An ingrown toenail is incurvation or impingement of a nail border into its adjacent nail fold, causing pain.
(See also Overview of Nail Disorders.)
Causes of ingrown toenail include tight shoes, abnormal gait (eg, toe-walking), bulbous toe shape, excessive trimming of the nail plate, or congenital variations in nail contour (eg, congenital pincer nail deformity). Sometimes an underlying osteochondroma is responsible, especially in the young. In older people, peripheral edema is a risk factor. Eventually, infection can occur along the nail margin (paronychia).
Symptoms and Signs
Pain occurs at the corner of the nail fold or, less commonly, along its entire lateral margin. Initially only mild discomfort may be present, especially when wearing certain shoes. In chronic cases, granulation tissue becomes visible, more often in the young.
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Diagnosis
Clinical evaluation
Redness, swelling, and pain may also suggest concurrent paronychia. In young patients (eg, < 20 years) with recurrent ingrown toenails, x-rays should be considered to exclude underlying osteochondroma. In the absence of an ingrown toenail, apparent granulation tissue around the toe suggests the possibility of amelanotic melanoma, which is often overlooked; biopsy is necessary.
Treatment
Usually nail excision and destruction of adjacent nail matrix
In mild cases, inserting cotton between the ingrown nail plate and painful fold (using a thin toothpick) may provide immediate relief and, if continued, correct the problem. If the shoes are too tight, a larger toe box is indicated.
