Ingrown Toenail
Onychocryptosis (also known as an “Ingrown nail,” or “Unguis incarnatus” ) is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails.
Causes
The main cause for onychocryptosis or “ingrown nail” is improper footwear including shoes with inadequate toe-box room and tight stockings that apply top and or side pressures; next is the damp wet atmosphere toes are subjected to all day in enclosed shoes, softening the nail-plate and swelling the epidermis keratin, which eventually increases the convex arch permanently; next is genetics; and last are trauma and disease.
Improper cutting of any nail may cause the nail to cut into the side-fold skin from growth and impact, whether or not the nail is “ingrown” (onychocryptosis). The nail bends inwards or upwards depending on the angle with which it has been cut. Looking from the perspective of the owner, when cutting the nail, if the cutting tool, such as scissors, are in an attitude where the lower blade is closer to the toe than the upper blade then that will cause the toenail to start growing from its base upwards. Vice versa, when the lower blade is farther than the upper blade, the toenail will turn inwards. The process is visible along the nail as it grows, appearing as a warp that advances towards the end of the nail. The upper corners turn more easily than the center end of the nail. As people cut their nails by holding the tool always in the same angle, they induce these conditions by accident, while as the nail turns closer to the skin, it becomes harder to fit the lower blade in the right attitude under the nail. When cutting a nail, it is not just the right angle that is important, but also how short it is cut. A shorter cut will bend the nail more, unless the cut is even on both top and bottom of the nail.
Causes include:
- Bad maintenance, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across
- Ill-fitting shoes, as those that are too narrow or too short can cause bunching of the toes in the developmental stages of the foot (frequently in those under 21), causing the nail to curl and dig into the skin
- Trauma to the nail plate or toe, which can occur by stubbing the toenail, dropping things on the toe or going through the end of the shoes (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh
- Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases, or a genetic susceptibility to nail problems like ingrowth
Treatment
Treatment of ingrown nails ranges from soaking the afflicted area to surgery. The appropriate method is dictated by the severity of the condition. In nearly all cases, drainage of blood or watery discharge should mean a trip to the doctor, usually a podiatrist, a specialist trained explicitly to treat these conditions. Most practitioners agree that trying to outwait the condition is nearly always fruitless, as well as agonizing.
Home care
In mild cases (not including the severe cases as in the photos above), doctors recommend daily soaking of the affected digit in a mixture of warm water and Epsom salts and applying an over-the-counter antiseptic. This might allow the nail to grow out so it may be trimmed properly and the flesh to heal. Also Dettol instant Hand sanitizer has been known to be effective in the treatment of minor cases. Note that infection may be somewhat difficult to prevent in cleaning and treating ingrown nails owing to the warm, dark, and damp environment in shoes.
Peroxide is immediately effective to help clean minor infections but iodine is more effective in the long term as it continues to prevent bacterial growth even after it is dry. However, iodine should not be used on deep wounds. In such cases a physician or podiatrist should be consulted. Also, although bandages can help keep out bacteria, one should never apply any of the new types of spray-on bandages to ingrown nails that show any discharge – preventing drainage will likely cause intense swelling and pain. Removal of spray-on bandages can be achieved with common rubbing alcohol.
Some doctors will apply silver nitrate to granulation tissue (overgrowth of irritated tissue at the side of the nail. This may look like reddish cauliflower, bleeds easily). This may shrink and or remove this sensitive overgrown tissue at the side of the nail.
These home remedies are, in serious cases, ineffective: when the flesh is too swollen and infected these procedures will not work. Thus, these more severe cases, such as when the area around the nail becomes infected or the nail will not grow back properly, must be treated by a professional and the patient should avoid repeated attempts at this type of ‘bathroom surgery’.
