What is an ingrown toenail?

An ingrown toenail occurs when the nail grows into the its surrounding skin and causes pressure, skin damage, inflammation or infection. It produces considerable pain, discomfort, and disability if there is no immediate treatment. An ingrown toenail may occur at any age, most patients are teenagers and adults. It usually affects the big toes. At first there will be pain and inflammation, where the nail grows into the skin. Ingrown toenails cause pain and affect the patient's ability to walk, run, or play sports. If not treated as soon as possible, a periungual abscess will develop at the nail edge skin (periungual abscess). If abscess ruptures spontaneously or by the patient, there will be pus discharge. Subsequently, it may develop into chronic inflammation, affect the normal nail growth, and it may develop pyogenic granuloma, an easy bleeding nodule at the wound edge.

Causes

There are many factors that can cause ingrown toenails:

  • The edge of the nail is cut too proximal or too round, resulting in sharp edges and sharp corners.
  • Wearing thin socks that cannot protect the toes.
  • Wearing short or narrow shoes that squeeze and press the skin against the sharp edges and sharp corners of the toenails.
  • Repetitive toe injuries such as sudden stops, or jumping and landing on toes.
  • Fungal infection of the toenail causes the nail to thicken or form a curved growth at the nail edge. These abnormal growths of the toenail will cause pressure sores and pressure injuries to the surrounding nail bed or nail skin edge.
  • If someone in the family has had an ingrown toenail, the patient has a slightly higher chance of developing an ingrown toenail.

Symptoms

In the early stages of an ingrown toenail, the skin edge of the toenail will be red, minimally swollen and cause minimal pain. It will feel slightly warm when touched and there is no pus discharge. Later, the skin adjacent to the ingrown nail becomes swollen, pus accumulates under the skin and a periungual abscess is formed. Patients usually feel severe pain and can see a red swelling next to the ingrown toenail. Sometimes white, yellow, or green pus may discharge from the periungual abscess as the abscess ruptures. Then, it may progress to chronic inflammation, and affect the normal growth of the nail. A red skin swelling may develop at the site with frequent bleeding after minor scratching, touching or trauma, this is pyogenic granulomas.

Treatment Methods

Conservative Management of Ingrown Toenail

For an early ingrown nail, soak your feet in warm water for 15-30 minutes every day to soften the skin and the nail. Use antiseptic to clean the nail and skin. Lift the softened sharp edge and sharp corner of the ingrowing toenail above the skin, and place a tiny piece of gauze under the sharp edge or the sharp corner of the nail. This separates the nail from the injured skin and protects the skin. It helps the nail grow above the skin surface and allows time for the skin to heal. The condition may heal in 2 to 12 weeks. Please consult your doctor for advice.

Surgery

There are two options for ingrown toenail removal surgery:

  • Ingrown Toenail Removal Surgery (Option 1): This involves removing part of the skin from the edge of the toenail, which will make room for the nail to grow. Clean and dress the wound daily and it should heal within a few weeks.
  • Ingrown Toenail Removal Surgery (Option 2): This involves:
    1. Partial removal of the ingrown part of the nail edge (usually less than one-fifth of the problematic nail edge is removed);
    2. Destruction of the matrix on which the nail cells grow;
    3. Removal of part of the skin from the edge of the toenail.

    Clean and dress the wound daily and it should heal within a few weeks. This procedure will significantly reduce the chances of the ingrown toenail returning.

Surgery for periungual abscess refers to incision, drainage, partial resection of the abscess wall, and cleaning of the wound surface (debridement).

Pyogenic granuloma excision surgery refers to the removal of the skin edge of pyogenic granuloma and a small amount of subcutaneous tissue, electrocautery of the wound, and hemostasis.

Please check with your doctor.

Ingrown toenail removal surgery (before)

Ingrown toenail+acute paronychia+pyogenic granuloma

Ingrown toenail removal surgery (after)

wound healing

FAQs

Q: How to prevent ingrown toenails?
A: When cutting the nail, you should keep the edges and corners of the nails while cutting the distal part of the nail. Afterwards, you should smoothen the corners and edges of the nails by emery board or metal grinding board. In order to prevent ingrown toenail, you should wear wide, long and roomy shoes, and keep your feet clean and dry.
Q: If I have ingrown toenails and I do not want any treatment, what will happen?
A. The affected toes can cause severe pain when it is accidentally hit or when you are having exercise. The edges of the ingrown toenail may bleed from time to time. If ingrown toenail can be cured in 4-6 weeks, why not treat it early? Delaying treatment of ingrown toenail is indeed unwise. Please consult your doctor for advice.
Q: Is paronychia surgery safe?
A: Yes. It is very safe.