What are Ingrown Toenails?
Ingrown toenails are alternatively termed as unguis incarnatus or onychocryptosis, from the Greek terms onyx and kryptos, with the literal meaning hidden nail . It is a condition wherein the toenail, instead of growing over, develops within the flesh .
Common among adults, this is usually present among men than women. It is more prevalent among population of shoe-wearers, from the descending pressure exerted by the shoe on the toenail. [ 3, 4, 5]
An illustration of an ingrown toenail.
What Makes An Ingrown Toenail?
When toenails are bent, budding into the skin, particularly at the boundaries or sides of the nails, it is considered ingrown. They can even be brought about by sharp corners of toenails digging and breaking through the skin either at the distal or lateral part of the toes. These consequently annoy the skin, causing inflammation, erythema, warmth and tenderness in the area of the toe. Initial manifestations of pain and swelling are usually first to appear at the area where the nails coil into the skin. [3, 6]
At times, these may sever the skin, causing breakage. Bacteria then penetrate the integumentary system, inducing infection. This is often manifested by a foul smelling discharge draining from the inflamed skin. [6, 7]
Rarely, infection may be rooted even from a nonpainful, non-erythematous, or a nonswollen toe. A simple nail coiled downward and penetrating the skin may likely progress to an infection. 
An image depicting differences of an ingrown toenail (right) versus a normal one (left).
Causes of Ingrown Toenails
A number of factors may induce and aggravate the presence of ingrown toenails. [2, 3, 6]
- Infections with etiologic agents, such as fungi, causing thickening of the toenail.
- Episodes of trauma including stubbing, extreme kicking or running, and even having a heavy object fell on the toes.
- Tight fitting shoes or elevated footwears, which cause compression of toes and induce pressure for abnormal nail growth.
- Incorrect trimming of nails, particularly cutting them round, cause the edges of the nails to grow into the skin.
- At times, heredity may also be a factor. These are more likely to develop among individuals whose family members also have them.
When to Consult a Physician
A physician’s consultation is warranted whenever one notes an ingrown toenail complicated by infection, as characterized by a presence of discharge, persistent pain and swelling, and fever. However, even if without those signs of infection, one must consult his doctor when no improvement if observed within 3 days, if the last tetanus vaccine was more than half a decade ago, or, if the patient is immunocompromised, has diabetes, with poor circulation, on chemotherapy sessions, and has Acquired Immunodeficiency Syndrome (AIDS). These said conditions can be prerequisites for poor wound healing and increased progression of infection. [3, 8, 9]
Home Remedies for Ingrown Toenails
If ingrown toenail is caught at its early course, home remedies may still be effective in treating it and preventing further infection. In doing so, one must: [3, 6, 7, 9, 10, 11]
- Avoid wearing elevated shoes and those which are tight or ill-fitting.
- Wash the foot twice daily with soap and water.
- The foot should be soaked in warm water four times daily, this can be done for 10 minutes.
- Dryness and cleanliness of the foot must be maintained for the rest of the day.
- Pain relievers can be given to alleviate foot tenderness.
- Gentle massage around the affected area may diminish its inflammation and swelling.
- By means of a cotton or a clean cloth, the skin fold must be pushed over the ingrown nail in a downward and distal manner. This is done allowing the nail to grow forward until it is clear of the edge of the toe.
- When no improvement is noted within 3 days, consult with a medical specialist must be done.
Application of a cotton on the affected toenail to allow the nail to grow forward.
Medically Managing Ingrown Toenails
Once the presence of ingrown toenails persist in 3 days time or there is a sign of impending infection, consultation with a physician is advised. In doing so, the specialist may choose to do the following: [3, 6]
- Antibacterials may be prescribed for presence of infection.
- Splints can be used to protect the skin against the sharp edges and corners of toenails. These can be made up of plastic strips, resins and cotton wicks.
- A hard plastic can be affixed to the toenail, making it grow out in a flat manner and in a straight line.
- Filing and cutting the toenail on the center may be done to change the shape the nail as it develops, preventing ingrowing of nails.
An image showing the use of splint among a patient with an ingrown toenail.
Surgical Treatments for Ingrown Toenails
The presence of too much swelling, tenderness, discharge, and inflammation are often manifestations of ingrown toenail infections. If medical management is not much of help, surgical procedures may be done. 
Wedge resection is characterized as partial avulsion of the edges of the nail plate. This may be part of the initial surgical approach among patients with ingrown toenails. This may be an alternativee to a complete toenail removal, which allows 3 to 4 months for nail regrowth. [7, 11]
Surgical procedures of ingrown toenails can prevent the edges of the nail from coiling inward and penetrate the flesh as the nails grow. Removing the nails permanently may be recommended for those with chronic and recurrent infections of ingrown toenails. 
Surgery performed to resect ingrown toenails.
Methods in Preventing Ingrown Toenails
The following must be remembered as measures in preventing ingrown nails: 
- Tight shoes must be avoided.
- Cotton, rather than synthetic, socks must be used.
- The feet must be kept dry and clean.
- Nails must not be trimmed too short or too low at the edges, it must be cut straight.
- When trimming, the corners of the nails must be evident over the skin.
- James, W, et al. Andrews’ Diseases of the Skin: Clinical Dermatology. 2002, 10th ed. Saunders. p 789.
- Shulman, P, et al. Survey in China and India of Feet That Have Never Worn Shoes. The Journal of the National Association of Chiropodists. 1949.
- Howell, D. 2010. The Barefoot Book. Hunter House.
- Heidelbaugh, J, et al. Management of the Ingrown Toenail. American Family Physician. 2009 Feb.; 79(4): 303-8
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