There are many causes of ingrown toenails, medically called Onychocryptosis, and they can happen at any stage of your life.
It appears as a painful, inflamed and even infected sulci with more severe manifestations as hypergranulation tissue (proud flesh, or whitlows). It tends to happen when the nail plate happens to be larger than the toe can handle so the sides of the nails curve down and into the sulci. As the nail grows forward it grows into the flesh.
Ingrown toenail symptoms
Usually an ingrown toenail will be visibly obvious, but you may not realise you have an ingrowing toenail until it is too late.
Onychocryptosis symptoms include pain, swelling and redness around the nail. Speak to a podiatrist for a professional identification of the condition and treatment recommendations.
Causes of ingrown toenails
- Incorrect cutting, where a spike may be left behind. This spike will be a source of irritation to the toe and can become infected. Where the nail curves in, it may be difficult to adequately clear or round the edge, leaving a small spike. In nails such as these cutting straight across may not necessarily work, and help may be needed in clipping and clearing the side of the nail.
- Onychophosis – A normal nail where the skin has folded over the edge of the nail. This folding may happen in over-weight people, or those who wear tight shoes, or those that pronate or the feet roll inwards too much. The folded skin can thicken leading to a painful callus on the edge of the toenail. This can be removed with skilled scalpel work, and the cause identified in attemting to prevent reoccurance. Onychophosis can accompany other types of ingrown toenails.
- The ingrown toenail that occurs as a result of a curving of the nail side due to repeated minor trauma. Sportsmen that like footballers or rugby players or feet that roll in too much may traumatise the side of the nail in the shoe. Ladies fashion footwear are often the culprits in creating this condition over long periods of time. The side that grows into the flesh can cause an infection as it grows in to the flesh.
- There is an inherited version of the ingrown toenail that tends to manifest in the teens as infected toenails. There will invariably be an family history of the problem.
- Infant ingrown toenails occurs in babies where the toenail is simply too wide for the toe and the sulci become irritable, red and sore.
- Trauma – an isolated damaging incident that alters the shape of the nail can lead to an ingrown toenail.
- Tight footwear or high heels can lead to repeated stress on the nail leading to alterations in the nail shape. The edges of the nail will curve in and eventually become uncomfortable.
- Old age, where diminished circulation has robbed the foot of nourishment, leading to changes in the nail that result in thickening and involution (curving).
- Systemic disease, diabetes, psoriasis, arthritis can lead to nail changes
- Fungal infection of the nail can lead to the changes that end in ingrown toenail, by thickening, and curving the nail.
People with normal nails need only cut the nail across the toe with a mild curve to match the contour of the toe. Leaving sharp corners may irritate corresponding toes.
Onychocryptosis: surgery or other podiatric treatment
Podiatric management of an ingrown toenail depends on what presents and to what level the nail is ingrown.
There are many people that are happy to have conservative nail clipping and clearing to keep them comfortable.
There are those that do not have an option but to remove the sides of the nail with a nail wedge resection. Surgical removal may be necessary when conservative management fails to keep the nail in shape, or becomes too painful to manage.
Those that present with a swollen, red and hypergranulated toe may have no choice but to undergo the minor procedure as conservative care will be too painful.
The nail wedge resection with phenolisation is a specialised technique used by podiatrists that is 95% successful in clearing the problem with minimum trauma and pain during and after the procedure. It can be done under local anaesthetic utilising a ring block of the toe.
Using local anaesthetic, a tourniquet, and specialised instruments the podiatrist can painlessly remove enough nail to leave the nail looking normal once healing has taken place. Healing depends on the health of the individual, but the average settling time of the wound is 10 -14 days, before closed shoes can be worn again.