Learn More About Ingrown Toenails
Ingrown toenails also known as *unguis incarnates, (*ungum from the Latin meaning nail and incarnates meaning growing into or invested into flesh) and also known as an onychocryptosis.
Ingrown toenails are a very common nail condition. They occurs when the nail edge grows into the soft tissues at the sides of the nails. Usually your big toenails are mainly affected. It is when part of the nail grows into the skin.
What is a retronychia nail?
More rarely and often misdiagnosed and also underdiagnosed is a condition called Retronychia. Here the nail in grows at the proximal nail plate into the proximal nail fold, (at the bottom of the nail).
According to authors Geizahl et al., (2019) we most commonly see ingrown toenails in the second and fifth decade; however, in our experience at the Chelsea clinic, we see them occur in babies to those aged well into their 90s.
What causes an ingrown toenail?
Risk factors include trauma, weight changes, poor nail-cutting technique, being predisposed to it from the shape of your nails, tearing or ripping toenails off and *hyperhidrosis (*excessive sweating). Authors Geizahl et al., (2019), Heidelbaugh et al., (2009).
What about nail biting?
At the Chelsea Clinic chiropodists and podiatrists we see children biting their toenails usually most children will grow out of this.
Does anxiety affect nails?
In high anxiety individuals, we also see a condition known as excoriation or dermatillomania, which is an obsessive skin picking condition; this too can lead to nail trauma leading to subsequent onychocryptosis.
Can any of my conditions affect me?
Diabetes, obesity, thyroid, cardiac, and renal disorders may predispose a person to lower extremity edema, increasing the likelihood of an ingrowing toenail. (Author Scher, 1983).
What are the stages of ingrown toenails?
According to authors Martínez-Nova et al., (2007) five stages of an ingrown toenail can develop and they include:
Stage 1
The Inflammatory stage – Erythema, mild edema, and pain on pressure applied to the lateral nail fold. The nail fold does not extend over the nail plate. General measures include conservative techniques and care.
Stage 2a
The Abscess stage: Increased pain, edema, erythema, hyperesthesia, oozing and/ or infection. The nail fold extends over the nail plate and measures less than 3 mm: antibiotic therapy, conservative intervention or permanent partial nail removal.
Stage 2b
This is similar to stage two a but the overgrown nail fold extends over the nail plate and measures more than 3 mm. Antibiotic therapy and end-stage conservative intervention or partial or total nail removal is recommended.
Stage 3
The Hypertrophic or overgrown stage: Granulation tissue and chronic hypertrophy of the nail fold, which widely covers the lateral nail plate. Resection of the toenail is recommended here, where conservative intervention has so far failed.
Stage 4
The Distal hypertrophic (spreading) stage: Serious chronic deformity of the toenail, both lateral nail folds, and the distal fold. Hypertrophic tissue completely covers lateral, medial, and distal nail plate.
In young patients, resection of the toenail with a partial nail removal is indicated; the same procedure is also advised in adults with chemical adopted to ensure a permanent solution is provided. (Authors: Khunger, et al., 2012 & Martínez-Nova et al., 2007).
How to avoid ingrown toenails?
General measures we recommend for the treatment of infected ingrown toenails includes proper footwear with a wide toe box and a deep heel cup. In summer we do prefer open-toed footwear for those of you who suffer with ingrown nail.
Try to avoid tight socks and shoes that are too tight, man-made materials such as nylon for example and correct trimming of nails such as straight across when we can. Don’t cut your toenails too short to prevent ingrown toenails.
We can also address underlying pathogenic factors such as hyperhidrosis and onychomycosis.
Very short salt bath soaks not more than two minutes due to the abrasive nature of the solution. Cleaning nails with hydrogen peroxide, iodine or silver nitrate application for granulation tissue (avoid silver nitrate if you have a propensity for allergies, especially a nickel allergy).
What other types of treatments are there?
Although there are many other types of non-invasive treatments as our evidence develops many alternatives we have found to not to be viable and in some instances it can create more problems than the so-called intervention presented due to the introduction of infection in our experience.
At the Chelsea Clinic chiropodists and podiatrist we only recommend measures we have mentioned above for the present time.
How we can help you
If you would like more information about your ingrown toenails, please call. We can discuss your specific nail shape, angle and position of your toenail/toes, footwear and anything else we feel tailored for you.
We are here to help you and to treat any painful nails. Let us make you pain-free as soon as possible. Are you also suffering from other foot problems? Schedule an appointment here or you may call us at 44 (0) 207 101 4000. 📞 We look forward to speaking with you.
References:
Geizhals,S & Lipner S.R. (2019). Review of onychocryptosis: epidemiology, pathogenesis, risk factors, diagnosis and treatment. Dermatology Review Online. Vol 25 (9):1
Heidelbaugh, J.J & Lee, H (2009). Management of the Ingrown Toenail. Am Fam Physician. Vol 79 (4): 303 – 308, 311-321.
Khunger, N & Kandhari, R (2012). Ingrown toenails. Indian J Dermatol Venereol Leprol. Vol 78 (3): 279-89
Malayala, S.V, Rehman, H & Vasireddy, D (2021). Dermatillomania: A Case Report and Literature Review. Cureus. Vol 13 (1): e12932.
Scher, RK. (1983). Toenail disorders. Clin Dermatol. Vol 1 (1):114-124.
