Alan Bryant Andrew Knox

Background

An ingrown toenail or onychocryptosis may occur at any age and is the mostly commonly encountered toenail problem likely to be seen in general practice.^1–3

Objective

This article will discuss the common surgical approaches available for the management of an ingrown toenail.

Discussion

Ingrown toenail can be a painful condition that can become infected and may require surgical treatment. The epidemiology of onychocryptosis is difficult to determine as it is often considered to be a minor medical problem and as such has been some-what neglected in the literature. The few studies that have been conducted suggest a slightly higher male-to-female ratio, partic-ularly in the 14–25 age group,4 but it can affect patients of any age. There are multiple reasons why an ingrown toenail will de-velop, including improper nail cutting technique, tight-fitting footwear, trauma, anatomical factors such as thickening of the nail plate, pincer-shaped toenail, pressure from abutting digits caused by hallux valgus or lesser toe deformities, the presence of a subungual exostosis and, occasionally, the use of isotretinoin in the treatment of severe acne.^5–7

Management of ingrown toenail

What is an ingrown toenail?

An ingrown toenail occurs when the nail edge is damaged, and the nail no longer fits properly into the side groove. The nail curls downward and digs into the skin, causing pain, swelling, redness, and drainage. Sometimes a piece of nail (called a lateral pointing spicule) becomes embedded in the side tissue, and the tissue becomes heaped up (hypertrophied).

What causes an ingrown toenail?

There are many causes for ingrown nails, but the two most common causes are poorly fitting shoes and improperly trimmed nails. Tight shoes compress the side of the nail and alter the fit of the nail in the groove. When nails are peeled off or torn, the edge of the nail can extend down into the corner of the nail groove. A torn nail can irritate the skin next to the nail, producing inflammation (swelling, pain, and redness) and sometimes infection.

This non-surgical treatment helps the body heal itself.

Have you noticed a sharp, stabbing pain at the bottom of your heel as you get up to go to the bathroom in the morning? Does the pain ease as you walk around a bit? If so, you might have plantar fasciitis.

Plantar fasciitis is a very common cause of heel pain in the United States. About two million Americans are treated for this condition every year, according to the American College of Foot and Ankle Surgeons. Approximately ten percent of all Americans will suffer from plantar fasciitis in their lifetime.¹