Ingrown toenail
Ingrown toenail, or onychocryptosis, occurs when the edge of the nail grows into the skin, causing redness, pain, and sometimes infection. Mainly affecting the big toe, this common condition can hinder walking and requires careful care, ranging from local hygiene to podiatric or even surgical interventions in the most severe cases. Here is a guide to understanding, preventing, and treating ingrown toenails.
What is an ingrown toenail?
An ingrown toenail is a nail that tends to grow under the skin, thereby causing tissue lesions with irritation and inflammation of the surrounding tissues. This condition is one of the most common problems in podiatry, mainly affecting the big toe. The nail can become ingrown at any corner of the nail plate, creating a painful local infection. This pathology is part of the most common foot diseases and disorders, sometimes requiring the intervention of a podiatrist or dermatologist.
How to recognize an ingrown toenail?
An ingrown toenail is easily recognizable by the presence of an inflammatory skin fold covering part of the nail. This skin growth has a characteristic redness, oozing, with small whitish or yellowish deposits corresponding to fibrin. It is generally very painful and can become infected quickly. This foot pain can have significant consequences on walking, requiring the use of suitable shoes and sometimes protective dressings to relieve the affected area.
How to know if the nail is infected?
To identify a superinfection around the toenail, observe the skin and soft tissues carefully: the area under the edge of the nail becomes red, warm, and painful, with swelling that increases with pressure. If a small purulent discharge or a pus pocket appears without the nail itself or its matrix being affected, this is a superinfection of the periungual growth. This infection requires consulting a doctor who can prescribe antibiotics and recommend disinfecting the wound three times a day with an appropriate antiseptic.
How do you know if it is a whitlow?
A whitlow can be distinguished from an ingrown toenail by the formation of a real subcutaneous abscess, most often affecting the fingernails but sometimes the toenails. It starts with a skin lesion (cut, crack, bite), then the skin becomes tense and very painful, warm and red, sometimes with reduced movement of the finger or toe. When it bursts, a purulent discharge appears, requiring antibiotic treatment. In contrast, an ingrown toenail remains limited to the lateral groove, the pain occurs mainly under pressure, and there is no pus-filled cavity requiring surgical drainage.
What are the causes of an ingrown toenail?
There are several causes that can facilitate the appearance of ingrown toenails, including repeated trauma and excessive sweating.
The technique for cutting nails is crucial. It is necessary to leave the nail long enough, allowing the corners of the nail plate to extend beyond the skin. Using suitable nail scissors or a nail clipper is essential. When the nail starts to become ingrown, it is tempting to cut it too short and at an angle to try to reach the nail covered by the inflamed tissue. This practice worsens the situation and the nail may become ingrown sooner, creating a vicious cycle that sometimes requires surgical intervention.
The deformity of certain toes can cause a nail conflict when wearing shoes. Excessive pressure causing increased stress on the edges of the toenail plate promotes the appearance of ingrown toenails. Wearing tight shoes or high heels can worsen these conflicts. This may occur in case of deformation of the toes in the forefoot area, or in case of hallux valgus. Other deformities such as claw toes or osteoarthritis can also create conflicts that promote ingrown nails. Diabetics must be particularly vigilant because their predisposition to complications requires regular foot care.
The shape of the forefoot can also promote the appearance of an ingrown toenail. In the case of a long big toe, called hallomegaly, shoe conflict can promote ingrown toenails. Problems with metatarsalgia can also change the distribution of pressure and indirectly contribute to ingrown toenails. The presence of fungus in the nails or onychomycosis can cause the nail to thicken, increasing the risk of ingrown toenails.
Certain anatomical factors can also explain ingrown toenails. Some nails have a tile-shaped form which makes the free edges of the nail plate particularly aggressive to the tissues, with an increased risk of injuring the skin. Excessive sweating between the toes can soften the skin and make it easier for the nail to penetrate. In these cases of tile-shaped nails, it is necessary to perform lateral X-rays of the toe to look for a dorsal bony outgrowth on the phalanx that can encourage the nail to grow in this deformation.
