Onychocryptosis or ingrown toenail is the introduction of the nail edges into the tissues surrounding the nail. It is also known as an incarnate nail, a nailed nail or a fingernail.
The problem occurs when the sides of the nail dig into the tissues that surround the nail (periungual tissue). It is a very common condition and has a high incidence within the pathologies that affect the foot. The ingrown toenail occurs most frequently in children, adolescents and young people, although it can occur at any age. In young people and children, the disease is almost always accompanied by an infection of the nail edge, with the formation of a pus-filled abscess.
This circumstance is more difficult to find in adults and the elderly, since in the latter case the nail causes the appearance of a callus in the tissues that surround the nail (periungual heloma) or nail canal. The explanation for this fact is that in adults and the elderly the skin is harder and the nail does not penetrate it as easily as in the case of children or young people where the skin is more vulnerable to breakage due to the pressure exerted by the nail edge.
Generally, the nail that is nailed is usually deformed, curved or tile. This circumstance causes the nail to traumatize the nail edge and therefore stick, causing the nail.
Despite being a very common and widespread condition in the general population, on certain occasions there are symptoms that are not related to this pathology, since apparently the nail does not look stuck or there is no visible purulent formation. In this case, we must go to the podiatrist to identify the cause of the problem, which is usually pain in the finger nail, and establish the appropriate treatment.
Generally, the nail that is most affected is the nail of the first toe or big toe. The other nails can also be nailed, but this situation is much less common. The nail of the first toe is more frequently nailed because it is a much stronger nail than that of the other fingers, and therefore exerts more pressure on the nail edges than a nail of a little finger (from the second to the fifth finger ).
Causes of onychocryptosis
The causes of ingrown toenail are multiple and can occur in isolation or coincide with each other.
The shape of the nail is a causative factor of onychocryptosis . If the nail plate is curved in the shape of a tile, the edges of the nail rest perpendicularly on the nail bed, and it is much easier for the nail to dig into this area. There are nails that have a fairly flattened nail plate, but the sides are arranged at right angles, which, as in the previous case, predisposes to dig into the skin.
Footwear also plays an important role in the production of the ingrown toenail. If the person wears a narrow-toed shoe, which compresses the toes with each other and presses on the side of the big toe, the pressure in the nail canal will be increased, favoring the conflict between the nail and the skin. that surrounds her. The use of tight socks or stockings also favors compression at the level of the nail edge and therefore predisposes the nail to being nailed.
In people who have increased sweating of the feet, it is much more common to find an ingrown toenail. Sweating softens the skin and macerates it, facilitating its breakage by means of the nail. This condition makes the ingrown toenail more common in young people or children where sweating is generally greater than in an adult person.
Certain sports practices also predispose to suffer this type of problems. In the case of footballers, the continuous impact on the tip of the foot can cause injuries to the tissues that surround the nail and favor the interlocking of the nail on the skin. In addition, any sports practice supposes an increase in the sweating of the feet, which again favors the appearance of the problem.
In the case of obese or overweight people , there is an increase in the size of the tissues that surround the nail, sometimes causing the ingrown nail due to the increased pressure exerted by these tissues against the side of the nail.
Another cause that can lead to ingrown toenail is the wrong cutting of the nail . As a general rule, people with nailed nails tend to trim the nail at its edges, rounding them off, which can cause the nail to dig deeper as the nail grows out. By cutting the edge of the nail we can leave small spicules that act like real harpoons when the nail grows and progresses towards the front of the finger. We must always cut the nail straight and not round the edges, thus avoiding that it can be nailed.
Certain diseases of the nail are associated with the problem of onychocryptosis. The most common are onychomycosis or fungal infection of the nail and onychogryphosis or thickening of the nail plate. If the nail increases in size and thickens, the sides of the nail have greater force to traumatize the periungual area and therefore it is easier for an ingrown toenail to occur.
Any of the above causes, in isolation or together, will cause increased pressure of the nail side against the skin that surrounds it. This circumstance can produce two situations.
The first, that the nail is capable of breaking the skin that surrounds it at its edge and therefore creates a wound in which the nail edge is going to be inserted. The body will react by trying to heal the wound, but it will be limited by the presence of the portion of the nail that gets into the skin and prevents the wound from closing. The wound generally tends to become infected and start a process of formation of pus that, when it remains inside the tissues, will cause a very sharp and unbearable pain. If the nail continues to traumatize this area for a long time, a fibroma or granuloma can form in response to the healing process of the skin.
Another situation that can occur is that the nail presses on the nail edge but cannot open it and does not cause injury. In this case, it is normal to find a callus in the tissues that surround the nail (periungual heloma) that also causes quite unbearable pain. Generally, this type of ingrown nails does not usually have an injury or infection and therefore fibroids or granulomas do not usually develop in the nail tissues.
What symptoms appear?
