An incurvated or ingrown toenail is a painful condition that causes pain and irritation of the toe where the nail meets the skin. Although it can occur on any of the toes, an ingrown toenail is most commonly found on the big toe.
Signs and Symptoms of Ingrown Toenails
An incurvated toenail causes pressure on the skin of the toe to the point that the skin can become significantly irritated. Most common symptoms include tender and swollen skin around the toenail. The skin may also appear red and inflamed and in some cases, the area may become infected.
What Causes Ingrown Toenails?
The primary cause of this painful condition seems to be hereditary since the shape of the toenails’ growth center (matrix) is abnormal in most of the patients that suffer from it. However, improper nail trimming, diseases of the nail, or tight fitting shoes can also cause this problem. It has also been the experience of our office that many cases of infected ingrown nails occur as the result of a pedicure.
Common Misconceptions about Ingrown Nails
Trimming the end of the nail in a “V” shape will not prevent it from becoming ingrown. “Self-digging” in the border of the nail may increase the likelihood of infection. And, despite advertising claims, no medication can cause the nail to “grow out” normally.
Treating Ingrown Toenails
There are several different techniques used for treating ingrown toenails with the chosen one based on the severity of the condition. In mild cases, the nail is simply cut straight across with a slight rounding of the toenails. If the problem is a first time episode, then a topical spray may be used to anesthetize the toe while the offending ingrown border is comfortably removed.
If the nail is significantly ingrown with an infection present, then the border of the nail can be removed easily and comfortably with the use of a local anesthetic in our office. Minimal discomfort is experienced following such a procedure, but the patient’s work schedule is seldom interrupted.
If there is a history of recurring episodes with frequent infections, then we will recommend permanent removal of either the nail border or, very rarely, the entire nail. Healing takes approximately two to three weeks, although there is no disability during this time. The technique of excising the portion of nail matrix which grows the nail, along with applying medication (phenol) to the matrix is the simplest, most effective method of permanent nail removal. No sutures are required, and there is no scarring of the adjacent skin. This procedure has an excellent rate of success. “Normal” skin, which is not sensitive to pressure, develops where the nail once grew.
In some instances where there is severe curving of the nail and pain centrally under the nail plate, X-rays are taken to determine whether or not a bone spur may be present under the nail and thus causing the deformity and pain. Conservative care for this problem consists of well-rounded shoes with a deep toe box, stretching of the shoes over the affected toe and use of pads. If these measures are unsuccessful, then a minor surgical procedure is performed under local anesthesia to remove the spur. The patient can usually return to work the next day in a surgical shoe or an open-toe shoe which is worn for approximately two to three weeks.
Most patients can prevent ingrown toenails by following a few simple tips:
- Trimming the toenails straight across with no rounded corners
- Wearing comfortable-fitting shoes and socks that are not too tight
- Practicing good foot hygiene by keeping your feet clean at all times