MANUAL MINORS
An ingrown toenail (onychocryptosis) occurs when the edge of the nail, usually on the big toe, grows into the surrounding skin, causing inflammation, pain, and infection. This condition is common and can be caused by wearing tight shoes, improper nail trimming, or repeated trauma to the feet. If left untreated, it may lead to severe infection or abscess formation.
Diagnosis
Diagnosis is clinical, based on localised pain along the nail edge, redness, swelling, and in advanced cases, purulent discharge or granulation tissue (“proud flesh”). Physical examination reveals the nail edge embedded in the nail fold. Additional tests are generally unnecessary unless complications arise from infection.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Acute paronychia | Infection of the periungual folds without nail penetration into the skin. |
Onychomycosis | Fungal infection of the nail, causing thickening and discolouration, without surrounding tissue inflammation. |
Nail trauma | Damage to the nail or nail matrix from impact, without embedding into the skin. |
Plantar wart | Painful lesion on the sole, unrelated to the nail. |
Emergency Management
In emergency settings, initial management of an ingrown toenail includes measures to relieve pain and prevent infection. Soaking the foot in warm saline water, applying local antiseptics, and gently lifting the nail edge to reduce pressure are recommended. If infection is present, topical or systemic antibiotics may be administered. In advanced cases, with abscess formation or severe pain, partial nail removal may be necessary under local anaesthesia.
Definitive Treatment
Definitive treatment depends on the severity. For mild to moderate cases, educating the patient on proper nail trimming and recommending roomy footwear are important. If the problem persists or there are frequent recurrences, partial nail avulsion (matricectomy) can be performed to permanently remove the problematic nail edge. This procedure reduces the likelihood of the nail becoming ingrown again.
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