A nail, of the hand or of the toes (foot) is ingrown when it goes into the skin that surrounds the nail. The tissues become red and swollen. Is that bad ? How to treat an ingrown toenail? Can an ingrown toenail go away on its own? How to simply remove it? With an operation? How to cut your nails so that this does not happen?

What is the definition of an ingrown toenail?

Having an ingrown toenail is a common problem that most often affects the hallux (the big toe) but it can also affect the other nails of the other toes and fingers. An ingrown nail is called when part of the nail inserts into the skin directly located around the nail.

Photo of an ingrown toenail

What are the symptoms of an ingrown toenail?

• The nail inserts into the skin that surrounds the nail
• The nail can be thickened
• The pain, felt around the nail, intensifies on pressure: walking or putting on shoes can, in more advanced cases, become painful.
• Redness and swelling associated with inflammation appear.

When an infection develops, the skin pad swells more and fills with pus. The pain then becomes permanent, pulsating and intensifies. The area may also be hot. If left untreated, the bulge continues to swell and takes the form of a large, raspberry-shaped pimple (botryomycoma).

What causes an ingrown toenail?

The ingrown toenail can be linked to:

• A bad cut of the nail (the nail is cut too short or rounded).
• Excessive sweating.
• Unsuitable footwear, in particular too tight.
• Repetitive trauma or micro-trauma.
• An abnormality in the shape of the nail.
• An abnormality in the position of the big toe (hallux), or little toes resulting in repeated impingement.
• A disease causing deformed toenails or poor vascularization of the extremities of the body (diabetes, in particular).

Who to consult in case of ingrown nail?

“An ingrown toenail does not necessarily require a medical consultation” assures Dr. Georges Delamare, general practitioner. However, he adds that“you have to be vigilant for signs of infection and super-infection” and specifies that the fact of suffering from certain diseases predisposing to complications “must be absolutely taken into account”.

You should consult your doctor within the following days:

• If you are diabeticsuffer from lower extremity arteritis, heart valve disease, neurological or immune disease
• If the bead around ingrown toenail took the form of a large red raspberry-shaped bud.

Your doctor can then refer you to a pedicure-podiatrist in order to receive the appropriate care.

The same day :

• If the inflammation of your ingrown toenail is not overe after 2 days despite the care provided and you observe an infection: swelling, redness, with pus, and the pain is sharp.
• If you have a fever.
• If, in addition to your ingrown toenail, you observe signs of lymphangitis : i.e. a red, sensitive line appears along the foot and (or) calf.

Dr. Delamare specifies that a “ingrown toenail does not require treatment in an emergency department”.

“If there is no sign of infection, you can overcome your ingrown toenail on your own by following a few simple instructions” explains the specialist:

• Dakin: Dip your finger inHot water 10-20 minutes, three times a day; You can also bathe with a topical antiseptic like Dakin® (ask your pharmacist for advice).
• Insert a small piece of compress between the nail and the skin to prevent the nail from penetrating.
• Let your finger as much as possible in the open air.
• wear wide shoes that allow your toe to move freely and without risk of constraint or friction.
• Wear socks that keep your feet dry.
• Avoid mules and high heels so that the load is evenly distributed between the front and back of the foot.
• In case of infection, your doctor will prescribe antibiotics in the form of a cream to be applied locally. Dr. Delamare specifies that “Oral antibiotics are reserved for cases where the infection has spread to surrounding tissues or when the patient has risk factors such as diabetes or an immune disease”.
• He may also prescribe care at the podiatrist. The latter will carry out an adequate cut and a filing of the nail and will be able to correct the causes of the ingrown nail in particular in the event of hypercurvature of the nail.

When to consider an ingrown toenail operation?

Surgical treatment, performed under local anesthesia, is indicated in case of treatment failure or in case of recurrence (1). The classic intervention consists of removing the bead in order to free the nail. Surgery can also be aimed remove part of ingrown toenail which injures the skin. It is then a question of partially removing the matrix, ie the thick tissue which rests directly on the bone and extends beyond the visible nail. The matrix produces the nail and its removal is not insignificant and the healing then takes 2 to 3 weeks – the complete regrowth of the nail will take about ten months. Thus Dr. Delamare warns: “Don’t leave the programming of your intervention dragging on so as not to spoil your vacation due to incomplete healing.” This partial removal of the nail matrix is ​​more and more frequently done chemically, with phenol, which seems to have better results but does not reduce post-operative pain and healing time.

What prevention to avoid ingrown toenails?

To prevent ingrown toenails, Dr. Delamare insists on the importance of a “irreproachable nail hygiene”. Their cut must be done regularly with specific disinfected scissors, taking care not to don’t cut too short or of circular way so that the regrowth does not take place in the skin. Also make sure:

• To limit profuse sweating of the feet and hands,
• Avoid wearing shoes that are too narrow or too small, which will put pressure on the toenails.
• Limit the wearing of high heels.

Finally, ask your doctor for advice if one of your nails seems too thick, if you notice an anomaly or if your nail has suffered a shock or any other trauma.

Thanks to Doctor Georges Delamare, general practitioner.

Source: (1) Treatments for ingrown toenails. Cochrane. April 2012.