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An ingrown nail, also known as onychocryptosis, is a common form of nail disease.
It is often painful.
The nail grows and cuts into one or both sides of the paronychium or nail bed.
Can occur in the nails of both the hands and the feet, but they occur most commonly with the toenails.
For the most part they are only problematic and painful on the big toe.
While most common digit to become ingrown is the big toe, but it can occur on any nail.
It is usually thought that the nail enters into the paronychium, but it can simply be overgrown toe skin.
The process starts from a microbial inflammation of the paronychium, and then a granuloma.
The nail buried inside of the granuloma.
A ingrown toenail is caused by actual penetration of flesh by a sliver of toenail.
Ingrown toe nails can be caused by blunt trauma in which the flesh is pressed against the nail causing a small cut that swells.
Injury to the nail can cause it to grow abnormally: wider or thicker, or even bulged or crooked.
Symptoms of an ingrown nail include pain, worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind, as the tissue is punctured further by the nail.
They are easily infected.
Signs of infection include redness and swelling of the area around the nail, presence of pus and watery discharge tinged with blood.
Swelling at the base of the nail on the ingrowing side is the main finding.
Its main cause is ill-fitting shoes, with inadequate toe-box room and tight stockings applying pressure to the top or side of the foot.
Shoes causing a bunching of the toes in the developmental stages of the foot can cause the nail to curl and dig into the skin.
Ill-fitting shoes that are too narrow or too short, particularly may cause an ingrown nail.
Dampness of enclosed shoes may soften the nail-plate and cause swelling on the epidermal keratin, and increase risk.
Ingrown toenails are caused by weight-bearing such as walking, standing, running in patients that have too much soft skin tissue on the sides of their nail.
Footwear that is too small, narrow, or a shallow toe box will exacerbate any underlying problem with a toenail.
Weight bearing causes this excessive amount of skin to bulge up along the sides of the nail.
Other factors associated with ingrown nails include: genetics, trauma, foot diseases, and improper cutting of the nail.
Improper cutting of the nail may cause the nail to cut into the side-fold skin from growth and impact: poor nail care, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across.
Nail trauma from dropping objects on or stubbing the toenail, can cause the nail to grow irregularly and press into the flesh.
Abnormally shaped nail beds, and those with nail deformities caused by diseases or a genetic susceptibility, increase the chance of an ingrown nail.
An ingrowth nail, however, cannot occur without pressure from a shoe.
Treatment includes partial or full removal of the nail.
Failure to address the skin problem can result in a return of the ingrowth and a deformity or mutilation of the nail.
Prevention of the process requires cutting nails straight across; not along a curve, not too short and no shorter than the flesh around it.
With proper nail care the leading edge of the nail remains free of the flesh, precluding it from growing into the toe.
Filing of the corner of the nail is reasonable management.
Some nails require cutting of the corners far back to remove edges, a partial wedge resection.
Its treatment depends on its severity.
Mild to moderate cases: treated conservatively with warm water and epsom salt soaks, and antibacterial ointment.
Surgical treatment may be required in refractory or severe cases.
Surgical treatment for an ingrown nail is carried as an in-office procedure requiring local anesthesia: the offending part of the nail plate is removed as a wedge resection.
If the ingrown toenail recurs,destruction of the sides of the nail with chemicals or excision is done- matrixcestomy.
Surgical treatment for ingrown nails is more effective at preventing the nail from regrowing inwards compared to non-surgical treatments.
Nail bracing management of ingrown nails works by lifting the sides of the toenail and eventually retraining the nail to grow to a flatter shape over time.
Nail bracing time needed for the nail to be reshaped is one full nail growth or about 18 months.