Ingrown Toe Nail

Growth Pattern of a Normal Toenail

The toenail (and any other nail) is produced by the nail’s germinal matrix (special nail-generating tissue) and grows forward to the end of the toe. Most of us have lost either a fingernail or toenail and watched as the nail re-grow slowly over several months. The area under the nail that attaches the nail to the toe is called the sterile matrix. This area is referred to as the sterile matrix because it doesn’t actually produce the nail, only attaches it to the toe. On either side of the nail is an area called the nail groove, where the skin of the toe meets the nail matrix and the edge of the toenail.

Causes of Ingrown Toenail

There are several factors that can lead to an ingrown toenail.

• The first is an abnormality of the soft tissue on the side of the nail.
• The nail plate can be forced out of the nail groove by shoes that have a toe box that is too small for the forefoot, by trauma, or by cutting the nail back in a curvilinear fashion.
• Cutting your toenails incorrectly, can cause them them to re-grow into the skin. This occurs because the ingrown nail is often in a warm, moist and bacteria-rich environment. When the nail penetrates the skin, it provides a convenient entry for germs that can cause infection.
• Heredity – Inwardly curved nail with distortion of one or both nail margins
• Bone pathology
• Obesity
• Antiviral therapy for HIV

Untreated, the nail can go under the skin, causing a more severe infection. In either case, the infection needs to be cured with sterile instruments and antibiotics.

Signs and Symptoms of an Ingrown Nail

The sharp end of the nail will be pressing into the flesh on one or both sides of the nail bed.

Skin near the nail may feel tender and look red and swollen as the nail pushes on the skin. Once the nail pokes through the skin, the skin will look redder and more swollen. You may feel a sharp pain that is worse when walking. With time, the skin will grow over the nail. It may also cause yellow drainage come from the nail. This may mean you have an infection.

Ingrown toenails are diagnosed clinically by their appearance. If pus is present, it may be cultured to determine the bacteria involved, but this is not always necessary. Infections that involve the bone or joint space may need to be ruled out with an X-ray, but this extent of infection is rare.

Ingrown toenails need to be treated immediately. In many cases, people with uninfected ingrown toenails can obtain relief with the following simple regimen:

1. Soak the feet in warm salt water

2. Dry them thoroughly with a clean towel

3. Apply a mild antiseptic solution to the area

4. Bandage the toe

If you have diabetes, do not try to treat an ingrown nail by yourself. Always call your caregiver first. Do not treat an ingrown nail without a caregiver’s help if you have certain long-term health problems.

If your nail is infected or your ingrown nail keeps coming back, you may need surgery. Many types of surgeries can be done to treat an ingrown nail. Often, a podiatrist will cut and remove a small section from the side of your nail. The section of nail is cut from the side of the fingernail or toenail that is ingrown.

Your podiatrist may also do a procedure called a matricectomy. During this procedure, the surgeon destroys part of the nail matrix. Your nail matrix is the “root” of your nail. You can see the top part of your nail matrix by looking at your fingernail. The matrix is the pale or white color at the base of your nail. Most of the matrix cannot be seen because it lies underneath the skin. A matricectomy causes a small section of the side of your nail to stop growing. You may continue to have problems with a recurring (keeps coming back) ingrown nail or bad infection. If this happens, the surgeon may need to remove your entire nail to stop the ingrown nail problem.

Cutting toe nails properly goes a long way toward the prevention of ingrown toenails. Using a safety nail clipper, cut the nails straight across, so that the nail corner is visible. If you cut the nail too short, you are inviting the nail corner to grow into the skin. It is the natural tendency, when the edge of the nail starts to grow in, to cut down at an angle at the nail edge, to relieve the pain. This does relieve the pain temporarily, but it also can start a downward spiral, training the nail to become more and more ingrown.