Ingrown nails – Causes,Treatment & Prevention

What is an Ingrown Nail?

An ingrown nail (unguis incarnatus, toenail) is a condition which may occur on both toenails and fingernails and is caused by the pressure from the ingrowth of the nail edge into the skin surrounding the nail. Ingrown nail is accompanied by disturbing pain and inflammation in the area caused by the fact that the sharp edge of the toe/fingernail literally digs into the skin.

Ingrown Toenail
Widge resection for ingrown toenail. Case of dystrophic nail.
Sorce: https://commons.wikimedia.org

If you ever had an ingrown nail, you are aware that what began as a slight discomfort can quickly become a painful infection that may require medical treatment.
According to Illinois Podiatric Medical Association, more around 5% of the American population suffers from ingrown toenails, but many people have wrong attitudes about treating this condition.

An ingrown toenail can become a real torture and could last for months if it is not treated properly. The consequences can be dramatic and include even medical surgery aiming to remove the entire nail.

Ingrown nail Treatment
A. Separation of the nail plate from the nail bed using a nail elevator;B. Lateral nail plate clipping
Source:https://openi.nlm.nih.gov

An ingrown nail usually affects the big toe. Such condition rarely affects the nails of the other fingers or even hands but let’s face it: everything’s possible.

Usually, the toe is affected either on one or both sides. The first symptoms include severe pain, swelling, burning sensation in the area and pulsations in the area. If the affected nail is not properly treated, the wound begins to secrete and becomes pus-filled within 2-3 days (the pus may be white or even yellowish).

There are three stages of toenail ingrowth: mild, moderate and severe. The worst cases sometimes force patients to get the entire nail surgically removed.

Causes

  • The most common reason for ingrown nail development is the improper trimming: Sometimes, when you cut your nails too short or remove their edges, the surrounding skin folds over the nail. As the nail continues growing, it pierces the skin
  • Compression on the toenails regardless of the type of shoes you are wearing (even sneakers can be the reason why your toes are compressed together and the nail is forced to grow abnormally)
  • All types of nail bed injuries (Periungual tissues) are potential reasons for ingrown nail development
Traumatic melanonychia
fig2: Traumatic melanonychia following a fracture of the great toe.
Source: https://openi.nlm.nih.gov
  • Another very common reason is the development of a fungal infection on the nails. Such conditions often thicken or widen the toenails, so they are more likely to penetrate through the skin.
Funga lInfection onIngrown Toenail
This is a picture of the fungus growing on my right thumb. The fungus grew from under the nail bed and eventually it clinged on to the surface of the nail itself.
Source: https://en.wikipedia.org
  • Genetic predisposition to such condition e.g. if someone in your family has ingrown nails, increases the chances for you to develop the same condition.
  • Repetitive traumas (e.g. running, kicking) or constant pressure on the feet may also cause nail ingrowth
  • Improper natural shape of the nail – the more curvy nail sides can easily pierce the surrounding skin, creating a wound which can easily fester and develop pus
  • Poor foot hygiene can also increase the likelihood of ingrown nails as well as fungal infections
  • Some medical conditions, including diabetes, obesity and thyroid disorder also increase the chances of ingrown nail development

Symptoms and signs

This condition can become very painful if not treated properly. The bad news is that as the nail continues growing, the problem usually worsens. Here’s a list of some of the symptoms to watch out for:

  • The skin surrounding the nail becomes more tender or hard, sometimes even swollen
  • Usually, if you have an ingrown nail, you will experience pain due to the fact that the nail is growing into the skin instead over it
  • Typically, skin redness is also present
  • There is excessive skin growth around the affected area

Home treatment

Before resorting to medication, try a few practical home recipes to deal with your ingrown nail!

The goal is to make the problem nail grow outside skin folds, which are already affected [[2].

  • Start by soaking the feet 2-3 times a day in warm water so the nail can soften. Dry thoroughly then place a cotton ball soaked in alcohol.
  • If the alcohol makes you experience excessive pain, try soaking the cotton ball in olive oil. The most important thing is to keep the toenail elevated in order to make it stop digging into the surrounding skin. This procedure may be extremely painful but it promotes proper nail growth. According to NCBI clinical trial, 79% of the patients there was an improvement of the condition, including relief of the pain.[1]
  • Instead of a cotton ball, you can also use a dental floss and lift the edge of the troubled end of the nail.
  • You can also try to treat the nail with apple cider vinegar. Just dilute 100ml apple cider in 2 L of warm water and soak your feet for several minutes. Apple cider vinegar has very strong anti-inflammatory properties and can do very good job in the process of healing.
  • Apply a topical antiseptic/antibiotic and bandage the toe. This is how you can treat the infected nail but remember that the cause of the infection is still there.
  • There are some tips that will help you overcome the painful feeling of the ingrown nail while treating the problem. Uncomfortable, tight shoes or socks may worsen the problem, especially if your nails are deflected or don’t grow properly. Try to let your feet breathe, especially if the weather allows you to wear open shoes such as sandals.

Over the counter treatment

There are several products on the market which are developed to cure ingrown nails.

  1. Gehwol Ingrown Toenail Fluid 15 ml

The fluid has great reviews on the Internet, claiming that it works within a week (which is actually a problem for some of the customers seeking for immediate effect). This treatment softens nails and makes them more flexible while prevents the nail to get infected. You should apply the fluid on the downside of the nail and try to get some between the nail and the end of the toe. Most of the customers inform that the application is very easy. Many of the comments also inform that trimming of the nail became easier after application.  However, you should remember that if the nail is curved down the side, you should not „dig” for it.

