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ingrown nail

aberrant growth of a toenail, with one or both lateral margins pushing deeply into adjacent soft tissue, causing pain, inflammation, and possible infection. The condition occurs most frequently in the great toe, and is often caused by pressure from tight-fitting shoes. Another common cause is improper cutting of the toenails, which should be cut straight across or with a curved toenail scissors so that the sides are a little longer than the middle.

in·grown nail

a toenail, one edge of which is overgrown by the nailfold, producing a pyogenic granuloma; due to faulty trimming of the toenails or pressure from a tight shoe.


/on·y·cho·cryp·to·sis/ (on″ĭ-ko-krip-to´sis) ingrown nail.

ingrowing toenail

; IGTN; onychocryptosis; OC perforation of the epidermis and dermis of the nail sulcus by a spike, shoulder or serrated edge of the adjacent nail plate; most commonly affects the hallux nail, especially in adolescent boys with hyperhidrosis; the degree of nail penetration increases over time (days to weeks) inducing further local swelling; involved soft tissues are inflamed (very tender, red and swollen), and may become infected (paronychia); an area of partially epithelialized hypergranulation tissue (i.e. a pyogenic granuloma) overlies the ingrown area of nail in long-standing cases; treatment includes excision of the nail spike (under local anaesthetic), partial avulsion of the nail plate (under local anaesthetic) with ablation of the associated nail matrix to prevent plate regrowth, together with treatment of the underlying cause (e.g. advice on nail cutting, control of hyperhidrosis, provision of antipronatory orthoses) and shoe advice (including correct fitting [ see Table 1] and use of laces); Table 2 and see Table M2
Table 1: Presentations and treatment approaches for ingrown toenail
IPatient complains of pain in the nail sulcus, especially in shoes
Minimal visual signs of IGTN (slight swelling, slight redness)
• May resolve with local removal of nail spike or small sliver of the outer margin of the nail plate and gentle packing of the sulcus with sterile cotton wool
IIPatient complains of acute pain
Visual signs of local inflammation: redness, swelling; hyperhidrosis
Hypergranulation arising from affected nail sulcus
Seropurulent (smelly) discharge
• May resolve with local removal of nail spike or small sliver of nail plate under local anaesthetic, together with gentle packing of the sulcus with sterile cotton wool
• May require excision of the section of the nail plate, together with gentle packing of the sulcus with sterile cotton wool, but there is a high risk that the problem will recur as the nail plate regrows
• May require excision of the section of the nail plate, together with ablation of the exposed pocket of matrix (by application of phenol or potassium hydroxide or electrosurgery or surgical excision); the hypergranulation tissue may be excised, or left in situ where it will gradually atrophy over the next 2 weeks; there is an approximately 5% risk of regrowth of the excised section of nail plate
IIILong-standing IGTN
As stage II, but epidermal overgrowth of granulation tissue
Table 2: Features of a well-fitting shoe
Shoe featureDescriptor
Retaining mediumThe means that retains the foot within the shoe: laces, buckle and bar, T-bar strap, Velcro straps
The foot should be well seated into the heel part of the shoe, with the plantar aspect inclined upwards at 45° to the ground surface before the retain medium is closed around the foot
Close-fitting medial and lateral quartersThe close fit of the shoe quarters around the tarsus of the foot complements the retaining mechanism, and reduces frictional forces around the heel
In a well-fitting shoe there will be no mediolateral or anterior-posterior drift, or slip of the foot against the heel counter of the foot during gait
Adequate toe boxThe forepart of the shoe should be wide and deep enough to allow normal toe function throughout gait, and should coincide with the natural outline of the forefoot
The tips of the toes should not be in contact with the toe end of the shoe, and the toe puff should not exert pressure on the dorsal nail plates
The toes will contact the inner of the toe box if the shoe is too large or too small for the foot
Correct lengthShoes that are too short or too long predispose to digital and nail lesions, toe deformity and reduced foot function
The MTPJs should coincide with the maximum width of the forepart of the shoe
Correct widthThe correct width of the shoe will allow the toes to lie straight and unrestricted and in their normal relationship during gait
The widest part of the shoe should coincide with the transverse width of the foot across the MTPJ parabola
Deep creases across the forefoot upper indicate a shoe that is too narrow for the foot
Adequate heel seatThe heel seat accommodates the heel of the foot
A too-narrow heel seat causes the formation of a ridge of callosity at the heel periphery
Appropriate heel heightThe vertical height of the heel of the shoe
The weight of the body is transferred to the forefoot, the lumbar spine is extended and the stride length is reduced if a shoe with a heel height of >5 cm is worn
The greater the height of the heel, the greater the instability of the foot and the greater the chance of trauma (inversion sprain, avulsion fracture)
Broad heel baseThe outsole of the heel should at least match the width of the rear part of the shoe in order to ensure maximum stability in the normal foot
The narrower the heel contact area, the greater the force transferred to the body during gait at heel strike, and the greater the chance of trauma (inversion sprain, avulsion fracture)
Leather upperLeather is supple and strong, and will stretch to some extent to accommodate toe deformity
Leather is permeable, and will absorb sweat
SolesSoles are ideally made of light-weight, insulating, cushioning, non-slip, hard-wearing materials
Thin soles neither insulate nor cushion the foot during gait

Patient discussion about onychocryptosis

Q. How to prevent an ingrown toenail? I recently had an ingrown toenail and am scared of having another. How can I prevent it?

A. When you trim your toe nails make sure your cut them straight a cross. What ever you do, don't tear the nail off.

Q. How to treat an ingrown toenail? I think I have an ingrown toenail. How to treat it?

A. When the problem is mild, you may only need to soak your foot in warm water for 15 to 20 minutes and place dry cotton, such as part of a cotton ball, under the corner of the nail. Signs that the problem is getting worse include increasing pain, swelling and drainage of the area. Sometimes minor surgery is needed to remove the part of the nail that is poking into the skin.

Q. What are the symptoms of an ingrown toenail? My son has a red toe and complains that it hurts. Is this an ingrown toenail?

A. The main symptom of an ingrown toenail is the pain from the nail growing into the skin instead of over it. If the ingrown toenail gets infected, it might be swollen or red, and it might drain pus. The area around the ingrown toenail is often painful.

More discussions about onychocryptosis
References in periodicals archive ?
Correct management of onychocryptosis requires identification of the stage and evaluation of the affected tissues.
Multiple onychocryptosis following treatment of onychomycosis with oral terbinafine.
Onychocryptosis is derived from Greek word (onyx= nail; kryptos= hidden)1.
001 which is statistically significant thus proving that this procedure is effective in treating onychocryptosis (Table-4).
Onychocryptosis can be accompanied by local sepsis, which is a serious concern in patients on anti-tumor necrosis factor-[alpha] therapy, Ms.
The full extent and impact of foot problems in these patients is not clear, but a retrospective 14-month audit in the rheumatology foot clinic at Leeds (England) General Infirmary identified nine cases of onychocryptosis developing in rheumatoid arthritis (RA) patients on biologic therapy.
None of the patients had experienced previous episodes of onychocryptosis.
s Ie d Dr Miriam says: The name for your painful condition is onychocryptosis and your first step should be to go and see your doctor, who will be able to treat you.