrown toenail can become infected. Signs of infection include increased redness, pus drainage, warmth in the affected area, and pain that worsens. In more severe cases, fever or chills may also occur.
4. Formation of Granulation Tissue: Over time, the skin around the nail can become overgrown and form a soft, red mass of tissue. This is called granulation tissue, which may bleed easily.
5. Restricted Mobility: The pain and swelling associated with an ingrown toenail can limit mobility, making it difficult to engage in regular activities.

Causes of Ingrown Toenails

Several factors contribute to the development of ingrown toenails, including:

1. Improper Nail Trimming: One of the most common causes of ingrown toenails is cutting the toenails too short or rounding the edges. This encourages the nail to grow into the skin rather than straight out.
2. Tight or Ill-Fitting Shoes: Shoes that are too tight or narrow can squeeze the toes together, exerting pressure on the toenails and pushing them into the skin. High heels or shoes with a pointed toe box are often culprits.
3. Trauma or Injury: Repeated injury to the toe, such as stubbing it or dropping something heavy on it, can cause the nail to grow abnormally and into the skin.
4. Genetics: Some people are genetically predisposed to ingrown toenails due to the natural shape or curvature of their nails.
5. Poor Foot Hygiene: Moist environments, combined with poor foot hygiene, can soften the skin around the toenails, making it easier for nails to pierce the skin.
6. Fungal Infections: In some cases, fungal nail infections can thicken or distort the shape of the toenails, increasing the risk of ingrown nails.
7. Abnormal Foot Structure: Conditions like flat feet or bunions can alter the pressure distribution on the toes, contributing to the development of ingrown toenails.

Diagnosis of Ingrown Toenails

A healthcare provider, usually a podiatrist, can easily diagnose an ingrown toenail through physical examination. The following steps are typically involved:

1. Visual Inspection: The doctor will closely examine the affected toe for signs of redness, swelling, and nail penetration into the skin. They may also check for any discharge or signs of infection.
2. Infection Assessment: If an infection is suspected, the doctor may take a sample of pus or tissue for laboratory analysis to determine the type of bacteria causing the infection.
3. Imaging: In rare cases where the ingrown toenail is severe or the surrounding bone may be affected, an X-ray may be ordered. This is more common in people with diabetes or chronic conditions that affect foot health.

Treatment Options for Ingrown Toenails

Treatment depends on the severity of the ingrown toenail and whether an infection is present. Both conservative and more invasive methods may be recommended.

1. Home Care for Mild Cases

For mild or early-stage ingrown toenails, home treatment can help alleviate symptoms and prevent further complications. Some effective home remedies include:

• Soaking the Foot: Soak the affected foot in warm water with Epsom salts for 15-20 minutes, 2-3 times a day. This softens the nail and skin, reducing discomfort and swelling.
• Lift the Nail: After soaking, gently lift the ingrown edge of the nail and place a small piece of cotton or dental floss underneath to keep it separated from the skin. Replace the cotton daily until the nail grows out.
• Use Over-the-Counter Ointments: Applying antibiotic ointments such as Neosporin can help reduce the risk of infection. Additionally, pain-relieving gels may be used for temporary relief.
• Wear Proper Footwear: Opt for open-toed shoes or loose-fitting footwear to relieve pressure on the affected toe. Avoid tight or narrow shoes.
• Nail Bracing: In some cases, a podiatrist may use nail bracing techniques where a small device is attached to the nail to straighten it as it grows.

2. Medical Treatments for Moderate to Severe Cases

If home care doesn’t provide relief or the ingrown toenail is moderate to severe, medical intervention may be necessary:

• Partial Nail Removal (Partial Nail Avulsion): This involves numbing the toe and removing the portion of the nail that has grown into the skin. After removal, the edge of the nail is treated to prevent regrowth in that area.
• Total Nail Removal: In severe cases where the entire nail is affected, the doctor may recommend removing the entire nail (total nail avulsion). The nail may eventually regrow, but in some cases, a chemical (phenol) can be applied to prevent regrowth altogether.
• Antibiotics: If the toenail becomes infected, oral or topical antibiotics may be prescribed to eliminate the infection.

3. Surgical Options

For chronic or recurring cases of ingrown toenails, surgical procedures may be required to correct the underlying problem:

• Matrixectomy: This procedure involves the partial or complete removal of the nail matrix, the part of the nail responsible for growth. This is done to permanently prevent the nail from growing back in the affected area.
• Vandenbos Procedure: In some cases, the Vandenbos procedure may be used, where the soft tissue surrounding the nail is removed, but the nail itself is left intact. This method has a high success rate for preventing ingrown toenails.

Prevention Tips

Preventing ingrown toenails is often possible by taking simple measures:

1. Trim Nails Properly: Always cut nails straight across, avoiding rounding the corners. Nails should be kept at a moderate length—neither too short nor too long.
2. Wear Comfortable Shoes: Choose shoes that provide enough room for your toes to move comfortably. Avoid shoes with pointed toes or high heels for prolonged periods.
3. Protect Your Feet: If you participate in sports or activities that put stress on your toes, wear protective footwear or padding to avoid injury.
4. Maintain Foot Hygiene: Keep feet clean and dry, especially if you are prone to fungal infections. Regularly change socks and avoid damp environments.
5. Check Your Feet Regularly: Especially for individuals with diabetes or circulation issues, inspecting your feet daily for signs of an ingrown toenail or infection is crucial.

Conclusion

An ingrown toenail can be painful and lead to complications if left untreated. Recognizing the symptoms early and seeking appropriate care is essential for preventing infections and further discomfort. Whether through home care or medical treatment, addressing ingrown toenails promptly can lead to fast relief and long-term prevention. Simple lifestyle changes, such as proper nail trimming and wearing comfortable shoes, go a long way in reducing the risk of this common foot problem.