How to treat an ingrown toenail?
Treating an ingrown toenail starts by keeping the skin bud perfectly clean: every day, after showering, wash the foot with an antiseptic and then apply red Betadine around the nail before thoroughly drying the area. A warm foot bath with baking soda or apple cider vinegar can help disinfect and soften the tissues. Soak the foot for 15 minutes for optimal relief.
When a bud is very inflamed and proliferating, you can dry out the area using a silver nitrate stick or an ointment prescribed by the podiatrist, which helps reduce swelling. To relax and soften the tissues, a gentle massage of the toe pad with a moisturizing cream or antifungal ointment makes it easier to dislodge the nail's corners. Tea tree essential oil can be applied as a local treatment for its antiseptic properties.
If the nail is too curved, the chiropodist-podiatrist can place a brace or use a special clamp: this device gently lifts the free edges of the nail plate, thus reducing pressure and irritation on the skin. A small piece of cotton can be placed under the nails to gently lift the ingrown edge. Finally, it is essential to let the nail grow back until its corners reappear, which indicates that healing is effective. During healing, wearing sandals or cotton socks helps limit sweating and promotes recovery.
An operation to treat ingrown toenail
A surgical operation is offered to treat an ingrown toenail that is resistant to medical treatment and conservative remedies. The surgical treatment, performed under local anesthesia, is proposed in a minority of cases where the infection persists despite care. This procedure is one of the foot operations performed in orthopedic surgery by a specialized surgeon. There are several surgical techniques, but the principle remains the same:
- resect the inflammatory tissue covering the nail and clean the wounds
- resect the portion or the two portions of the nail plate that are aggressive to tissues, using surgical scissors
- sterilize the nail matrix facing the resected nail plate to prevent recurrence
Occasionally, a skin plasty may also be suggested to expose the nail plate and treat hypertrophy of the lateral folds. The use of phenol at the matrix level promotes its sterilization and limits the risk of ingrown toenail recurrence. After the procedure under anesthesia, a compressive dressing is applied and antibiotics may be prescribed orally to prevent infection.
It is important to note that post-operative complications may occur, such as a hematoma or redness, although these are rare for this type of procedure. The bandage should be changed regularly and the area disinfected with a disinfectant spray until complete healing.
FAQ
The first step in treating an ingrown toenail is the application of topical antiseptics to reduce the risk of local secondary infection and to dry out the inflammatory skin bump. It is important to consult a chiropodist or podiatrist, who can gently file the nail and remove dead skin. Massaging the nail bed with a moisturizing cream helps lift the toenail. A compress soaked in antiseptic can be applied to the infected area. Allowing the nail to regrow until the lateral edges of the nail plate are visible is essential. Therefore, one should not remove an ingrown toenail oneself, but it can be treated with proper care and sometimes with an antibiotic treatment if necessary.
Some nails have a tiled shape, which may be due to a small dorsal phalangeal exostosis or associated with a nail fungus. In this case, certain podiatry treatments involve placing a clip on the nail to straighten it. The chiropodist can also cut the nail in a specific way and apply a therapeutic nail polish. For more complex cases involving fungus or a fungal infection, an antifungal treatment may be prescribed. Itching and thickening of the keratin may be signs of fungal infections that require a consultation with a dermatologist.
To prevent ingrown toenails, it is necessary to take care when trimming the toenails. The nail should be long enough so that the lateral edges of the plate extend beyond the skin after trimming. Avoid cutting the nails too short and biting the cuticles. Wearing properly fitted shoes, neither too tight nor with very high heels, helps to minimize trauma. Shoes should allow the feet to breathe to avoid excessive sweating. Walking barefoot regularly may help prevent deformities. For people with diabetes or psoriasis, regular foot care is recommended. In case of plantar warts or suspicious white spots under the nail, consult promptly to rule out any risk of melanoma. Using a nail file after trimming helps avoid sharp corners that may become ingrown.