With no regard for demographic, geographic or topographic boundaries, the Ingrown Toenail (IGTN), or onychocryptosis, has burdened people for millennia. Despite being labelled a ‘minor medical issue’, the invasion of a portion of toenail into the surrounding soft tissue skin will cause considerable pain, pose an immediate risk of infection and inhibit the use of shoes, which may in turn restrict access to work. 80% of all IGTN presentations involve one side of one toe, predominantly affecting the big toe (hallux). Some literature indicates adolescent males to be most commonly affected, although, IGTN can present at any age for any gender.
Peculiar anatomical features, such as pincer shaped nails or abnormally thick nails, will certainly amplify IGTN vulnerability, however, environmental factors are often more influential. Poor nail cutting technique or ‘tearing’ the nail can establish a small spicule that pierces the skin as the nail grows stronger and longer. Tight-fitting footwear (e.g. high-heels) will exert a prolonged, compressive force on the toes and increase the likelihood of IGTN development. Similarly, an acute incident of trauma, such as a fallen object or coffee-table stubbing, is likely to bring about an IGTN.
Whether anatomically destined or catalysed by environmental factors (e.g. footwear), the principle process underlying an IGTN is compression of the nail plate and the adjacent skin. Acting as an irritant, the nail eventually pierces the surface of the skin, stimulating an inflammatory response as it grows. If not managed quickly, in accordance with infection control policy, the IGTN can quickly become complicated by bacterial colonisation, hypergranulation tissue and, ultimately, infection. In the case of infection, antibiotics are often warranted before physical intervention.
Conservative treatment involves careful removal of the offending nail piece piercing the skin. As the troubling nail portion is removed from the sulcus, the majority of associated pain is alleviated almost immediately. Of course, any corn or callous that may have developed in conjunction to the IGTN is carefully removed as well. IGTNs are very rarely an isolated incident, often recurring several times per year. Surgical intervention is an alternative treatment option for severe and recurrent cases of IGTN. Performed under a local anaesthetic, surgical removal of an IGTN offers a long-term solution with high-rates of success. The phenol employed during this procedure works to prevent any future IGTNs from developing.
Medical literature has identified regular, careful maintenance of toenails as well as properly fitted footwear to be of greatest value with regard to the prevention of IGTNs. Research and experimentation has debunked several, long-held beliefs relating to management of IGTNs. Despite conventional wisdom, cutting a ‘V’ into the end of toenails does nothing to prevent onychocryptosis. Additionally, elevating the nail edge with cotton wool is an effective means to produce discomfort, although, has a negligible effect on IGTNs.
Common, painful and easily managed, onychocryptosis afflicts a large percentage of the patient population at Brindabella podiatry. With the expertise and experience in treating countless IGTN presentations, the podiatrists at Brindabella Podiatry are experts in conservative and surgical treatment options. Book an appointment with one of our podiatrists for all your ingrown toenail needs.
By Thomas McMahon