Ingrown toe nail

Toe nails are a thin plate of protein material called keratin, the same material that makes up your hair. Their two primary purposes are to protect the toes from injury and to help provide the shape of our toes. The average toe nail takes 6-12 months to grow out completely, or about twice as long as a fingernail.

What is an ingrown nail?
The name “ingrown toe nail” is a misnomer. Toe nails do not grow sideways into the skin. Rather, toe nails only grow from their base to the tip of the toe. An ingrown nail occurs when the side of a nail curves into the adjacent skin. Most cases are a matter of the nail shape changing in response to pressure from activity and shoes. However, there is a genetic variety in which the congenital shape of the nail plate is wide or curved. The pressure of the nail against the skin causes pain, swelling, or even an infection. If the tissue becomes swollen or infected, then the pressure of the nail against the skin increases.

What causes an ingrown nail?
The most common cause of ingrown nails is pressure against the toe and nail over time. Genetics plays a role in some ingrown nails, most notably those found in infants or those with a family history of ingrown nails. In addition, the rapid growth of the feet seen in adolescents can lead to ingrown nails. Toenails may become infected with a fungus, causing them to become thick, brittle, and have an irregular texture and yellow-brown appearance. This may lead to the edges of the toenail ingrowing into the adjacent skin. There are other nail diseases that can cause ingrown toenails as well.This occurs when the side of the toe nail breaks the skin either through pressure (i.e., running) or when someone attempts to cut out the side of a nail and breaks the skin barrier. Finally, in some cases, a bone spur forms on the smallest bone at the tip of the toe and underneath the toenail. This spur may cause the toenail to lift up and the edges to curve into the skin. Typically, an x-ray can reveal if this is the cause of an ingrown toenail.

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Treatment
Treatment for an ingrown nail is typically performed in the office. This generally involves treating an infection if present and removing the ingrown edge of the nail. The nail edge can either be “avulsed,” meaning to remove, or it can be removed along with the nail root, or matrix. The root is removed when the ingrown nail has been a chronic issue or when the patient does not want the nail border to regrow. Typically, this type of procedure is best reserved once any infection is resolved.

The question is sometimes asked about removing the entire toenail. However, this is rarely necessary. In most cases, just the nail margin causing the problem needs to be removed. In cases where a bone spur is causing the ingrown nail, the bone spur needs to be removed. The best treatment option for you will depend on the history of the problem, how the nail appears currently, and whether you decide to have the matrix removed. In the end, the specific procedure(s) can be tailored to fit each patients needs and circumstances to achieve not only pain relief, but a cosmetically normal looking toenail.

When to seek medical care
Anytime the edge of the nail remains painful, becomes swollen or red, looks infected, or if drainage appears, medical treatment should be sought. Those with certain health conditions, such as diabetes, should also seek care for even minor nail problems. Prompt medical care can often help patients avoid costly or painful procedures down the road.

Prevention
The prevention of ingrown toenails is an obvious are of interest for anyone who has suffered from this painful condition. Proper nail care, hygiene, and proper shoe sizing can help reduce the chance for an ingrown nail. Toenails should be cut with a gentle curve in the same shape as the tip of the toe. Do not cut into the corner in an attempt to remove the ingrown portion of nail yourself. This may lead to infections or failure to remove the entire width of the nail. Cutting a “V” shape in the end of the toenail does not affect the edges where the ingrown nail occurs. Also, leaving the end “square” can lead to injury of adjacent toes as the sharp corner can press against them.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.