Ingrown Toenail
What Is an Ingrown Toenail?
An ingrown toenail is a condition in which the edge of the nail digs into the skin and causes inflammation. It is especially likely to occur on the big toe, and when it becomes severe, a red growth called a pyogenic granuloma can form beside the nail and bleed, the surrounding skin swells, and walking can become difficult.
The difference from a curved (pincer) nail
Many people may think that the everyday word for the technical term “ingrown toenail” is “curved nail” (makizume), but this is a little different. The term “ingrown toenail” sounds as if the nail is the main subject, but to put it simply it is a skin condition, a disease, of “the nail sticking in and the skin hurting.”
A “curved nail” is thought to refer to a nail that is curled sideways, but patients with an ingrown toenail do not all necessarily have a severely curled nail. Sometimes a curved nail leads to an ingrown toenail, and sometimes an ingrown toenail is caused by the reasons listed below.
Main Causes of Ingrown Toenails
How the nail is cut
Cutting the nail too short, or leaving a pointed corner by cutting it poorly, makes it easier for the nail to become buried in or to stick into the skin.
Choice and fit of shoes
When the size or shape of the shoes does not fit, or they are worn incorrectly, the skin beside the nail is repeatedly compressed. This is often accompanied by nail deformities such as a curved nail, and usually a bunion as well.
How you walk
When your gait changes due to a spinal disease, a foot injury, surgery, or the like, it becomes easier to put pressure on a particular toe.
Sports and injury
For example, it can occur when you stub your foot, the nail cracks, and the nail sticks in. It can also occur when a strong impact during sports such as soccer presses the nail into the skin.
Treatment Methods for Ingrown Toenails
Lifestyle guidance
First, it is important to identify the cause. If there is a problem with how you choose or wear your shoes, we will guide you on the correct way.
Wedge resection of the nail plate
Because the skin inflammation is caused by the nail digging in, in most cases we cut out the part of the nail that is sticking in, in a wedge shape.
Liquid nitrogen cryotherapy
When a granuloma has formed, we freeze it with nitrogen cooled to a liquid to shrink it down. When the granuloma is large, it can take several weeks or more. We often combine this with the taping method. You will feel strong pain especially when there is an infection.
Taping method
There is a method called taping, in which the skin is pulled away from the nail so that the nail does not dig in; this requires the patient to change the tape every day at bath time. Because it does not stick well when the foot is damp, you need to wipe off any water thoroughly before applying it. It comes off easily for people who sweat a lot, and it can cause tape irritation.
Cauterization with a high-frequency electric scalpel
When a granuloma is slow to heal, we may cauterize it with a high-frequency electric scalpel (Surgitron). There is a risk of an anesthetic allergy or of pain persisting for a long time after the procedure. There is also a risk that the wound does not heal for a long time or that it recurs.
Phenol method
When the nail digs in severely, we may trim the nail narrow and then chemically burn the base of the nail with a chemical so that the nail no longer grows there; but because it often recurs if the cause is not corrected, and because there is a risk of after-effects of the procedure such as lingering pain from the phenol method or the nail growing back partway and sticking in again, it is a last resort that should be considered carefully.