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Ingrown Toenails

ingrown-toenail
 
ingrown-toenail
Ingrown Toenail, Onychocryptosis Source: See #4
Ingrown toenails
happen when an edge of the nail grows into the skin.

The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. If toenail edges are sharp, smooth them with an emery board. You can also get an ingrown toenail if your shoes are too tight.


The list below contains links to several sources of information about this topic, of varying length and complexity of detail. Links to to source websites and / or other points of origin are provided below each write-up.
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Ingrown Nails

Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure. Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers. If painful or infected, your podiatric physician may remove the ingrown portion of the nail; if the condition reoccurs frequently, your podiatrist may permanently remove the nail.

If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water, then apply an antiseptic and bandage the area.

People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self treatment and seek podiatric medical care as soon as possible.

Other "do-it-yourself" treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications, should be avoided.

[ Link to the Source ]

Ingrown Toenails

(HealthDayNews) -- When you trim your toenails too short and taper the corners, your toenail can grow into the skin. This is called an ingrown toenail, says the American Academy of Orthopaedic Surgeons.

Wearing shoes that are too tight or too short also can lead to this painful condition, which is most common in big toes.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may turn red, and become very sore and infected.

To treat an infected ingrown toenail, soak your foot in warm, soapy water several times a day. Gently lift the edge of the ingrown toenail and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day. If your infection is severe, your doctor may prescribe antibiotics. If you are in a lot of pain or the infection returns, your doctor may remove part or all of the affected nail.

You can lower your risk of developing an ingrown toenail by trimming your nails straight across with no rounded corners. The length of your toenail should extend past your skin, and the top of each nail should form a straight line across, level with the top of your toe.

Copyright © 2004 ScoutNews LLC . All rights reserved.

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Ingrown Toenails

An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, and can be extremely painful. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too.

A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin isn't an ingrowing toenail, but can feel very painful and also appear red and inflamed as well.

Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not reach their toes!)

If left untreated, the infection can spread to the rest of the toe. The quicker you treat it, the less painful the treatment.

Firstly, learn to cut your nails properly. Cut your nails straight across and don’t cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Also, cut them after a bath or shower when they’re soft.

Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials and choose socks and shoes of natural fibre. In the summer, wear open-toed sandals where possible.

For the most basic painful and irritable ingrowing toenail, your podiatrist will remove the offending spike of nail and cover with an antiseptic dressing.

If your toe is too painful to touch, your podiatrist may inject a local anaesthetic before removing the offending portion of nail.

If you have involuted nails, your podiatrist may remove the bit that’s curling into the flesh and file the edges of the nail to a smooth surface.

If you have bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, you’ll need antibiotics to beat the infection as well as having the offending spike removed.

If you are particularly prone to ingrowing toenails from underlying problems such as poor gait, your podiatrist may recommend correction of the underlying problem as well as a more permanent solution to the nail itself, such as partial nail phenolisation (PNA). This is done under a local anaesthetic, where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it regrowing in the corners. This is 97-98% successful.

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Ingrown Toenail (Onychocryptosis)

ingrown toenailWHAT'S THE PROBLEM?

An ingrown nail occurs when a portion of a toenail on either side of the toe turns downward and presses into the skin. Nails normally are nearly flat, with just a slight arcing downward at the borders. When the border of the nail is turned downward, it begins to injure the skin.

HOW DOES IT FEEL?

Patient's usually feel pressure and eventually pain, as the hard and sharp nail edge creates further injury. Shoes that apply pressure to the toe increase the pain. If an infection develops, the pain becomes intolerable.

LET'S DO A TEST!

An Ingrown Nail is identified by the doctor's physical exam. If an infection has developed, the doctor may send a sample of the drainage to a lab, to identify what bacteria has caused the infection and which antibiotics will most easily cure the infection.

HOW DID THIS HAPPEN?

