An ingrown toenail is a very common, painful condition of the toe that occurs when the sides or corner of the toenail dig into the skin at the end or side of the toe. It involves inflammation of the nail, which is accompanied by pain, local edema, redness of the skin, and quite often drainage of pus or serous fluid.
In most cases it leads to the destruction of the area under the nail and to a permanent nail deformity. In vulnerable populations, such as diabetics, this infection may lead to osteomyelitis, and consequently, to toe amputation. The condition mostly affects the outer edge of the big toe, although the nail on both sides of the toe, or nail on any toe can become ingrown.
In general, ingrown toenails are especially common in teenagers and young adults due to rapid development that is not accompanied with the use of suitable shoes (tend to wear outgrown shoes). The condition also often affects soldiers, because of the constant strain they put on their feet, the lack of topical hygiene and their ill-fitting shoes (army boots).
Ingrown toenails can be classified into three stages according to severity. In stage I there is local edema, erythema (redness) and pain which is usually mild. In stage II the pain severity increases and there is discharge of serous fluid or pus. In stage III, lateral nail-fold hypertrophy (overgrowth of skin tissue around the affected toe) is observed, accompanied with the presence of intense inflammation.
The applied treatment depends on the stage of the condition. Initially is conservative, and includes the use of antibiotics and topical care with antiseptics. In particular:
When conservative treatment is not effective, the problem is recurrent or the surgeon diagnoses the patient with stage 2 or 3 symptoms, then surgery is the only and best treatment. Usually, the conservative treatment significantly helps local infection’s control, but doesn’t actually solve the problem. It only relieves its symptoms.
Surgery either involves resection of the affected nail section reaching to the nail matrix, or the excision of the entire nail in order to provide a definite solution for the patient. The surgical treatment of ingrown toenail, called nail plastic surgery or onychectomy, if done properly, may lead to a definite cure of the condition.
The procedure is performed under local anesthesia, with minimum postoperative pain, and the patient may walk directly after the treatment and return to his/her daily activities. The toenail heals completely within three weeks, and with the proper surgical technique, recurrences are extremely rare.
In conclusion, the ingrown nail is a very common condition of the toenail, which, if not properly treated, will cause problems to the patient’s daily life. Especially for diabetic patients, the infection may spread to the surrounding tissues, including the bone (osteomyelitis), and lead to more drastic surgeries and to hospitalization for intravenous antibiotic treatment. For all those reasons, patients should consult a doctor in the early stages of the infection in order to receive a combination of conservative and surgical treatment, and solve the problem permanently, minimizing the risk of ingrown nail recurrence.