Ingrown toenail: causes, treatment, prognosis
An ingrown toenail (Unguis incarnatus) usually affects the big toe. The ingrown toenail presses itself into the nail bed and causes pain or inflammation. Possible causes are, for example, shoes that are too tight or incorrect nail cutting. Read more about the causes and symptoms and what treatment options are available when a toenail has grown in.
Ingrown toenail: Description
Ingrown toenails usually press into the surrounding tissue. This pressure often causes inflammation with painful swelling. The irritated tissue is more susceptible to the entry of bacteria, which worsens the inflammation. If an ingrown toenail becomes inflamed, so-called “wild flesh” (granulation tissue) is formed, which begins to proliferate as the wound heals.
Ingrown nails cause unpleasant pain, which is why those affected often cut their nails even shorter, in many cases oval. Even slight pressure through the shoes then pushes the nail edge into the tissue – again an ingrown toenail is created. It is difficult for those affected to free themselves from this vicious circle on their own. An ingrown toenail therefore belongs in professional treatment. A doctor or a medical pedicurist should be the first point of contact.
Ingrown toenail: symptoms
An ingrown toenail usually affects the big toe, more rarely the remaining toenails or fingernails. It can cause severe localized pain. The accompanying inflammation causes swelling, the tissue is often reddened and feels warm. Wearing stockings or lying on a bedspread can sometimes become a torture. In the advanced stage, the tissue may start bleeding. In addition, in many cases an ingrown toenail brings pus with it.
Ingrown toenail: causes and risk factors
An ingrown nail can have various causes. Ingrown toenails can be encouraged by the wrong technique when cutting nails. If the toenail is cut too far down at the edges (i.e. cut oval), they will then grow more easily into the surrounding nail bed.
Especially women often wear shoes that are too tight. The permanently increased pressure between skin and toenail can easily cause an ingrown toenail. Heavy perspiration on the feet also softens the skin around the nail and also increases the risk of ingrown toenails.
In addition, an ingrown toenail occurs more often in families. Some people have naturally wider nail beds than others. The innate anatomical conditions of the nail bed therefore also play a role.
Ingrown toenail: examinations and diagnosis
Patients can usually see for themselves what causes the pain and inflammation on the foot: an ingrown toenail. But which doctor or specialist can help with such a problem? In lighter cases, the help of a medical chiropodist (podiatrist) is usually sufficient. If an ingrown toenail is more advanced and associated with considerable discomfort, a dermatologist or foot surgeon should be consulted.
Ingrown toenail: treatment
Once a nail has grown in, prompt treatment is required. There are several possibilities:
Ingrown toenail: conservative treatment
As a first measure it is recommended to tap the ingrown toenail to relieve the surrounding tissue from the nail. A padded strip of plaster is inserted between the nail and the inflamed nail wall. The patch is then pulled around the toe so that there is more air between the skin and nail. Patients usually experience this measure immediately as relief and the pain is relieved.
An ingrown toenail can also be treated with anti-inflammatory iodine ointments. Foot baths can be useful in advance: they soften the tissue so that an ingrown toenail can be better treated with ointments and plasters afterwards.
An ingrown toenail can also be treated by another non-operative (conservative) method – the nail correction brace. It is applied by a medical chiropodist (podiatrist) when the nail is too round at the lateral edges. The nail clasp can be made of plastic or wire. The nail brace is applied over a period of approximately six to twelve months. It is attached to the edges of the nail and fixed in the middle of the nail. Thus an ingrown toenail is slowly pulled up again from the depths of the nail bed. The nail grows into a new form from scratch, which is why this process takes so long.
Ingrown toenail – Surgical Treatment
If the conservative measures are not sufficient, an ingrown toenail should be treated surgically: The ingrown nail corners and the surrounding granulation tissue are removed under local anaesthetic. The wound is then treated with a plaster or a small bandage. However, it is important to check the wound regularly to see if the inflammation has healed and the toenail has not grown back in.
If there is a risk of recurring ingrown toenails, an operation to reduce the nail bed (emmert plastic or nail excision) may be advisable. The affected part of the nail and the lateral nail wall are removed in a wedge shape. The nail therefore becomes narrower overall, which reduces the risk of re-growth.
After the operation the tissue is still very sensitive for some time. The patch applied should be changed regularly after the first two to three days.
Ingrown toenail: course of disease and prognosis
An ingrown toenail can usually be treated well:
In the case of early treatment, conservative methods are usually sufficient. However, they require the reliable cooperation of the patient. As this is a longer lasting treatment, the patient should be patient.
In worse cases, an ingrown toenail often requires surgery. The intervention brings rapid success – the complaints disappear.
After every conservative and surgical treatment, the patient should take care to cut the nails correctly (straight and not oval) and not wear too tight shoes. Otherwise, an ingrown toenail will quickly develop again.
Especially with older people, an ingrown toenail often occurs without them really noticing it. Due to a lack of mobility, many older people are no longer able to provide adequate foot care. Then a medical pedicure may be necessary. In addition, wearing sufficiently large and breathable footwear can prevent (re)formation of an ingrown toenail.
About this text
This text complies with the requirements of medical literature, medical guidelines and current studies and has been reviewed by medical experts.
ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity to work.
- Kessler, S. & Volkering, C.: Unguis incarnatus, surgery basic training, Springer Verlag, 2013
- Chiriac, A. et al.: “Ingrown toenails (unguis incarnatus): Nail braces/bracing treatment”, in: Proceedings (Baylor University. Medical Center) 27.2 (2014): 145.