There are also negative reviews about the product, informing that the main ingredient is glycol anti-freeze, which is quite disturbing for some of the customers. Also, for some, there was no positive effect.

  1. NAIL FIX. INGROWN TOENAIL TREATMENT AND PREVENTION 10m

There are fewer reviews about this product but the ones available are totally positive. Customers inform that there is a visible effect after a couple days of application. The product description says that there are all natural ingredients containing in the substance. The product is also diabetes-friendly.

  1. CurveCorrect Ingrown Toenail Home Treatment

This is a set for ingrown nail treatment. Its purpose is to correct the curve of the toenail if the problem has resulted from abnormal nail growth. The product is intended for the big toe, but there are many customers who are successfully treating other toenails or fingernails. This is actually ‘toenail braces’ that can be very effective even if the condition is from a long time ago. However, customers should be patient with this product and expect visible results no less than a week or two.

„ In less than two weeks, a severely curved nail is 50% back to normal.”

Another problem regarding this product is that there is no tutorial provided, so customers could only follow the instructions on the product description sheet.

  1. MASSIVE BIZARRE.LY Professional 5 Piece Ingrown TOENAIL KIT

This kit contains instruments for nail care especially suitable for conditions such as ingrown nails. Products’ rating is really impressive – almost all customers rated with the highest score. Suitable for both finger and toenails.

Negative comments claim that the kit is not easy to use and the instruments are not sharp enough.

  1. Ingrown Toenail File – Double Sided – Professional Surgical Grade

Here’s another product with very good customer reviews. Almost all of the comments are extremely positive. Some people inform that they had painful sensation while treating the affected area with the professional surgical toenail file but after a couple of days their problem disappeared completely. Even one of the critical reviews describes the product:

„This tool is sanitary and the most effective method to tend painful ingrown toenails at home.”

Other negative comments mark that the ingrown toenail is very sharp and it should be used with extreme caution.

However, if the home treatment methods do not improve the condition of the nail within 2-3 days, it is highly recommended to visit a podiatrist. If the affected nail causes infection, even an abscess (paronychia) [3] can be formed. The usual manipulations performed by a physician for such conditions include:

  • Partial or complete surgical removal of the nail
  • Removal of a portion of the nail;
  • Removal of a portion of the underlying nail bed;
  • Removal of the nearest soft tissues;
  • Removal of a part of the growth center;[4]

Surgical treatment

A local anesthetic is injected into the toe at its base – on both sides – in order to reduce the pain. The essence of the procedure consists in removing the side of the nail in depth, together with fissile (germline) layer cells in its base, from which it grows.

In more severe cases, sometimes a part of the adjacent skin and soft tissue should be cut or even the entire nail. The wound that formed is stitched with thread a few (usually 3 stitches) to allow the finger to gain proper form. After that, a bandage soaked in antibacterial detergent is applied to the affected finger or toe. Typically, the bandage can be removed the day following the procedure.

The wound that formed is stitched with thread a few (usually 3 stitches) to allow the finger to gain proper form. After that, a bandage soaked in antibacterial detergent is applied to the affected finger or toe. Typically, the bandage can be removed the day following the procedure.

After that, a bandage soaked in antibacterial detergent is applied to the affected finger or toe. Typically, the bandage can be removed the day following the procedure.

In very rare cases, it is necessary to perform a complete removal of the “parent” cell layer, in other words, to completely remove the nail for good.

It is important to note that surgical treatment is painless. The only discomfort which can be experienced during manipulation is associated with the placement of anesthesia. Once the anesthesia effect pass, some patients might develop mild symptoms of pain.

The success rate of surgery on methods described above exceeds 98%.[5]

Complications after the surgical removal of toenails

Such complications include increasing pain, redness, swelling and drainage. All of these are very good predispositions for the development of infections. Such infections are very typical after surgical intervention, therefore antibiotic oral therapy is highly recommended in preventing further complications due to the infection.

It is very important to note that:

In a case of typical complaints of excessive pain in the finger or toenail area, it is highly recommended to seek medical help.

Early diagnosis and prompt treatment:

  • Decreases the need for surgical intervention;
  • Reduces the number of surgical procedures needed;
  • Ensures better cosmetic results;
  • Shortens the recovery period and the post-surgical discomfort experienced

Prevention

  • The most effective method for prevention of such condition is the proper clipping of the toenails without tapering or rounding the corners. Nails should be clipped straight across, no shorter than the edge of the toe. Never cut your nails at an angle or down the edges – this will only increase the risks of future problems.
  • Another very important tip you should follow is to wash your feet daily and dry them thoroughly after.
  • Choosing comfortable shoes also plays an important role in preventing ingrown nails. A well-fitted pair of shoes allows your feet to move and breathe freely.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1290344/
    Conservative outpatient management of ingrowing toenails.
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472971/
    Managing infected ingrown toenails
  3. http://www.aocd.org/?page=ParonychiaNailInfe
    Paronychia Nail Infection
  4. http://orthoinfo.aaos.org/topic.cfm?topic=a00154
    Ingrown Toenail
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359688/
    A New Surgical Technique for Ingrown Toenail

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