Ingrown Toenail

Ingrown toenails are a common type of nail problems that can cause pain or sometimes become infected. This happens when a nail's side cuts the skin around it, causing a painful wound. The wound and friction can also cause the skin to become inflamed or even infected. It is a common issue for youngsters and young adults and it usually affects the nail on the big toe, although any nail can become ingrown.

What are the causes of ingrown toenails?

Usually, ingrowing toenails start when the edge of a nail becomes like a sharp spike that pierces the skin around it. There are several possible causes for it. It usually happens if your nails were not trimmed correctly or if you wear tight shoes or socks. Foot sweating is another possible cause, especially during intense exercise. Tight shoes are a major risk since they force the toes against each other, which makes nails grow into the skin. Active people who play a lot of sports are more vulnerable since they wear tight shoes and also sweat due to effort. High heels and shoes with pointed toes are also considered to be risk factors. People with deformed nails are also more likely to develop this condition. However, it can also start without any obvious reason.

One of the most common root causes of ingrown toenails is cutting your nails incorrectly. The proper way to do it is a straight across cut, which prevents the condition and allows the nails to grow normally. However, many people cut them round and extremely short, which is not correct. Trauma to the nail can also make it grow inwards, as well as some medications like isotretinoin and certain nail fungal infections.

Nail spikes that manage to pierce the toe skin allow pathogens to enter it. These germs are harmless when found on the skin surface but can cause infections if they penetrate the deeper layers.

What are the symptoms of ingrown toenail?

Ingrown toenails are a common condition that is not considered to be very serious. It can happen on any toe and can affect any side or even both of them but is usually found on the outer side of the big toe. The toe can become painful, while the skin area near the toenail corner gets inflamed, red and swollen.

The early symptoms of an ingrown toenail are minor swelling, redness and pain at the end of the toe. The infection can make the area warm but doesn't always cause fever. At this stage, pus doesn't appear and there is no drainage.

If the infection progresses further, a white or yellow fluid starts to drain from the area and swelling grows in size. Sometimes, a patch of red skin surrounds one with a lighter color. Fever is also possible but only happens in very severe cases of infection.

Treatment options

If you start treating it early, an ingrown toenail can be cured quite easily using simple home care techniques. Just soaking your foot in warm water can be very effective but you'll have to repeat it four times per day. Clear water is good enough, without soap or any antiseptic agents.

Another routine treatment is to wash the entire foot twice per day with soap. Make sure it stays clean and dry during the rest of the day. As long as you have an ingrown nail, avoid wearing tight shoes or models with high heels. In order to speed up the healing process, you can even wear loose sandals for a while.

In order to treat the ingrown nail yourself, you'll have to stop its edge from cutting into the skin. Lift the corner and try to maintain it elevated using a small piece of cloth. You must roll the cloth into a small wick and place it as a buffer between the nail and the skin. This is much easier after soaking, try to push the roll a bit further every time. It can be painful but it's an essential part of the home treatment. You should already notice an improvement after three days. If the condition remains the same or gets worse, go see a doctor.

Ingrown toenails that persist for a long time or cause infections have to be removed surgically. Any abscess must be opened and drained. Typically, the procedure is done by a surgeon in a hospital but some podiatrists can also perform it. Depending on the severity of the abnormal growth and infection, the doctor will decide how deep the surgery will be.

A possible dangerous side effect of wounds caused by ingrown toenails is tetanus, which has to be considered before any surgery. The patient will be given a tetanus vaccine booster, if needed. The toe is then numbed with a local anaesthetic. This is injected in the place where the toe and foot join and numbs the toe completely.

The doctor will then deal with the infection and drain any pus if needed. Afterwards, he will cut a part of the nail, in order to allow the infected area to fully heal without any contact with it. In severe cases, the whole nail is removed.

In severe or recurring infections, the surgeon has to prevent the nail from growing in the vulnerable area again. This can be done by cutting off a part of the nail bed or by applying a chemical on the nail bed that kills the cells that regenerate the nail. In both cases, the goal is to make sure the nail edge will no longer reach the skin. After the procedure, a cure of antibiotics might be prescribed as a precaution. At the end, the toe is covered with ointment and bandaged with gauze.