The ingrown toenail can cause several symptoms depending on whether or not it causes infection and also on the time of evolution of the disease. The general symptoms are:
- Nail pain, more localized on the nail side. The pain is exacerbated if we press this area but also by pressing directly on the nail plate we increase the pain, because we also press the nail together towards the surrounding tissues. Sometimes the pain is so acute that the simple rubbing of the sheets on the bed causes excruciating pain.
- Inflammation and redness of the tissues around the nail. The skin of the finger appears flushed in the area near the nail, and especially on the nail edges. Finger coloration can vary from deep red to purplish.
- Infection of the nail edge with the formation of pus, which can come out due to the explosion of the abscess.
- Calluses in the tissues surrounding the nail, which is known as periungual heloma. Generally, the nail edges are hardened by the pressure exerted by the nail edge against the skin that surrounds it.
- Inability to put on shoes or tight socks or stockings.
- Appearance of small fibromas or granulomas on the nail edge as a consequence of the wound healing phenomenon.
- Sometimes the socks appear stained with blood in the area of the ingrown nail, as a result of the wound that exists at this level.
Diagnosis of ingrown toenail or onychocryptosis
The appearance of the symptoms related to the ingrown toenail together with the clinical examination of the lesion serves to make the diagnosis of the disease. It is not necessary to use complementary means of diagnosis, however, the podiatrist must analyze the cause of the problem and make sure that the symptoms of the finger nail are due to an ingrown toenail problem.
By means of a small clinical examination, it is possible to observe if the nail is nailed and to plan the treatment according to the state of the injury.
Ingrown toenail treatment
The treatment of the ingrown nail can be approached from two points of view. One that would be aimed at solving the cause that has caused the problem and the other that should solve the problem of the nail itself.
Treating the cause
The first treatment that can be carried out in the event that the nail has penetrated the skin is to make a cut that frees the portion of the nail that is causing the problem. The removal of the side is performed by the podiatrist using specific instruments for this problem aided by the use of electric micromotors that allow cutting the nail without causing any pain. The cut that the podiatrist makes allows the pressure to be released in that area and makes it possible to heal the wound that has caused the side of the nail.
This treatment alone is not going to solve the problem definitively since in many cases the nail is nailed again when it grows back. If the problem that caused the nail still exists, simply cutting the side of the nail only temporarily fixes the problem. There are treatments that offer longer-term solutions such as orthonixia or nail surgery.
Orthonixia consists of trying to educate the growth of the nail using different materials and techniques whose objective is to prevent the nail edges from digging into the skin.
In the past, small arc-shaped wires were used to lift the nail, making it more horizontal as the wire was tightened. Nowadays, bands of methacrylate or other plastic polymers are used that stick to the nail and lift the nail plate due to the memory of the material used, which tries to return to its original state by lifting the nail in this way.
There is a definitive treatment for the problem of the ingrown toenail that consists of the surgical treatment of the nail. Surgical techniques nowadays offer a satisfactory result, solving the problem in a radical way and avoiding possible recurrences. It is necessary to clarify that the surgery does not consist in pulling out the nail, but in eliminating the nail edges only so that the rest of the nail plate remains intact and the finger is not devoid of a nail. The most commonly used technique is the Phenol-Alcohol technique, which consists of applying carbolic acid to the nail edges, once these have been removed. This technique achieves a good aesthetic result and a painless postoperative period, which allows the patient to quickly return to normal life.
How to avoid it?
To prevent the nail from digging into the finger, the following tips should be taken into account:
- Cut the nail straight without rounding it at the edges and avoiding going deep into the sides of the nail. We must always see that the nail is free and that it is not hidden in the nail canal.
- Use a suitable instrument for cutting the toenails, such as nail clippers or specific pliers for this. Avoid using scissors and especially if they have a point.
- Do not trim the cuticles that surround the nail, since we can cause a wound on the finger that can become infected.
- Do not pick the nail with your fingers or pull any spike. Use a cutting instrument to remove it.
- Do not wear a pointed toe shoe that compresses the foot.
- Do not wear tight socks or stockings that compress the tip of the foot.
- Control the excessive sweating of the feet with the use of a specific antiperspirant. Wear yarn, wool or cotton socks and avoid wearing synthetic socks or stockings.
- If I have difficulty cutting my toenails, see a Podiatrist to do it.
- If you practice a sport that predisposes you to hitting your fingers, wear suitable footwear and control any nail problem by going to the Podiatrist to solve it.
You should go to the podiatrist in the following cases:
- If you suffer from any type of pain in the nail that a priori you cannot identify, go to a Podiatrist to examine it and identify the cause of the problem.
- If the nail has been nailed, do not try to solve the problem by yourself, go to a Podiatrist as soon as possible to solve it. This will avoid infections and added problems.
- If your nail is curved or tile-shaped, go to the podiatrist to have it cut and try to educate it, preventing it from being nailed.
- If you have limitations in bending or have impaired vision, see a Podiatrist to cut your nail.
- If the nail is very thick or very hard, go to the Podiatrist to cut and cut it.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.