An ingrown toenail is a common condition where the side or corner of the toenail curves down and digs into the surrounding flesh.  Ingrown toenails grow into the skin and flesh causing pain. The growth of the nail into the surrounding skin and flesh may also cause a painful infection of the skin beside the toenail, a condition known as paronychia. Ingrown toenails most commonly occur over the big toes.

How does it occur

Ingrown toenails can be caused by a number of factors including,

• Excessive cutting of toenails. Short, curved nails have a higher chance of growing into the surrounding flesh
• Shoes that are too tight can increase the risk of ingrown toenails
• Damage to the toenail, especially to the growth plate can cause deformities in the toenail, which may result in ingrown nails.

Symptoms and infection

At the initial stage, ingrown nails can cause pain, especially with tight shoes and with sporting activities. As the condition worsens, paronychia usually develops, causing excruciating throbbing pain. This may be accompanied by bloody or yellowish discharge from the edge of the nail.

If left alone, the infection may spread to the pulp of the toe, or to the bone causing even more severe pain. Patients may develop fever and chills at this stage.

Assessment and work-up

When seeing your doctor for ingrown nails, he/she will conduct a medical interview and perform a focused examination on your affected toe. Based on the information gained, your doctor may recommend that you undergo plain radiographs (X-rays) of the toe to assess if any infection has spread to the bone. Further radiological evaluations are generally not necessary.

Treatment

Based on the severity of the ingrown toenail and the presence of infection, treatment options may differ.

Non-surgical treatment may be offered for patients with mild cases of ingrown nails. This usually entails a change in footwear to loose fitting shoes, soaking of nails to soften them, and placement of cotton wads in order to prevent further ingrowth. Nail care such as the correct way to trim nails is usually also taught to patients.

Patients with minor infections may also be treated with a short course of oral antibiotics. Oral pain medication such as non-steroidal anti-inflammatory drugs may also be prescribed in order to treat pain.

Patients with recurrent, recalcitrant or badly infected ingrown nails may be offered surgery. This can range from,

• Removal of the nail to drain any nail fold abscess
• Excision of part of the nail causing the ingrowing
• Destruction of part of the growth plate that is responsible for the part of the ingrown nail

These procedures are generally performed as day surgery, and under local or regional anaesthesia. There is a small risk of recurrence after surgery. In general, if the entire nail is removed, it will take about 2 months for the nail to regrow.

For assessment of your condition, please book an appointment with Dr Yong Ren.

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