A progression of events occurs. Routinely cutting the nails improperly, down at an angle instead of straight across, is the most common cause of Ingrown Nails. Wearing narrow or pointed shoes can apply enough pressure to a normal nail to turn the nail edge downward. Once the nail matrix, the tissue where the nail grows from, gets injured in this way, it continues to produce a nail edge that is more vertical than horizontal. From this abnormal nail growth, the nail edge applies mild pressure on the skin over a long period of time. The skin at the nail edge thickens and becomes hardened. You may begin to notice an enlargement or swelling of the skin around the nail edge. This can be accompanied by an increase in pain. The condition can progress as a result of other factors. These factors include: pressure from a tight or pointed shoe, injury such as stubbing a toe, excessive wetness, either from perspiration or application of ointments or creams, or improper cutting of nails If these factors come into play, the possibility increases that the nail edge can then penetrate the skin, just like a knife, and cause an infection. The skin at the nail edge becomes reddened and swollen. You may notice drainage or pus from the area and the pain becomes intolerable.

WHAT CAN I DO FOR IT?

In mild cases, where no infection is present, pain relief can be obtained by applying a standard moisturizing cream to the nail edge and covering with a bandaid. This softens the hard skin and often provides temporary pain relief. In more advanced cases, where redness or obvious infection is present, seek the attention of a doctor.

WHAT WILL MY DOCTOR DO FOR IT?

In the most minor cases, the podiatrist will simply cut the nail to shorten it, and show you how to cut the nail in the future, to prevent ingrowing of the nail again (See below for instructions on proper nail cutting). In more severe cases, but not those in which an infection hasn't developed, the podiatrist may gently remove the ingrown portion of the nail. This affords considerable relief, but is temporary. After a few weeks, when the nail grows long again, it will again grow in. In cases where the nail has grown in repeatedly, or more critically, when the nail edge has penetrated the skin and caused an infection, the podiatrist will perform a minor procedure called an Ingrown Nail Correction or Matricectomy. The podiatrist will gently numb your toe, reshape the nail edge and finally, apply a medicine which will, in most cases, permanently prevent the nail edge from growing improperly again.

CAN I PREVENT FROM IT HAPPENING AGAIN?

Cutting toe nails properly goes a long way toward the prevention of ingrown nails. Use a safety nail clipper, available at every drug store on the planet. Cut the nails STRAIGHT ACROSS, so that the nail corner is visible. If you cut the nail too short so that the nail corner is not visible, you are inviting the nail corner to grow into the skin. It is the natural tendency, when the edge of the nail starts to grow in, to cut down at an angle at the nail edge, to relieve the pain. This DOES relieve he pain TEMPORARILY, but it also starts the downward spiral, training the nail to become more and more ingrown. What happens is that cutting down at an angle creates a space at the nail edge. When the advancing nail edge reaches the space, it rolls downward, taking the course of least resistance. The edge becomes more and more ingrown, until it pierces the skin and makes an infection. So, cut the nails STRAIGHT ACROSS and never have an ingrown nail again.

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Ingrown Toenails

Ingrown toenails are one the more common foot problems treated by the Podiatrist. They can be very painful, with people limiting their activity to keep off their sore feet. Ingrown toenails are caused by impingement of the skin along the margins of the nail by the nail plate. Some ingrown toenail are chronic, with repeated episodes of pain and infection. Pain can be present without infection, and occasionally infection is present without pain. The usual signs of infection include; redness ( erythema), swelling ( edema), increased warmth ( calor), and pain ( dolor).

