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Ingrown Nail (Onychocryptosis)

An ingrown toenail. also known as onychocryptosis, is a painful condition of the toe that occurs when the sides or corner of the toenail digs into the skin at the end or side of the toe.

 

The condition mostly affects the outer edge of the big toe, although the nail on both sides of the toe, or nail on any toe/ finger(rare) can become ingrown. You should also never attempt to self-treat an ingrown nail / let a non-medical professional treat this condition as it will only lead to further complications and discomfort.

What causes In-grown nails?

The causes for ingrown toenails are listed below, but the two most common reasons are ill-fitting shoes and improper nail cutting.

  • Small/ tight/ narrow shoes, high heels and pointed-toe shoes

    • As the toes compresses together, pressure against the nails causes it to curl into the skin, thus inducing a structural change to the nail.

  • Improper nail cutting

    • Especially rounding the edges, can cause the nail edge or corner to dig into the skin.

    • Cutting the sides too deep can also cause accidental nail spikes to be formed, thus digging into the sulcus (sides).

    • Toenails should be trimmed straight across so that the top of the nail makes a straight line.

  • Trauma

    • The force from the trauma can induce a structural change to the nail, causing the nail to curve into the sulcus.

  • Nail picking/ biting​

    • This leads to irregular edges of the nail, causing it ti curve into the sulcus and cause recurrent in grown nails (until habit is ceased). ​

  • Fungal infections of the nail

    •  Can cause a thickening or widened toenail to develop. As the nail becomes brittle, and eventually chipped off, the irregular structure can form in grown nails. 

  • Prescribed medications

  • Abnormal nail shape (genetic/ structural)

    • E.g. such as pincer or trumpet nails.

Stages of ingrown nail

Ingrown toenails can be classified into three stages according to severity.

Stage 1
 

  • End of the toe becomes reddened with mild swelling

  • May feel warm and be painful to touch

  • No pus or drainage
     

Stage 2
 

  • Toe becomes increasingly red, swollen and painful

  • May have presence of white or yellow coloured pus or
    drainage from the area

  • Mild - moderate infection may have developed (Paronychia)

  • May or maynot have foul odour
     

Stage 3
 

  • Symptoms of redness, swelling and pain are increased

  • Granulation tissue forms and adds to the swelling and discharge of pus

  • May have presence of foul odour

  • Lateral nail-fold hypertrophy (overgrowth of skin tissue around the affected toe)

  • More severe infection with fever may follow


 

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I think my infant has an in-grown nail, is this possible?

Although ingrown nail is more prevalent in children and adults, it can happen to any age group including newborns.

 

In about 2% of newborn babies are noted at birth to have ingrown toenails because the growing nail plate is very short. It is rarely painful. The appearance rights itself within a year or so. This is termed Pseudo-in grown nails.

When babies experience this, the tenderness may cause tears or whimpering when you touch the area. If you have a toddler, they may complain while walking, refuse to put on shoes, or even walk with a limp.

If there’s any kind of discharge, the ingrown nail may be infected. This can cause further symptoms of infection (like fever) and warrants an immediate visit to the podiatrist. 

Did I cause this to my child?
 

A lot of parents worry or assume that they’re at fault for a baby ingrown toenail. Let us clear your conscience: Baby ingrown toenails are very common, even if you’re doing everything by the book. Baby nails are soft and grow rapidly — and come in contact with shoes, socks, and more.

Plus, genetics can play a role. Those soft nails are sometimes just prone to growing in a curved or inward way.

While carefully trimming your little one’s nails may help, short nails can become ingrown if cut too close to the skin. And in Parenting 101, you may not always be told on how to properly trim toenails (straight across rather than cutting a curve), which can also lend itself to ingrowth, so you can hardly blame yourself.
 

Preventing future ingrown nails

  • Avoid shoes and socks that are too tight — no small task, since baby feet grow quickly!

  • Trim toenails regularly, but not too often — every 1 to 2 weeks depending on your baby.

  • Use a clipper rather than nail scissors.

  • Cut toenails straight across rather than in a curve.

  • Lightly file any sharp corners.
     

  • Avoid trimming too close to the skin.
     

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Can in -grown nail be prevented

Adhering to the following simple rules can easily prevent ingrown toenails:

  • Clip toenails straight across – do not cut them too short and do not round off the edges.

  • Wear well-fitting shoes.

  • Keep the feet clean and dry.

  • Visit a podiatrist as soon as you spot an in-grown nail.

  • Instruct yournail artist to prevent cutting the nail edges too deep.

How are ingrown nails treated?

Treatment is dependent on the stage of the condition, in most cases would be conservative and for severe cases a surgical intervention may be needed.

 

However, at any stage of an ingrown toenail, the patient should avoid tight-fitting or high-heeled shoes. If possible, wear sandals until it has cleared up.

Podiatrists are professionally trained to help & treat, contact us for a consultation today! 

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