Ingrown Toenail, What To Do?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Ingrown toenail

An ingrown toenail is the penetration of the nail plate into the lateral edge of the nail fold. Doctors call this phenomenon onychocryptosis. Most often, it is the thumb of the lower extremity that suffers. In this case, the nail roller turns red, swells and becomes inflamed. This is accompanied by intense pain.

Until the moment when tissue suppuration has occurred, many people do not pay attention to the fact that the nail is growing incorrectly and do not consult a doctor about this. As a rule, patients appear in the doctor's office complaining of severe pain. In 50% of cases, an ingrown toenail is a chronic condition.

Content:

• Causes of ingrown toenails
• Ingrown toenail symptoms
• Diagnostics
• Treatment with conservative methods
• Surgery
• Complications
• Prevention

Causes of ingrown toenails

The reasons that lead to the fact that the nail grows into soft tissue:

• Incorrect cutting of the nail plate. This is the most common cause of violation. Such a situation happens when a person cuts off the corner of the nail, leaves a sharp edge, a burr, or cleans under the nail with scissors. It is impossible that after cutting the nail, a rounded edge remains in its place. You should not cut your toenails too short.
• Wearing tight shoes that are too small or too tight in the toes. When outside pressure is constantly exerted on the nail, it will begin to change its shape.
• Excessive load on the lower limbs.
• Fungus of the nail. This disease leads to the fact that the plate begins to deform, becomes thick, so the nail can grow into soft tissues.
• Hallux valgus, flat feet. With these diseases, the thumb is bent, which causes an abnormal growth of the nail plate.
• Congenital features of the structure of the nail fold. Sometimes there is too much soft tissue in the subungual cushion, resulting in a corresponding problem.
• Pregnancy. The problem of an ingrown toenail is often faced by women 2 months after childbirth, during breastfeeding, and also before childbirth, which is associated with increased loads on the lower extremities.
• Diseases that negatively affect the nutrition of the nail. These are such pathologies as: diabetes mellitus, endocrine diseases, overweight, disorders in the functioning of the cardiovascular system.
• Diseases of a dermatological nature: warts, lichen, psoriasis, etc. All of them lead to the fact that the nail plates will be deformed.
• Cancer therapy. Both radiation therapy and chemotherapy negatively affect cells that tend to grow constantly. This is also true for the nail plate.

Ingrown toenail symptoms

If the nail begins to grow into the roller, then this will manifest itself with symptoms such as:

• Soreness in the affected area. The pain tends to get worse, especially when walking in shoes.
• Formation of an ulcerative defect in the ingrown nail. An ulcer is the result of permanent soft tissue injury.
• Swelling of the roller, its hyperemia. These symptoms indicate that an infection has entered the soft tissue. At the same time, the pain intensifies, becomes pulsating.
• Excessive growth of tissue on the nail. Such fabrics will have the bright color of fresh meat. This symptom is called granulation.
• Deformation of the nail, accompanied by shortening of the plate and its thickening. These changes are irreversible with a long course of the violation. The soft tissue that surrounds the nail becomes rough.

Diagnostics

When the first signs of an ingrown nail appear, you need to go to an appointment with a surgeon or a podologist. The doctor will give a referral for the delivery of a general blood test, which will assess the degree of the inflammatory reaction. You will also need to determine your blood glucose level. This analysis will make it possible to exclude or confirm diabetes mellitus.

If there are symptoms of nail fungus, then a dermatologist should be seen. Without eliminating the underlying disease, it will not be possible to cope with the problem of an ingrown nail.

The surgeon can additionally send the patient for X-ray, which will allow assessing the extent of the lesion, excluding osteophyte (the so-called bony outgrowth on the finger). Symptoms of this disorder have a similar clinical picture to an ingrown toenail.

Treatment with conservative methods

If the violation has just begun to develop, then it can be dealt with by conservative methods.

Such treatment is carried out at home, but only after a medical consultation:

• Antiseptic baths. Feet can be disinfected in a solution of potassium permanganate, sea salt, baking soda. The procedure is carried out up to 4 times a day. When the tissues become soft, the nail comes out of them. This allows the ingrown part to be gently removed. Then you can treat the affected area with iodine. Baths will need to be done until the pathological symptoms completely disappear.
• Compress. It is applied all night long. The procedure is repeated 3-4 times a day. For the preparation of the impregnation, 10 ml of Dimexide, 1 ampoule of analgin, 1 ml of dexamethasone and 20 ml of water are used. All components are mixed, applied to gauze and applied to the affected area. Cover the gauze with cellophane, bandage and put on a sock. If it was not possible to cope with an ingrown nail with a compress, then you need to contact a surgeon.
• Chlorhexidine. A sterile bandage is moistened in the drug solution and placed between the nail and the skin roll. To prevent the bandage from drying out, it must be impregnated with Chlorhexidine. Every day, the bandage will need to be pushed deeper and deeper, thereby freeing the nail. If you perform this procedure correctly, then you will be able to cope with the problem as soon as possible.
• Furrow formation. To do this, saw a vertical strip in the nail with a nail file. You can only touch the stratum corneum of the plate. This furrow will tighten, resulting in a natural lift of the nail.
• Boiling water treatment. If the inflammation has just begun to develop, that is, the finger turns slightly red and began to hurt, then you can use the treatment described below. It is strictly forbidden to use this method if an abscess is already developing. A sore finger must be immersed in hot water for 1-2 seconds and removed. The treatment should be repeated 30 times in 10-20 minutes. Such treatment should be continued until the symptoms of the disorder disappear.
• Taking medicines. If the pain is very severe, then you can take drugs from the NSAID group, for example, Ibuprofen or Paracetamol.

