Ingrown toenails are a common condition experienced by the young children and adults. This condition is termed as onychocryptosis or unguis incarnates. It leads to discomfort and pain while walking and can cause difficulty in performing day to day activities at school and work. Although it is a minor medical condition it can sometimes lead to painful inflammation of the toenail and the surrounding area. It is most commonly found in the big toe of men as compared to women due to their lifestyle and involvement in outdoor sports activities.(1)
It occurs when a nail grows into the surrounding skin following trauma. This trauma can be caused by either wearing ill-fitting shoes, cutting nails at certain angles and also by hitting the foot onto a hard surface or object. A pre-existing fungal infection can lead to thickened or widened toenail that might lead to development of ingrown toenail. It is also thought to be running in families and if a member of a person’s family has an ingrown toenail, there are chances of him developing the toenail ingrowth.
Should I Go To The ER For An Ingrown Toenail?
An ingrown toenail can be managed at home and it is usually not necessary to visit an emergency room (ER) until and unless the symptoms are worrisome i.e. extreme pain, swelling, pus collection, redness and odor at the affected site. This inflammation occurs as a result of increased blood supply to the toe. There is sometimes growth of new tissue over the toenail and it might resemble a granuloma. An unpleasant smell or odor is associated with it when there is bacterial infiltration present at the wound site. It is most common in athletes (especially in soccer players due to constant stubbing of the foot with the ball), obese people, diabetics, kidney and heart diseases that might lead to retention of water in the feet and cancer patients (suppressed immunity).(2)
An ingrown toenail can be easily recognized by a close examination of the foot and a positive history of disabling symptoms. Sometimes additional tests are needed to be performed to rule out cellulitis that is a common complication of ingrown toenails. It is accompanied by fever and infection and deeper layers of the skin along the toe.(2)
It is important to maintain good care of the feet by cutting toenails properly along the edges and not trim them very short. Very tight shoes should also be avoided and if somebody has sweaty feet it is advisable to wear footwear that is open or breathable to prevent infection.(1)
Treatment mostly depends upon the severity of the symptoms and degree of inflammation. When the inflammation is mild and the toenail does not hurt much then soaking of the feet in warm water followed by application of antiseptic/anti-inflammatory creams or gel is beneficial. People who play outdoor sports should dry their feet properly before wearing shoes and should avoid any kind of pressure on the ingrown toenail. A foot specialist can advise use of splints or braces that help in free growth of the nails. Any medical condition that can aggravate symptoms should be addressed to the doctor to seek measures of prevention. When the toenail is severely inflamed then surgery is advised. This involves the removal of the toenail along with the inflamed tissue. The procedures done are partial nail avulsion or total nail avulsion. They are recommended when the conservative treatment is not helpful on relieving the symptoms and the foot remains inflamed.(2)
The procedures must be carried out by a specialist as there is risk involved with removal of toenail. The extensor tendon can be injured and nerve damage might take place that will lead to restricted movement of the toe. In some cases profuse bleeding and improper healing of the wound might take place in immuno-compromised patients. Some people showed better result with cauterization of the of the nail matrix using phenol that completely prevents the ingrown toenail form returning.(1)