Ingrown Toenails

Ingrown Toenails


Ingrown toenails, also known as onychocryptosis, is usually caused by trimming toenails too short, particularly on the sides of the big toes. They may also be caused by pressure from footwear (from socks or shoes that are too tight or short), injury, fungus infection, heredity, or foot structure. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection. A common ailment, ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender. As symptoms progress, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.

Preventing ingrown toenails involves treating, mitigating or eliminating causative factors. To prevent ingrown toenails from developing, proper nail trimming, footwear and shoe gear, foot hygiene are essential. Patients with diabetes or peripheral vascular disease need to be particularly careful and should see a podiatrist for proper nail trimming. Choose footwear that fits properly, including shoes, socks, tights and stockings. Shoes must be the right length and width so that the toes do not crowd. Tight shoes cause pressure, but if shoes are too loose, the toes may hit against the tip of the shoe. This, too, adds pressure and could cause an ingrown toenail.

Left untreated, an ingrown toenail can become infected and infect the underlying bone and lead to a serious bone infection. A bone infection is called osteomyelitis and often requires hospitalization and removal of the infected bone. People with diabetes or other diseases that compromise the immune system should be extra careful because these infections can quickly become serious. Always contact your podiatrist if you suspect an ingrown toenail.

Treatment Options.

Partial Nail Avulsion (PNA) or Total Nail Avulsion (TNA)- If the area is infected, your doctor may talk to you about doing a procedure to remove the nail that is growing into the skin. This can involve cutting a small portion or in some cases removing the entire nail.  The doctor will numb the affected toe with two lidocaine (a local anesthetic) injections. The doctor will perform the procedure to remove part or all of the nail as needed. The removal takes approximately 3-5 minutes. If performing a permanent removal, a chemical called phenol will then be applied to destroy that portion of the nail bed to prevent that portion of the nail from growing back. The medical assistant will then wrap the toe and go over all of the aftercare instructions.

Wedge Excision- If the nail is not yet infected, a wedge excision may be done to temporarily take care of the problem. The doctor will cut the nail back to relieve pain where it is growing into the skin. In a wedge excision, the nail will not be cut back to the root. Depending on how far down the nail needs to be cut, the doctor may have to numb the toe. The doctor will give recommendations to help prevent a recurrent ingrown nail but it is likely to return once the nail grows out.

There are numerous methods of at home remedies that have been tried over the years. Although soaking and cotton balls may provide temporary relief from time to time, these methods do not correct the problem and ultimately do not provide adequate long term relief. When patients try to remove ingrown nails themselves, a practice that physicians often refer to as "bathroom surgery," the risk of infection and dangers of complications increase significantly.  Instead of risking prolonged discomfort and complications, make an appointment with your podiatrist at Frederick Foot and Ankle Specialists. One office visit can alleviate your symptoms and the source of your pain will be properly treated in a sterile manner as well.