Ingrown Toenails

Ingrown toenails are a very common problem affecting primarily the great toenail. They are caused by sideways growth of the nail edge into the skin of the toe. The abnormal extension of the toenail pushes into the surrounding skin causing discomfort. Normal toenail growth should be vertical or outward toward the tip of the toe. The medical term for ingrown toenail is onychocryptosis.

Symptoms of ingrown toenails are sore, often painful, nail folds with various degrees of redness, swelling, and sometimes clear or yellow drainage. Frequently, ingrown toenails resolve without medical treatment. Complicated cases may require treatment by a physician.

What causes ingrown toenails?

The sideways growing portion of nail acts like a foreign body and pokes into or pinches off a small piece of skin at the outer edge of the toe. This may cause a break in the skin, causing inflammation and possibly infection. The inflammation often causes more thickening of the nail skin fold, further exacerbating the problem. The protruding piece of nail keeps pushing into the skin, causing further injury and pain.

Some people are simply more prone to ingrown toenails. Some risk factors include

  • athletic adolescents and children,
  • tight or narrow shoes (poorly fitted shoes),
  • repeat injury or trauma to feet,
  • poor foot hygiene,
  • poor posture and gait,
  • congenital foot deformity,
  • congenital toenail malformation,
  • very long toes,
  • naturally short nails,
  • obesity,
  • diabetes,
  • toenail infections,
  • fungal nail disease,
  • prior nail surgery,
  • abnormal nail growths,
  • arthritis, and
  • excessive foot sweating.

Which nails are most commonly affected?

The great toes are the most commonly affected sites. Other toenails may less commonly become ingrown. Fingernails may rarely become affected.

What causes infections in ingrown toenails?

Bacteria and fungi can easily infect the skin of the feet and nails. The foot’s warm and moist environment is a great breeding ground for many kinds of infections including Staphylococcus, Pseudomonas, Candida, and Trichophyton. It is important to treat any secondary infections resulting from or following ingrown toenails.

What are possible complications of ingrown toenails?

Ingrown toenails may cause deeper bacterial tissue infection (cellulitis), localized infection of the nail fold (paronychia), and scarring of the nail fold and skin.