Also found in: Dictionary, Wikipedia.
onychocryptosis/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
|I||Patient 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
|II||Patient 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
As stage II, but epidermal overgrowth of granulation tissue
|Retaining medium||The 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 quarters||The 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 box||The 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 length||Shoes 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 width||The 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 seat||The 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 height||The 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 base||The 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 upper||Leather is supple and strong, and will stretch to some extent to accommodate toe deformity|
Leather is permeable, and will absorb sweat
|Soles||Soles 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?
Q. How to treat an ingrown toenail? I think I have an ingrown toenail. How to treat it?
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?