Ingrown Nails – Onychocryptosis

Condition and Causes

Onychocryptosis also known as an ingrown toenail, or unguis incarnatus 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. This condition has been found only in shoe-wearing cultures and does not occur in habitually barefoot people since it requires downward pressure on the nail by a shoe.

Symptoms

Symptoms of an ingrown nail include pain along the margins of the nail (caused by hyper granulation that occurs around the aforementioned region), worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind. Bumping of an affected toe can produce sharp, even excruciating, pain as the tissue is punctured further by the nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken to treat the condition early on and keep the area clean. Signs of infection include redness and swelling of the area around the nail, drainage of pus, and watery discharge tinged with blood. The main symptom is swelling at the base of the nail on the side the nail is ingrowing (may be both sides).

Prevention

Ingrown nails can be avoided by cutting nails straight across; nails should not be cut along a curve, nor should they be cut too short. It is important to avoid cutting the nail shorter than the flesh around it.
Footwear that is too small or too narrow, or with too shallow a ‘toe box’, will exacerbate any underlying problem with a toenail. Frequent nail filing can also help to prevent development of ingrowing toe nails.

Possible Treatment

Conservative treatment
In mild to moderate cases conservative treatment with warm water and salt soaks, antibacterial ointment and using dental floss or a gutter splint to provide a track along which the nail may grow is possible.
If conservative treatment of a minor ingrown toenail does not succeed or if the ingrown toenail is severe, surgical treatment may be required.

Nail Bracing
A less widely used non-surgical treatment for ingrown toenails is nail bracing. Nail braces work by gently lifting the sides of the toenail and eventually retraining the nail to grow to a flatter shape over time.

Surgical Treatment
Involves removal of in-growing portion of the nail with laser ablation of the in-growing portion of the nail bed to prevent recurrence.