Ingrown toenails (Onychocryptosis)

Onychocryptosis, more commonly known as an ingrown toenail, is one of the most common complaints we see as Podiatrists.

Signs and symptoms of an ingrown toenail include:

• Pain or tenderness of the affected side
• Redness
• Inflammation

Causes:

Incorrect cutting of toenails

A good general rule to follow is to cut straight across the top of the nail. Cutting down the sides can tend to cause irritation as the nail grows through.

The natural shape of the toenails

Involuted (curved) nails often dive deep down the nail sulcus, causing irritation and inflammation. Occasionally the nail plate can be too wide for the space it has to grow and therefore it sits underneath the skin.

Footwear

Tight-fitting footwear around the forefoot area can irritate the nail sulcus and causes inflammation around the nail plate.

Family history

As with many things, if there is a family history of ingrown nails you will be at a greater risk of developing them yourself.

Treatment of ingrown toenails

When left for a long period of time, the risk of the area becoming infected increases so it is important to manage in an efficient manner. First-line treatment involves clearing the side of the nail that is causing the pain and inflammation. Whilst conservative care is a good way to manage ingrown nails, in some situations it is best to look at a more long-term solution for recurring ingrown nails to resolve the issue entirely.

Ingrown toenail surgery 

As Podiatrists, we are able to carry out nail surgery. There are two main types of nail surgery; ‘partial or total nail avulsion’ and wedge resection (matrixectomy).

This treatment involves numbing the affected toe with a local anesthetic. The nail portion causing the irritation is then removed, along with cauterisation of the nail matrix with a chemical called phenol. As a result, the potion of the nail that was removed will no longer grow back, resolving the pain associated with the ingrown nail.

Infection and ingrown toenails 

Infection of the surrounding skin is common with ingrown toenails. Antibiotics are regularly prescribed to address these infections and are often effective in reducing the associated redness and inflammation. Despite this effectiveness, antibiotics do not address the cause of the pain, that being the ingrown toenail itself and recurrence of the infection often occur on cessation of the antibiotics. The only way to address an ingrown toenail effectively is to remove the aggravating portion of the nail. This can be done conservatively without local anaesthetic or surgery as outlined above. However, for the persistent painful ingrown toenails, surgical intervention is an effective, well-tolerated procedure.