Ingrown Toenail – Causes, Risk Factors, and Treatment.

What is Ingrown Toenail?

An ingrown toenail (onychocryptosis) is caused by the pressure from the ingrowth of the nail edge into the skin of the toe. Once the edge of the nail breaks through the skin, it produces inflammation. Initially presenting as a minor discomfort, it may progress into an infection in the adjacent skin (cellulitis) and/or become a reoccurring problem. Ingrown toenails most commonly affect the large (great) toes.

Pathophysiology

The underlying cause of this condition is a foreign body reaction. When the nail bed is compressed from the side, the edge of the nail penetrates the cuticle. A foreign body reaction is set up by the presence of the keratinaceous nail material in the flesh of the toe.

Ingrown Toenail Causes

You’re more likely to get ingrown nails when you:

• Cut your toenails too short
• Round your nail edges. To avoid ingrown nails, always trim straight across.
• Wear ill-fitting shoes or tight hosiery that press your nail into your toe
• Injure your toe by stubbing or jamming it
• Put repeated stress on your toes from poor posture or physical activity that stresses your feet, such as running, ballet, or soccer
• Inherit genes that make you more likely to have them

If the condition causing theingrown toenail continues, the skin that grows over your nail can lead to permanent changes in the tissue that can cause infection, more pain, and more swelling.

Risk factors of Ingrown Toenail

There are a number of risk factors that may predispose a person to having an ingrown toenail. The following are some of the more common:

• Athletics, particularly stop and start sports such as tennis, soccer, and basketball
• Improper shoe gear that is either too small or too large
• Repetitive pressure or trauma to the feet
• Poor foot hygiene
• Abnormal gait and poor foot mechanics such as pronation
• Foot or toe deformities, such as bunions, hammertoes, and flat foot
• Congenital toenail deformity
• Abnormally long toes
• Obesity
• Diabetes
• Heart, kidney, and thyroid problems, which may cause foot and leg swelling
• Fungus infection of the nails (onychomycosis)
• Arthritis
• Bony or soft-tissue tumors of the toes
• Hyperhidrosis (excessive sweating of the feet)
• Edema of the lower extremities

Ingrown Toenail Symptoms

When one of your nails starts growing into the skin, you typically have symptoms in stages. First, you’ll have:

• Swelling
• Tenderness
• Hardness

If your ingrown toe gets infected, you’ll move on to other symptoms including:

• Redness
• Pus coming out of your toe
• Bleeding
• Pain
• Feeling hot or shivery

Complications of ingrown toenails

• If left untreated, an ingrown toenail infection can cause an infection in the bone in your toe.
• A toenail infection can also lead to foot ulcers, or open sores, and a loss of blood flow to the infected area.
• Tissue decay and tissue death at the site of infection are possible.

• A foot infection can be more serious if you have diabetes. Even a small cut, scrape, or ingrown toenail may quickly become infected due to the lack of blood flow and nerve sensitivity. See your doctor right away if you have diabetes and are concerned about an ingrown toenail infection.
• If you have a genetic predisposition to ingrown toenails, they may keep coming back or appear on multiple toes at once.
• Your quality of life may be affected by pain, infections, and other painful foot issues that require multiple treatments or surgeries. In this case, your doctor may recommend a partial or full matrixectomy to remove the toenails causing chronic pain. Read more about foot care and diabetes.

How is an ingrown toenail diagnosed?

You can often diagnose an ingrown toenail yourself, based on your symptoms and how the toe looks.

Your healthcare provider (which may be your regular provider or a foot specialist called a podiatrist) will likely diagnose an ingrown toenail by inspecting it. They’ll examine the skin at the edge of the nail. They will diagnose an ingrown toenail if the skin is:

• Growing over the nail.
• Swollen, tender, warm and red.

Test

You typically don’t need any tests or X-rays to diagnose an ingrown toenail. In rare cases, when the toenail is severely infected, your healthcare provider might take a sample culture to identify the infection.

• X-ray may also be required in more serious infections.
• Blood tests may be performed if there is a severe infection or a history of diabetes.

What Are Ingrown Toenail Home Remedies?

If it is early in the course of the ingrown toenail, then home care may be successful in preventing the need for surgery.

• Soak the foot in warm water four times a day. There is no need to add soap, Epsom salts, or antibacterial agents to the water.
• Wash the foot, including the affected area, twice a day with soapy water. Keep the foot clean and dry during the rest of the day.
• Do not wear high heels or tight-fitting shoes. Consider wearing sandals, if possible, until the condition clears up.
• Try to lift up the corner of the nail that is digging into the skin. Take a small piece of cotton or gauze and roll it between the fingers to form a small roll or wick. Then place the roll between the nail and the skin to keep it elevated. This is painful but is the most important part of home treatment. After every soaking, try to push the roll a little farther in. Change the roll out every day. It may take from seven to 15 days for the nail to grow out so that it does not poke into the skin any longer.
• A piece of dental floss can be threaded under the nail transversely under both sides and then glued to the edges of the nail and skin to keep it in place.
• It’s OK to take a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
• If there is no improvement within three days, call a doctor.

Treatment

• If home remedies haven’t helped your ingrown toenail, your doctor may recommend:
• Lifting the nail. For a slightly ingrown nail (redness and pain but no pus), your doctor may carefully lift the ingrowing nail edge and place cotton, dental floss or a splint under it. This separates the nail from the overlying skin and helps the nail grow above the skin edge. At home, you’ll need to soak the toe and replace the material daily.
• Partially removing the nail. For a more severe ingrown toenail (redness, pain and pus), your doctor may trim or remove the ingrown portion of the nail. Before this procedure, your doctor may temporarily numb your toe by injecting it with an anesthetic.

• Removing the nail and tissue. If you have the problem repeatedly on the same toe, your doctor may suggest removing a portion of the nail along with the underlying tissue (nail bed). This procedure may prevent that part of your nail from growing back. Your doctor will use a chemical, a laser or other methods.
• Your doctor may also recommend using topical or oral antibiotics, especially if the toe is infected or at risk of becoming infected.

Prevention of Ingrown Toenail

A few simple strategies can reduce the risk of ingrown toenails:

• Use clippers specifically designed for toenails, since these are the right shape and provide enough force to quickly trim the nails.
• Wash nail clippers before and after use. Using dirty clippers can introduce bacteria and infections into the skin under the nail.
• Do not cut the toenails very short. The nail should not be significantly shorter than the toe. Cutting a toenail so short that it hurts or is much shorter than the toe increases the risk of the toenail growing into an unusual shape.

• Cut the toenails straight across. Rounded or pointed shapes create misshapen edges that may grow into the skin.
• Wear shoes that fit well. Shoes that are too tight can pinch the toes, potentially causing an ingrown toenail. Shoes with pointed toes may also increase the risk, particularly when they are uncomfortable or pinch the toes.