Ingrown Toenail

INTRODUCTION

The ingrown toenail, also known as onychocryptosis, is a very common, painful condition of the nails in which the corner or side of a nail grows down into your skin. It is a nail inflammation that causes pain, local swelling, redness and sometimes is accompanied by the drainage of pus or serous fluid. It leads, in the majority of cases, to the destruction of the area under the nail and permanent deformation of the nail. In vulnerable groups, such as diabetics, this inflammation can lead to osteomyelitis, which in turn can lead to amputation of the finger. It is mainly a foot condition and it usually affects the big toe, however, it can affect any of the toes, too. It is a condition that affects many people and can cause serious problems if not treated in time. But what can lead to an ingrown toenail?

Causes of Ingrown Toenail

1. Cutting toenails too short or not straight across. It is may be the most common cause of ingrown nail.
2. Congenital causes (increased curvature of the nails)
3. Use of narrow or tight shoes. (inappropriate shoes)
4. Injuries to the area that are usually caused by very narrow or tight shoes.
5. Diseases of the big toe
6. Physical activity that creates pressure on the fingers
7. Heredity

INGROWN TOENAIL DEVELOPMENT

In the ingrown toenail development, there are three stages. During the first stage, we find local swelling, erythema and pain, which is not so intense. During the second stage, the intensity of the pain is greater and is accompanied by an outflow of serous or purulent fluid. Finally, in the third stage, there is the development of hypertrophic granular tissue on the affected side, as well as the presence of intense inflammation.

INGROWN TOENAIL TREATMENT

The treatment is initially conservative, which includes antibiotic treatment and local antiseptic care. More specifically:

1. Frequent foot baths (3-4 times a day) with antiseptic soap.
2. Comfortable shoes or use of sandals
3. Antibiotic treatment, which should cover gram positive microorganisms. In diabetic or

immunosuppressed patients should be administered broad-spectrum antibiotics.

4. Painkillers and anti-inflammatory drugs
5. If no improvement is observed within a few days, then a reassessment of the condition by a Surgeon is required.

If, conservative treatment does not work, there are continuous relapses or the patient comes to the Surgeon with second or third stage symptoms, then the surgical approach is the only and appropriate treatment. Usually, the conservative approach helps significantly in controlling the local inflammation, but does not actually solve the problem. It has only a soothing effect.

In this case, either the part of the affected nail should be removed or the entire nail should be resected to provide a permanent solution for the patient.

The surgery is performed under local anesthesia with minimal post-operative pain. The patient can walk immediately and return to his/her daily activities. Complete healing within about three weeks, and with excellent surgical technique, recurrences are extremely rare.

In conclusion, ingrowing nail is a very common condition of the nail, which if not treated properly causes problems in the patient’s daily life. Particularly, in diabetic patients, the inflammation may extend to the surrounding tissues, including the bone (osteomyelitis), and lead to more aggressive surgical procedures and hospitalization for intravenous antibiotics.

For all these reasons, the patient should visit the doctor in the early stages of inflammation, so that a combination of conservative and required surgical treatment can solve the problem permanently, significantly reducing the chances of recurrence.