Ingrown Toenail

An ingrown nail, also known as onychocryptosis is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed.

Signs and symptoms
Symptoms of an ingrown nail include pain along the margins of the nail, worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind, even the weight of bed-sheets. Bumping of an affected toe can produce sharp and even excruciating pain as the tissue is punctured further by the nail.

Cause
The main contributor is footwear, particularly ill-fitting shoes with inadequate toe-box room and tight stockings that apply pressure to the top or side of the foot. Other factors may include the damp atmosphere of enclosed shoes, which soften the nail-plate and cause swelling on the epidermal keratin (eventually increasing the convex arch permanently), genetics, trauma and disease. Improper cutting of the nail may cause the nail to cut into the side-fold skin from growth and impact, whether or not the nail is truly "ingrown".

Treatments
The treatment of an ingrown toenail partly depends on its severity.

Conservative treatment
Mild to moderate cases are often treated conservatively with warm water and epsom salt soaks, antibacterial ointment and the use of dental floss. If conservative treatment of a minor ingrown toenail does not succeed, or if the ingrown toenail is severe, surgical treatment may be required.

Surgery
Surgical treatment for an ingrown nail is carried out by a podiatrist. This is typically an in-office procedure requiring local anesthesia and special surgical instruments. The surgical approach is the removal of the offending part of the nail plate known as a wedge resection. If the ingrown toenail recurs despite this treatment, destruction of the sides of the nail with chemicals or excision is done; this is known as a matrixcestomy. Antibiotics may be used after the procedure but are not recommended, as they may delay healing. Surgical treatment for ingrown nails is more effective at preventing the nail from regrowing inwards compared to non-surgical treatments.