Ingrown Toenails

Key Points
Condition affecting the toe and toenail
Typically due to environmental causes (i.e., badly fit footwear, toenail care issues)
Presentation is painful, with the toenail piercing the skin on the side or end of the toe

Ingrown toenails are a painful condition which affects the toe and toenails. The condition is painful, and consists of the nail piercing the skin on the side or end of the toe. It typically only affects the outer edge of the toe, especially the big toe, but may affect the inner edge and other toes as well. Ingrown toenails generally progress through three stages. The first stage consists of swelling and redness in the affected toe, which may be warm to the touch and painful. In stage two, swelling and redness increases, and may be accompanied by pus or other drainage. Secondary infection is possible in this stage. Stage three sees an increase in swelling, redness and pain, accompanied by increased discharge, and skin overgrowth. This may be accompanied by severe infection and attendant fever.

While there are several causes of Ingrown toenails, they typically develop due to environmental factors. Improper footwear which does not fit properly, placing undue pressure on the toes may lead to its development, as well as improper care of toenails. Other factors which may lead to Ingrown toenails include injury to the nail or nailbed, fungal infection, and some medications, including orally administered retinoids. Anyone may develop the condition

Differential Diagnosis (Other conditions with similar appearance)
Impetigo
Lymphangitis
Obesity
Osteomyelitis
Staphylococcus Aureus Infection
Streptococcal Infection, Group A

Diagnosis
Key Points
Diagnosis based on appearance of the affected area
Other tests may be performed to determine the causal agent, if necessary

Ingrown toenails are diagnosed based on the appearance of the affected area. If a causal agent is suspected, other tests such as fungal cultures may be performed to assist in determination.

Treatment
Treatment predicated on the stage of the condition
Stage one cases may respond to self-treatment
In more severe cases, prescription medicines and even surgery may be necessary

Treatment of Ingrown toenails is predicated on the stage of the condition. In all stages, it is recommended that loose-fitting footwear that does not put pressure on the affected area be worn. Cases in stage one may respond to self treatment, which should include soaking the area in warm water, strict hygiene, and even inserting a piece of rolled gauze underneath the toenail to prevent further damage. As the condition progresses to stage two, prescription of topical and/or oral Antibiotics may be recommended. Topical antibiotics may be used in conjunction with Local anaesthetics to promote fast healing and relieve pain. Surgical excision may be utilized if the ingrown toenail worsens. Stage three typically requires surgical options, most often a process to remove the nail, cauterize the wound, and remove any excess pus, tissue or other debris. In any surgical excision, proper care of the toe afterward is paramount to full recovery.