Ingrown Toenails

An ingrown nail is a nail that curves into the skin. The medical term is onychocryptosis. It may or may not be painful, and may or may not cause infection. An ingrown nail that causes infection or inflammation is called a paronychia. Ingrown toenails that cause inflammation or infection are usually very painful. The picture to the right is a mild ingrown nail with some redness and inflammation.    


Trauma, or any damage to the nail or the nail bed can result in ingrown nails.
Microtrauma: Repetitive pressure from shoes. Military cadets in basic training, runners, tennis & soccer players commonly have ingrown toenails.
Blunt trauma: dropping something on your toe or kicking a chair.
Shoes, especially narrow shoes which are too small, place pressure on the big toenail, resulting in repetitive microtrauma.
Fungus causes changes in shape of the nail and the nail bed, sometimes resulting in ingrown toenails.
Genetics: some people are born with nails which naturally turn inat the sides and typically develop ingrown nails very early in life.

Treatment Options - Ingrown Nails
   1. Triming & Soaking

At the first sign of an ingrown nail, soak the nails in warm water and epsom salts (about 1/2 cup to a gallon of water) for 15 minutes twice a day.
After the nail has softened, trim the edge of the nail. (Do NOT trim down the sides of the nail, this will make the problems worse).

   2. Wedge Resection

A wedge resection involves a trip to see a podiatrist.
A section of the nail is removed, without anesthetic.
For some types of ingrown nails, this will work well. But, there is a higher chance that the ingrown nail will return.

   3. Antibiotics

Although antibiotics will treat the infection, they will not treat the problem.
They may be necessary in some instances of severe infection.
Antibiotics are commonly used to eliminate the infection before a definitive procedure.

   4.  Nail removal - temporary

A partial nail avulsion is the removal of part of the nail.
This procedure involves an injection of anesthetic to numb the toe.
The nail is removed on one or both sides.
The nail always grows back in, but the idea is to allow the surrounding skin area to heal and inflammation to decrease before the nail grows back in.
This is a good procedure for 1st time ingrown nails, ingrown nails which started after an episode of trauma or a certain pair of shoes.
With chronic ingrown nails, there is a high recurrence rate with this procedure.
In the image to the right the section outlined is the only portion of the nail removed. The entire nail does not need to be removed if only one side of the nail is ingrown. Mouse over image to see area removed.            

   5.  Permanent Nail Removal

This is called a matricectomy or matrix for short.
In most cases only the side of the nail is removed, not the entire nail.
A chemical is used to kill the nail root, called the matrix.
This procedure involves an injection of anesthetic to numb the toe.
About 5-10 % of the time, the nail will regrow.
This treatment is best for those that have chronic ingrown nail problems and those that have deformities of the nail bed.
Those individuals with very poor circulation as diagnosed by a physician, should not have this procedure done.
In the diagram to the right, the matrix, which is the root of the nail is labeled. This is the area where the chemical is placed to destroy the nail root and prevent regrowth.

A matricectomy starts just like a nail avulsion, with a partial nail removal. After the nail removal, a chemical is placed at the nail root (matrix) to destroy the nail root on one side, and prevent regrowth.

[Ingrown nail first stage of the matrix] [Ingrown nail second stage of the matrix] [Ingrown nail third stage of the matrix] [Ingrown nail forth stage of the matrix]
Area of nail to be removed during the procedure is outlined here. The nail is removed. Chemical is applied at the base of the nail fold.
Appearance of toe after nail has been removed. 
Appearance of nail after the area has healed

Removal of the entire nail is done, both temporarily and permanently, when necessary. Soaking is advised with each treatment. This involves using warm water and epsom salt. You could also use a small amount of betadine. You should soak for 15 to 20 minutes. Also, as a side note: It is not recommended to put on topical antibiotic after these procedures, it will block drainage. But, your physician may dispense a gel to use after the procedure.

A surgical procedure can also be performed, in place of the chemical nail removal. This involves numbing the toe and cutting the nail root out. For ingrown nails which have not responded to the chemical matrixectomy, this may be an appropriate procedure.