Symptoms
  •   Pain along the margin(s) of the toenail
  •   Aggravated by wearing shoes, particularly those with narrow toes.
  •   May be sensitive to any pressure, even the weight of the bed clothes.
  •   There may be signs of infection.
  •   There may be drainage of pus, or a watery discharge tinged with blood.
Causes
  •   Improper trimming of toenails
  •   Tight fitting shoes which compress the toes together
  •   Hose or socks that are too tight
  •   Abnormally shaped nail plate
  •   Other toenail deformities (eg. excessively thick nail plate)
  •   Trauma to the nail plate or toe
What you can do
  •   Cut toenails straight across, and leave slightly longer then the end of the toe
  •   Avoid tight fitting foot wear
  •   If discomfort develops try soaking the foot in a basin of warm water two or three times a day. If you are diabetic or have poor circulation the water should never be more than 95 degrees Fahrenheit. Contact your podiatrist or physician immediately.
  •   An infected ingrown nail requires prompt professional attention.
What the doctor may do
  •   Trim a small spicule of nail to relieve the pressure. Callus (dead skin) may have accumulated in the nail groove, which needs to be removed. Routine ingrown toenail care may need to be done periodically.
  •   Elevate the end of the nail plate to prevent impingement on the soft tissues
  •   Surgically drain an infection
  •   Prescribe special soaks and/or antibiotics
  •   Surgically correct a chronic ingrown toenail
  •   Completely remove a deformed toenail so it will not grow back.
Complications of an ingrown toenail
  •   Infection, if present, may spread to foot and leg, or into blood stream.
  •   Loss of nail plate from infection or inflammation of the nail bed.
  •   Chronic in-growing nails can cause deformity of the nail plate and/or surrounding soft tissues.
  •   A small benign tumor called a granuloma can form along the nail margin.
  •   Diabetics and those with poor circulation to the feet must never attempt to treat an ingrown toenail at home, consult with a podiatrist or physician immediately
Infected ingrown toenail
Infected ingrown toenail #1

This is an infected ingrown toenail in a 13 year old diabetic male. The infection was drained by removing a thin margin of nail from the outside ( lateral) border of the nail. This was a chronic problem for him, with repeated episodes of infection. He will require permanent correction after the infection has resolved.
      






Infected ingrown toenail
Infected ingrown toenail #2    

This is another example of an infected ingrown toenail. This is an adult male, the problem is with the inside ( medial) border of the nail. Treatment was as described above.
       







Toe before surgery Toe after partial nail removal Application of phenol
Toe after phenolization Toe with dressing

This patient suffered from a chronic ingrown toenail on the outside (lateral) border of her large toe(hallux). The location is marked with an arrow. From left to right:

   1. The toe is anesthetized, prepped with antiseptic, and a tourniquet applied.
   2. The lateral border of the nail has been removed.
   3. Liquified phenol is being applied to cauterize the nail matrix (growth area) and nail bed.
   4. The chemical cautery is complete.
   5. All wrapped up and ready to go home!

The procedure is painless, as the toe is put "to sleep" with a local anesthetic agent. There is minimal post-operative discomfort. The wound heals in about four to six weeks. During this period it is simply dressed with topical antibiotic and bandaids. After healing the nail is normal in appearance, somewhat more narrow than before. The incurvated nail border is gone, leaving a toenail unlikely to ingrow again.

[ Link to the Source ]

Ingrown Toenails

When a toenail is ingrown, the sides or corners of the nail curl down and dig into the skin, causing swelling, pain and redness.
What causes an ingrown toenail?

While many things can cause ingrown toenails, the major causes are shoes that don't fit well and improperly trimmed nails. Shoes that are too tight press the sides of the nail and make it curl into the skin. Nails that are peeled off at the edge or trimmed down at the corners are also more likely to become ingrown.

To avoid ingrown toenails, you should cut your nails straight across. The top of the nail should make a straight line.
What is the best treatment for a painful ingrown toenail?

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.
What kind of surgery is performed to fix the toenail?

