At a glance:
- Ingrown toenails are a common, painful condition also called onychocryptosis.
- Any nail may be affected but the big toenail is most common
- Ingrown toenails may result from multiple causes, including trauma, foot wear, genetics and nail cutting technique
- Many conservative treatments, through to surgical interventions are available.
- Due to presentation, ingrown toenails may be confused with other conditions.
What is an ingrown toenail?
Ingrown toenails, or onychocryptosis, is a painful condition caused by the nail breaking the skin and allowing a bacterial infection to occur. There will typically be pain, swelling, occasionally granulation tissue, bleeding and puss.
You can get an ingrown nail on any toe, although it is more likely to occur in the big toe. There are multiple causes of ingrown nails. Anything that puts pressure on the nail, or causes a break in the skin around the nail border can cause an ingrown nail.
Common risk factors are a involuted or curved in nail, poor cutting technique (not cutting to the edge of the nail, cutting too short or trying to cut down the side), large impact trauma n(ail falling off and regrowing or cracks in the nail), tight shoes, bunions (increases pressure between the 1st and 2nd toe) or repetitive microtrauma putting pressure on the nail.
Signs and symptoms of an ingrown nail
Ingrown nails can start off as a tender end of the toe. This will often occur following a nail cut, long period of exercise, wearing tight shoes, or in some cases the nail becoming elongated. They can be pink, swollen, may bleed, or may have a crust/puss present. They may change from being pain free to painful in a very short amount of time. The pain can sometimes be described as hot, pulsing or throbbing.
Grading of ingrown nails
- Stage 1 Pain - reddening and swelling in the nail sulci
- Stage 2 Pain - further reddening, swelling from worsening infection, pus may be present as well
- Stage 3 Pain - redness and swelling of sulcus, as well as the development of granulation tissue (red swollen tissue that often folds over nail).
Treatment for an ingrown nail
There are many treatments for ingrown toenails. Some are aimed at relieving pain/pressure while others are more invasive and aimed at preventing a recurrence.
- Home Remedies - Salt water soaks and over the counter antiseptic. If pain has not reduced in 24hours seek the advice of a medical professional (stage 1)
- Medication - antibiotics are typically used to treat the bacterial infection. They relieve pain, reduce swelling and will sometimes be the only required treatment. Unfortunately, if a large nail spike or crack is present, the infection may reoccur, or if you have a resistant bacteria the antibiotic may fail. It is important to follow up with your health professional once the course has finished. (stage 2, 3)
- Podiatry - with early intervention, when the pain or discomfort is first felt, invasive techniques may be avoided. The podiatrist may be able to cut, shape or remove the offending nail to give you relief and prevent an infection from occurring. (stage 1, 2, and 3)
- Surgical intervention - surgery is the most invasive treatment for ingrown nails. The type of surgery performed will depend on your personal circumstances, and the professional who is doing it. Wedge resections (the edge of the nail removed) with and without matrixectomy (killing the nail cells responsible for the ingrown portion of the nail) are common. Total nail avulsions (removal of the entire nail) are less common but may be used in some cases.
Podiatrists, some GPs and general surgeons are all trained to complete these types of surgeries. They will usually be used to treat a badly ingrown nail, or for individuals who have repetitive ingrown nails and want a solution to a chronic problem. (stage 2 and 3)