What is an Ingrown Nail?
When any portion of a toenail punctures the skin and begins to push into the skin as it grows, it may become and ingrown nail. They can occur in patients of all ages. In some cases, even the whole nail can be involved. The medical term is onychocryptosis or paronychia.
What is the purpose of our toenails?
Our toenails do not function for any purpose. We used to use them to climb trees. They do not serve to protect the toe or the specialized skin under the nail. Loss of a portion or the entire toenail does not restrict people from any function or activity nor does it increase any chance of infection or damage to the toe.
What Are the Symptoms of an Ingrown Nail?
Patients will complain of mild to severe pain usually in the corner of the nail. The pain starts as a mild achy pain. As the nail continues to move into the skin, the pain will become more severe. There will be redness and swelling around the nail. An infection is usually present and can present as a pus pocket under the skin. Some patients will even see pus drainage from the area. As the nail continues to go into the skin, there is a reaction of overgrown tissue that develops. This extra tissue is very vascular and tends to bleed easily. In very severe cases when left untreated, a cellulitis, or streaking severe infection can develop. A portion of the nail or the whole nail could be involved.
What are the Causes of an Ingrown Nail?
An ingrown nail occurs when the nail produces a sharp edge and punctures the skin as it grows forward each day. This usually occurs from trauma to the nail. The trauma could come from an external force such as a kick to a soccer ball cracking the nail, or tight shoes. In most cases an ingrown nail occurs due to the poor cutting of the nail. This can happen at home, or even at the pedicurist. When the nail is cut too short or at an angle, a sharp edge is left on the nail. Days later, this sharp edge can cut into the skin and the ingrown nail begins.
Some patients are prone to ingrown nails if there nail is severely curved or thickened. Those with a fungal infection to the root of the nail are also prone to ingrown nails.
How is an Ingrown Nail Diagnosed?
An examination of the nail and the surrounding skin is the most common way to verify the presence of an ingrown nail.
How is an Ingrown Nail Treated?
Mild to Moderate Cases:
In cases when the ingrown nail is mild and has just started, a home course of therapy may eliminate the pain. The patient will be asked to soak the foot in warm water and salts each day for about 20 minutes. The area should then be covered with a bandage and antibiotic ointment. This regimen will soften the nail and the surrounding skin and help the nail to come out of the skin as it grows. The doctor may use an instrument to elevate the nail out of the skin to aid in its growing the proper way. Cutting of the nail is not indicated as it will create another sharp edge and the problem will recur.
Moderate to Severe Cases:
In most cases, the portion and side of the nail that is affected will need to be removed to the level of the root or matrix. By removing the entire side of the nail, a new nail is able to grow with the remaining nail with a straight edge. This almost eliminates the chances of a recurrence of the ingrown nail. If there is any infection or pus, this will also be drained and cleaned. Any overgrowth of tissue will also be removed. Antibiotics are usually not needed since the body’s immune system can effectively treat the infection once the nail is removed.
Partial Nail Avulsion Procedure:
The procedure is performed in the office setting in less than 10 minutes. The patient is given 2 small injections at the base of the toe to numb the affected area. The toe is then cleaned for the procedure. The affected are of the nail is lifted away from the nail bed and nail root using specialized instruments. The nail is then cut away from the healthy nail and removed from the root. Any pus or granulation tissue is removed. There is minimal bleeding and no pain during the procedure. The toe is then wrapped with light bandages. The patient will be asked to perform a home therapy protocol to treat the area during healing. Patients do not experience pain and are not restricted from activity or shoes during the 1 week healing time. The nail will grow full width over 9 to 12 months.
Patients who have multiple recurrences of ingrown nails may require more aggressive treatment. In these cases, the affected portion of the nail may need to be removed permanently. This is called a Matrixectomy.
Partial Matrixectomy Procedure:
The procedure is performed in the office setting in less than 20 minutes. The patient is given 2 small injections at the base of the toe to numb the affected area. The toe is then cleaned for the procedure. The affected are of the nail is lifted away from the nail bed and nail root using specialized instruments. The nail is then cut away from the healthy nail and removed from the root. Any pus or granulation tissue is removed. A specialized acid mixture called Phenol is then carefully placed over the root (matrix) of the nail to kill the root cells. The area is then washed with alcohol to dilute the phenol. There is minimal bleeding and no pain during the procedure. The toe is then wrapped with light bandages. The patient will be asked to perform a home therapy protocol to treat the area during healing. Patients do not experience pain and are not restricted from activity or shoes during the 1 week healing time. The patient should not see any growth of ne nail at the affected area.
Total nail Avulsion or Matrixectomy:
Some patients may have a problem with the entire nail. In these cases, the whole nail may need to be removed temporality or permanently. The same procedures are followed as above, yet removing the entire nail. No special attention is needed to the skin under the nail. If the nail root is left intact, the nail will regrow over 9 to 12 months.
In very rare cases, a patient may require surgical excision of the nail root where a chemical matrixectomy is not advised. The procedure is performed in the operating room with light sedation. The offending nail portion is removed. The skin is cut and moved away from the nail root. The matrix of the nail is then completely removed in the affected area. The skin is then closed with stitches. The patient can walk in a special shoe until the stitches are removed in 2 weeks.