Your doctor will first numb your toe by injecting it with an anesthetic. Then he or she will cut your toenail along the edge that is growing into the skin and pull out the piece of nail. Finally, your doctor may apply a small electrical charge or a liquid solution to the exposed part of the nail bed. This keeps the toenail from growing into the skin again. This part of the surgery is called ablation, and your doctor will decide whether it needs to be done. Not all patients need ablation.
What should I do to care for my toe after surgery?
  •   Soak your foot daily in warm water.
  •   Apply antibiotic ointment (some brand names: Bacitracin, Neosporin) to the site at least twice a day.
  •   Keep a bandage over the site until it heals.
  •   Take acetaminophen (one brand name: Tylenol) or ibuprofen (one brand name: Motrin) as needed for pain.
  •   Keep the wound clean and dry. It is okay to shower the day after surgery.
  •   Wear loosely fitting shoes or sneakers for the first 2 weeks.
  •   Avoid running or strenuous activity for the first 2 weeks.
  •   Call your doctor if you have problems with the area, such as increasing pain, swelling, redness or drainage.
  •   Avoid high heels and tight-fitting shoes now and in the future.
  •   Trim nails straight across. Don't pick at your nails or tear them at the corners.
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Ingrown Toenails

If you trim your toenails too short, particularly on the sides of your big toes, you may set the stage for an ingrown toenail, a common disorder. Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin. An ingrown toenail may also happen if you wear shoes that are too tight or too short. Any of your toenails can get ingrown, but it’s most likely with your big toes.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may get red and infected, and feel very sore. You may see pus drain from it. Finally, your skin may start to grow over the ingrown toenail.

Treatment

To treat an infected ingrown toenail, soak your foot in warm, soapy water several times each day. You may need to gently lift the edge of the ingrown toenail from its embedded position and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day. If your infection is severe, your doctor may prescribe a course of antibiotics. Learn how to trim your toenails properly. Wear clean socks and open-toed shoes, such as sandals.

If you are in a lot of pain and/or the infection keeps coming back, your doctor may remove part of your ingrown toenail (partial nail plate avulsion). Your toe is injected with an anesthetic and your doctor uses scissors to cut away the ingrown part of the toenail, taking care not to disturb the nail bed. An exposed nail bed may be very painful. Removing your whole ingrown toenail (complete nail plate avulsion) increases the likelihood your toenail will come back deformed. It may take 3-4 months for your nail to re-grow.

Ingrown toenails often recur. If you have a chronic problem with an ingrown toenail, your doctor may recommend another surgical procedure in which the toenail’s formative part is permanently removed.

Prevention

You can lower your risk of developing an ingrown toenail by trimming your toenails straight across with no rounded corners. The length of your toenail should extend out past your skin. The top of each nail should form a straight line across, level with the top of your toe. Some additional guidelines for preventing ingrown toenails include:
  •   Don’t pick at your toenails or tear them off.
  •   Make sure your shoes and socks are not too tight.
  •   Keep your feet clean at all times.

[ Link to the Source ]

Ingrown Toenails

WHAT IS AN INGROWN TOENAIL?

An ingrown toenail occurs when a section of the nail curves into the flesh of the toe and becomes embedded in the soft tissue. It can occur on all toes, but almost always affects the big toe. Sometimes callused or red granulation tissue ("proud flesh") grows over the embedded edge. If dirt and sweat enter this area, infection can occur, causing the skin at the side or tip of the nail to become red, swollen and tender. Sometimes, a small amount of pus can be seen exiting from the embedded area.

WHAT CAUSES IT?

While many things can cause ingrown toenails, two major causes are poorly fitting shoes and improperly trimmed nails. Shoes that are too tight press the sides of the nail and encourage it to curl in. Nails that are peeled off at the edge or trimmed down into the corners are also more likely to become ingrown.

HOW IS IT TREATED?

If the toe is infected, soaking in warm, soapy water as often as possible is recommended - at least 3 or 4 times daily. If the infection is more severe, oral antibiotics may become necessary. When infection occurs, or discomfort from the ingrown nail is severe, minor surgery to remove part, or all, of the nail may be necessary. If surgery is performed, you will need to avoid physically strenuous activities for two weeks post operatively.