Treatment should be accompanied by adherence to recommendations such as:

• Shoes worn by the patient should be as loose as possible.
• Feet must be carefully looked after.
• Socks should be changed at least 2 times a day.
• The nails must be trimmed correctly.

Solutions and ointments for an ingrown nail

• Balm Nogtinorm. This tool makes the nail plate softer, which makes it easier to get rid of the problem. The drug has an analgesic and anti-inflammatory effect. They are provided with the substances that are part of the balm: St. John's wort horophyte, licorice and maclea extract, petroleum jelly and palm oil. Nogtinorm is applied to the nail roller over the entire nail plate. First, you need to steam your legs.
• Ointment Uroderm. The preparation contains urea. This substance softens the nail and the surrounding tissue, which allows cutting the plate without any problems. The ointment is applied to the affected area for 3-4 days. The finger should be dry. The cream is injected into the gap between the periungual roller and the edge of the nail using a special spatula. Then they put socks on their feet and leave them for a while. After 4 days of this treatment, you can cut off the ingrown nail.
• Levomekol. This medication is used only after the nail has been removed by the surgeon. It contains chloramphenicol (an antibiotic) and methyluracil (a substance aimed at accelerating metabolic processes in tissues). After the operation, gauze is applied to the treatment area, which is pre-soaked with ointment. The dressing should be changed regularly. It is used until the wound is completely cleansed.
• Vishnevsky ointment. This drug is used only if the affected area begins to fester. The ointment contains birch tar, castor oil, xeroform. The drug is applied to the affected area, and a bandage is applied on top. They take it off in the morning. If the nail has come out of the soft tissue, it can be carefully cut off.
• Ichthyol ointment. Apart from ichthyol, the preparation contains petroleum jelly. This agent has analgesic, anti-inflammatory and antibacterial effects. It allows you to soften the nail plate. The drug is applied at night under a bandage. In the morning it is removed and the excess nail section is cut.

Staples and plates

Braces and plates allow the ingrown nail to be lifted. They do not cause discomfort to a person, they allow you to wear shoes without pain. By their appearance, such devices resemble braces. They should be prescribed by a doctor.

Surgery

There are several methods of surgical treatment for an ingrown toenail:

• Resection of the edge of the nail or the entire plate as a whole. The operation is performed using local anesthesia. If the process is not complicated by suppuration, then you can do with cutting off part of the nail plate. When the infection has joined, the entire nail is removed. The new plate will grow back after 3 months. However, it cannot be ruled out that repeated ingrowth of the nail into the soft tissue will occur. To prevent this from happening, you need to remove granulation and part of the skin from the side of the finger. This will prevent contact between the nail and soft tissues.
• Laser treatment. If the nail grows into the roller at the level of the cuticle, then cauterization of its ingrown edge and growth cells is performed after the affected plate is removed. Such treatment allows to exclude relapse. The laser affects growth cells and an ingrown nail, and also removes inflamed tissue and granulation. Laser treatment is the best way to deal with an ingrown toenail.
• Radio wave removal of an ingrown nail. This method does not leave behind scars and scars, and the likelihood of recurrence is minimal. During the procedure, the ingrown nail itself, as well as its matrix and growth cells are removed.

Nail care after surgery. When the nail has been removed, the soft tissue is left unprotected and will hurt. Recovery is quite long and takes about 30 days. At this time, you need to protect the treated area from infection.

Every day (the first 5 days after the operation), you need to treat the nail with antiseptic agents (hydrogen peroxide, Chlorhexidine), and then apply antibacterial ointment (Levomekol, Ofloxin, Gentaxan). The finger is tied with a bandage. The first 5 days, the bandage is changed every day, and then every other day.

The leg should be at rest. It must be protected from injury and overload. If a person is in severe pain, then pain medications are required.

A sore finger should not be pinched, so shoes should be wide and comfortable.

Complications

Complications that can result from ignoring the problem of an ingrown toenail:

• Lymphadenitis and lymphangitis. In this case, the infection through the lymphatic vessels reaches the lymph nodes located in the immediate vicinity and leads to their inflammation.
• Finger abscess. At the same time, its soft tissues fester and swell greatly.
• Osteomyelitis. In this case, bone tissue is involved in the inflammation process.
• Gangrene of the finger. His tissues blacken and die off, a finger is required to be amputated.

Prevention

In order to prevent the ingrowth of the nail into soft tissue, the following recommendations must be followed:

• Pedicure needs to be done correctly. Before processing the nails, they are steamed. Cut nails in a straight line, without rounding the edges. They must be carefully processed using a soft nail file for this purpose. Nails should not be cut too short, the free edge should be at least 2 mm. If dirt has accumulated under the nail, then it is cleaned with cotton wool, and not with scissors.
• If the nails grow in, then you can use a special liquid, for example, GiGi No Bamp Topical Solution, Genwol med. These products soften the skin, prevent keratinization, prevent the nail from growing into soft tissues.
• Shoes with heels exceeding 4 cm for women and 2 cm for men should not be worn.
• If there are orthopedic disorders, then you need to use insoles and the right shoes.
• Feet should be washed regularly, socks changed.
• It is important to lose weight.
• If signs of nail fungus appear, then you should not delay treatment.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.