Ingrowing Toenail (Onychocryptosis)

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.

Δρ. Ιωάννης Δαλιανούδης
ΠΛΑΣΤΙΚΟΣ ΧΕΙΡΟΥΡΓΟΣ

“Ingrowing Toenail leads, in the majority of cases, to destruction of the area under the nail and permanent deformation of the nail. In vulnerable groups, such as diabetics, this inflammation can lead to osteomyelitis, which in turn can lead to amputation of the finger”, says Dr. Ioannis Dalianoudis, Plastic Surgeon and Medical Director of Advanced Plastic Surgery.

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Ingrowing Toenail (Onychocryptosis)

Causes

It occurs mainly on the big toe, but there are many cases where it also occurs on the other toes. But what can lead to ingrowing toenail?
  • Too short cut nails, especially at the corners. Perhaps the most common cause of ingrowing toenail.
  • Congenital causes (increased curvature of the nails)
  • Use of narrow shoes (inappropriate shoes)
  • Injuries to the area, usually caused by very narrow shoes
  • Diseases of the big toe
In general, there is an increased incidence of ingrowing toenail in adolescents and young adults as a result of rapid growth not accompanied by the use of appropriate footwear. It is also quite common during military service due to constant stress, poor local hygiene and inappropriate footwear (military boots).
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Ingrowing Toenail (Onychocryptosis)

Stages

1

Swelling

In the first stage we see local swelling, erythema and pain, which is not so severe.
2

Discharge of fluids

In the second stage the pain is more intense and is accompanied by an outflow of serous or purulent fluid.
3

Development of granular tissue

In the third stage there is a development of hypertrophic granular tissue on the affected side, as well as the presence of intense inflammation.
Ingrowing Toenail (Onychocryptosis)

Συντηρητική Θεραπεία

Treatment is initially conservative, which includes antibiotic treatment and topical antiseptic care. More specifically:

  • Frequent foot baths (3-4 times a day) with antiseptic soap
  • Comfortable footwear or use of sandals
  • Antibiotic treatment, which should cover gram positive microorganisms. Patients who belong to the diabetic or immunosuppressed category should be given broad-spectrum antibiotics
  • Painkillers and anti-inflammatory drugs

If no improvement is seen within a few days, then a re-evaluation of the condition by a Surgeon is needed. If, conservative treatment does not work, there are continuous relapses or the patient comes to the Surgeon with second or third stage symptoms, then surgical approach is the only and appropriate treatment.

Usually, the conservative treatment helps significantly in controlling local inflammation, but does not actually solve the problem. However, it does have a palliative effect.

Ingrowing Toenail (Onychocryptosis)

Surgical Treatment

Either the part of the affected nail should be removed or the entire nail should be resected to provide a permanent solution for the patient. The surgical treatment of ingrowing toenail also called onychoplasty or onychectomy, if done properly, can lead to a permanent solution to the problem.

The surgery is performed under local anesthesia with minimal post-operative pain, and the patient can walk immediately and return to his/her daily activities. Complete healing within about three weeks, and with excellent surgical technique, recurrences are extremely rare.

In conclusion, ingrowing toenail is a very common condition of the nail, which if not treated properly causes problems in the patient's daily life. Particularly in diabetic patients, the inflammation may extend to the surrounding tissues, including the bone (osteomyelitis), and lead to more drastic surgical solutions and hospitalization for intravenous antibiotics.

For all these reasons, it is necessary for the patient to visit the doctor in the early stages of inflammation, so that a combination of conservative and required surgical treatment can solve the problem permanently, significantly reducing the chances of recurrence.

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