CAN IT BE PREVENTED?

Several steps can be taken to decrease the risk of developing ingrown toenails.
  • Cut nails straight across without tapering the corners, which should reach out from the toe, as shown in the illustration. This is probably the most important factor in preventing ingrown toenails.
  • Avoid wearing shoes and socks that are too tight.
  • Keep feet clean to prevent the ingrown nail from becoming infected.
 
propely trimmed nail
Properly Trimmed Nail   Improperly Trimmed Nail


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Ingrown Toenail

ingrown toenailIngrown ToenailIngrown toenails are known to physicians as onychocryptosis. They are common, painful conditions that occur when the skin on the side of a toenail grows over the edge of the nail, or when the nail grows into the skin.

Causes

Ingrown toenails can develop for many reasons. In some cases, the toenails are simply too large. Persons whose toes curl (congenitally or from disease such as arthritis) are prone to onychocryptosis. Trauma, such as stubbing a toe or having one stepped on can cause a piece of the nail to jam into the skin. Frequent running also can cause ingrown toenails. Ingrown nails can be caused by trimming them incorrectly, causing them to regrow into the skin, by excessively tight stockings, or by shoes with narrow toe boxes. Bedridden patients commonly develop ingrown toenails if the bedsheets are kept tucked-in tightly.

Signs and Symptoms

Onychocryptosis should be treated as soon as it develops. If the skin is red, painful, or swollen on the sides of the nail, there may be an infection. The ingrown nail is in warm, often moist, and bacteria-rich environment and it provides a convenient entry for germs that can cause infection. At first, the skin around the nail may be mildly red or inflamed. Untreated, the nail can go under the skin, causing a severe infection. The infection must be cured using sterile instruments and antibiotics. People who attempt to fix an infected toenail themselves may worsen the problem.

Treatment

Uninfected ingrown toenails can be treated following this regimen:
  •   soak the feet in warm soapy or salt water;
  •   dry them thoroughly with a clean towel;
  •   apply a mild antiseptic solution to the area; and
  •   bandage the toe.
Various over-the-counter preparations are available that can harden the skin and shrink the soft tissue along the edge of the nail so it grows normally. A soft, foam toecap can be worn while the ingrown nail heals.

If excessive inflammation, swelling, pain, and discharge develops, the toenail probably is infected and should be treated by a physician. A podiatrist can trim or remove the infected nail with a minor in-office surgical procedure. A portion of the nail or overgrown skin is removed with a scalpel and the infection is treated.

If an ingrown toenail recurs, it may require a more permanent solution. A small portion of the nail and nail matrix (part of the nail that actually grows) is removed with a scalpel or burned with a concentrated chemical solution. This makes the nail narrower and prevents a portion of the nail from growing back, ensuring that it will not irritate the adjacent skin. The chemical treatment is a slightly less invasive procedure. It causes mild inflammation that lasts about a week. This procedure often cannot be used in severe infections because the chemical used (phenol) may be neutralized by the infection. In these cases, the physician must remove the infected nail with a scalpel.

Prevention

Unless the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and wear shoes with adequate room for the toes. Nails should be trimmed straight across with clippers to a comfortable length.

[ Link to the Source ]

Ingrown Toenails

An ingrown toenail is a common condition in which the corner or side of one of your toenails grows into the soft flesh of your toe. The result is pain, redness, swelling and, sometimes, an infection. The condition usually affects your big toe.

In most cases, you can take care of ingrown toenails on your own. If the pain is severe or spreading, however, your doctor can take steps to relieve your discomfort and help you avoid complications.

If you have diabetes or another condition that causes poor circulation to your feet, you're at greater risk of complications. Seek a doctor's advice earlier on caring for an ingrown toenail.

Ingrown toenailIngrown toenail    
An ingrown toenail is a common condition in which the corner or side of ...



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