Definition

Also referred as onychocryptosis, an ingrown toe nail is a common, painful condition that occurs when the nail itself grows into the skin from either one or both sides of the nail boarder. In turn the skin on one or both sides of the nail grows over the edges of the nail, sometimes covering part of the nail completely. This condition is usually very painful and can be associated with infection of the toe. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Irritation, redness, an uncomfortable sensation of warmth, as well as swelling can result from an ingrown toenail.

Cause

Ingrown toenails develop for many reasons. In some cases the condition is congenita. People whose toes are involuted (curled in shape), either congenitally or from diseases like arthritis, are prone to ingrown toenails. Often trauma, like stubbing a toe or having a toe stepped on, can cause a piece of the nail to be jammed into the skin causing an ingrown nail. Repeated trauma, such as the pounding to which runners typically subject their feet, also can cause ingrown nails.

The most common cause is cutting your toenails incorrectly, causing them to re-grow into the skin. Tight hosiery or shoes with narrow toe boxes only make matters worse. If the skin is red, painful or swollen on the sides of the nail, an infection may be present. This occurs because the ingrown nail is often in a warm, moist and bacteria-rich environment. When the nail penetrates the skin, it provides a convenient entry for germs that can cause infection. Untreated, the nail can go under the skin, causing a more severe infection. In either case, the infection needs to be cured with sterile instruments and antibiotics. 

Treatment and Prevention

Ingrown toenails should be treated as soon as they are recognized to their tendency of causing excessive pain. 

If excessive inflammation, swelling, pain or discharge is present, 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, known in podiatric medicine as conservative treatment. He or she can remove the offending portion of the nail or overgrown skin with a scalpel and blade and treat the surrounding infection. If pus is present, indicating infection, this is drained accordingly. Unless, the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and wear shoes with adequate room for the toes.

If you are awaiting an appointment with a Podiatrist you can prevent inflammation and infection by applying saline solution (bath of clean water + two spoonful’s of salt) for around 15 minutes and afterwards using sterile gauze path dry and clean the affected toenail boarders well. Afterwards a topical antiseptic such as povidone- iodine can be used. The toe should be kept covered at all times in order to avoid risk of dirt being entrapped in the area of the ingrown increasing risk of pain and infection. 

The best prevention of an ingrown toenail is by cutting the toe nails correctly. This can be done as follows:

• Do not cut the nail too short as you would be inviting the nail to grow into the scan. 
• Cut the nails across and not in a curved shaped using a clean nail clipper which is beforehand swiped with surgical spirit. The nail corners should be visible. If these are of discomfort file them with a nail file/ emery board.
• Avoid cutting the edges of the nails at an angle at the nail edge.  

Nail Surgery 

In cases wherein the affected nail has a structural deformity or a nail pathology is present causing a recurring ingrown nail the Podiatrist may advise nail surgery as a long term solution. Depending on the nature of the nail and the particular problem the Podiatrist may advice on two main surgical procedures, a total nail avulsion or a partial nail avulsion.  Both these are minor interventions (similar to a tooth removal at a dentist) and involve the administration of local anaesthesia at the site of the affected toe so that the intervention is done painlessly. 

The principle difference between the two techniques are that in a partial nail avulsion only the ingrown part of the nail is removed while in a total nail avulsion all the nail is removed. The Podiatrist will also recommend whether it’s worthwhile allowing the nail to grow again or whether a chemical should be applied to prevent the nail or part of the nail to grow again. Selection of which method is most appropriate should be done through consultation with your Podiatrist and depends on several factors including, lifestyle, nail anatomy, presence of nail pathologies and others.