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Onychocryptosis

Ingrown toenails are one of the more common foot problems treated by a Chiropodist. They can be very painful, sometimes making it necessary to limit activities.

Ingrown toenails are caused by a nail spike which penetrates the skin along the margins of the nail, causing pain. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Pain can be present without infection. If there is infection, the usual signs include: redness, swelling, increased warmth and pain. There also may be drainage of pus or a watery discharge tinged with blood.

Ingrown Toenails May Be Caused By:

  • Improper cutting of the toenails leaving a sharp spike of nail to penetrate the skin.
  • Tight fitting shoes which “squish” the toes together.
  • Socks that are too tight.
  • Abnormal shape of nail plate.
  • Other toenail deformities (ie. excessively thick nail plate).
  • Trauma to the nail plate or toe.

Complications Of An Ingrown Toenail:

  • Infection if present, may spread to the foot and leg, or into the bloodstream.
  • Loss of the nail plate due to infection.
  • Inflammation of the nail bed.
  • Chronic ingrowning toenails can cause deformity of the nail plate and / or surrounding soft tissues.
  • A small benign tumor called a granuloma can form along the nail margin.
  • Diabetics and those with poor circulation to the feet must never attempt to treat an ingrown toenail at home. Consult your Chiropodist/ Podiatrist.

Permanent Partial Or Total Nail Avulsion

Some ingrown toenails only require a local anesthetic and simple procedure that removes the offending piece of nail. OOften these will never recur. However, chronic ingrown toenails that are causing repeated irritation and infection require corrective surgery to eliminate this recurring problem. It may involve part of the nail or the whole nail being removed.

Toenail Surgery

This patient suffered from a chronic ingrown toenail on the inside (medial) border of her large toe. This requires a procedure called a Partial Nail Avulsion, which permanently removes a narrow piece of the toenail from the side of the nail.

  1. The toe is anesthetized and prepped with an antiseptic solution. The piece of nail being removed is indicated with an arrow.
  2. A tourniquet is applied and the medial border of the nail is removed.
  3. Liquified phenol is applied to cauterize the nail matrix (growth area) and the nail bed.
  4. The chemical cautery is complete.
  5. All wrapped up and ready to go home.
  6. Six weeks later the toe has healed with a nice cosmetic result. The toenail is slightly narrower and the pain from the ingrown toenail has disappeared.

The procedure is painless as the toe is anesthetized with a local anesthetic agent. There is minimal postoperative discomfort. The wound heals in about four to six weeks. During this time period it is simply dressed with a topical antibiotic and band-aids. After healing, the nail is normal in appearance and somewhat narrower than before.

Reducing The Risks

What You Can Do To Prevent An Ingrown Toenail?

  • Cut the toenails straight across, and leave them slightly longer at the end of the toe.
  • Avoid tight fitting footwear.
  • Never use scissors to cut your toenails.
  • An infected ingrown nail requires prompt professional attention. Contact your Chiropodist/ Podiatrist immediately.
  • If you are a diabetic or have poor circulation the water for soaking should never be more than 95 degrees Fahrenheit.