Ingrown Toenail

The ingrown toenail, known in the medical field under the name of onicocryptosis (in Greek translation “hidden nail”), is a pathology commonly encountered in the adult, active population, characterized by the growth and development of the lateral margin of the nail in the depth of the nail bed, and cutting through it, thus creating a continuity solution between the subcutaneous soft parts and the external environment. Although ingrown nails can occur on both the hands and feet, the most commonly affected is the hallux (big toe).

Radical treatment of ingrown toenail at the start of the XIX century.

The main mechanism causing the symptoms is the microbial contamination of the nail bed and its underlying structures, which leads to an inflammatory reaction and the formation of a granuloma that encloses the lateral edge of the nail and amplifies the inflammatory and infectious process.

The etiological or favorable factors for the appearance of the ingrown toenail can be:

  • inappropriate footwear, which puts pressure on your toes,
  • incorrect posture, athletic activities and prolonged orthostatism,
  • improperly cutting your nails to either be very short or to round the edges,
  • various nail lesions or daily micro-trauma applied to the nails (fungi-related),
  • psoriasis,
  • genetic predisposition for abnormal nail bed forms,
  • various foot infections (fungal),
  • psoriasis,
  • peripheral vascular disease,
  • ichthyosis,
  • tuberous sclerosis.

The symptomatology revolves around pain which, depending on the stage of the evolution of the ingrown toenail can be more and more intense, often unbearable, forcing the patient to step improperly, or preventing them from standing or being able to put shoes on.In the first phase of inflammation, the skin is inflamed (red, swollen), and the pain appears when the area is touched, or pressure is applied. If it becomes infected, the pain becomes more and more intense, accentuated at night or spontaneously. Occasionally, seropurulent secretions and blood from the lesion may occur, and the entire inflammatory process continues with the appearance of granuloma and periapical inflammatory tissues. Preventing the occurrence of the ingrown toenail can be done by rigorous hygiene of the feet and the correct pedicure of the nails (avoid excessive cutting of the corners of the nail, because that will create a tendency of the nail to cut into the nail bed). The nail will be cut at the same level, carefully distancing from the nail bed the deeply oriented corners. The treatment of the ingrown toenail is performed according to the evolution stages of the lesion: – if there is edema or erythema (redness) on the toe, without purulent secretions, one can try a conservative treatment at home which includes: soak the toes in a warm saline solution mixed with diluted betadine (10: 1) for 20 -30 minutes, then try to place a splint (splint-type bandage on the nail edge). Local antibiotic ointments, nonsteroidal anti-inflammatory drugs and cold local packs can be used. We recommend you preventively wear light shoes, and also during treatment. – if the pain becomes unbearable and there is purulent secretion present, it is recommended to consult a specialist doctor, to establish a surgical treatment.

 

The surgical treatment is performed under local anesthesia and consists of removing the lateral edge and the corner of the nail which are deeply ingrown, along with the nail bed and the related nail root. The excision is made in the form of a “melon slice”, up to healthy tissue.

  • “Melon slice” type excision

The nail fold is recreated through skin suture. If both nail beds are affected, bilateral intervention is performed. If the entire nail is septically transformed, the specialist may decide on nail ablation (excision) and and to then reconstruct the nails and nail bed. The intervention lasts up to 1 hour and you will be discharged from the hospital on the same day.

Postoperative recommendations include:

  • following an antibiotic and anti-inflammatory drug treatment;
  • avoiding using the affected foot for 3-5 days, until you the inflammatory period ends;
  • clean the affected area with betadine and apply antibiotic creams (these you can be performed at home);
  • the removal of the wires 14 – 21 days after the surgery;
  • wearing comfortable, light shoes;
  • elevate the affected leg above knee level, to help speed up your recovery.