Ingrown toenail is a common condition. Most of them are embedded in the nail groove and repeatedly infected, causing persistent pain in the nail groove, which seriously disturbs the patient’s working life.
I. Anatomy
The normal nail complex is composed of nail plate, nail bed and surrounding soft tissues.
II. Etiology
1.Incorrect trimming of the toenail leads to short and too deep
This is the most common cause, the side edge of the nail is not cut flush and cut too short and too deep, then the side edge of the toenail can be like a “hard thorn” into the soft tissue of the nail groove
2.Wearing shoes too tight
Mostly seen in female patients, wearing shoes with a high head tip, squeeze the lateral edge of the toenail to the nail groove soft tissue growth, and friction nail and nail fold and cause soft tissue swelling aggravate ingrown nail
3.Trauma
Tearing of the nail plate after kicking or being stepped on by others causes the lateral edge of the nail plate to be closer to the soft tissue of the nail groove and forms ingrown nail, which is more common in young students.
4.Other factors
Congenital local deformities, such as bunion, nail dystrophy, thick nail disease or with nail fungal disease and other related. Some people think that the curvature and axial direction of the toenail is related to ingrown toenail. Nail ingrowth is also related to the occupation, mostly in service occupations such as standing work.
Skin breakdown → infection (onychomycosis) → poor drainage → swelling → granuloma → increased pressure → increased infection (vicious circle)
III. Staging
Stage I (inflammatory stage): mild redness, swelling and pressure pain in the lateral nail fold.
Stage II (abscess stage): local redness, sweating, increased pressure and pain, swelling of the nail fold above the lateral edge of the nail plate, and the beginning of exudate flow.
Stage III (granulation stage): granulation tissue is formed and covers the lateral nail fold, preventing drainage flow.
IV. Conservative treatment
Patients in stage I : padding the toenail, soaking the feet, correct trimming of the toenail, fixation of the nail plate, and placement of a nail groove orthosis.
Stage II patients : This stage is still potentially curable with non-surgical treatment options!
1. Eliminate the pressure on the toe.
2.Soak the feet in warm water 4-5 times a day for 10-15 minutes each time.
3.Culture of secretions and use of broad-spectrum antibiotics.
4.If the symptoms are relieved, start the treatment method of stage I.
Patients with stage III: At this time, conservative treatment is not effective and surgical treatment is needed.
V. Surgical treatment
The surgical treatment of ingrown toenail is based on two aspects of etiology
1. The toenail is the main invasive structure, while the soft tissue is the invaded tissue.
2, It is necessary to remove all or part of the nail plate and the nail bed eruption area and vice versa.
3, Since the nail fold is the culprit of the disease, the purpose of surgery is to remove or correct the nail fold.
Therefore, the choice of surgery is determined by the cause and severity of the ingrown nail. If you or your family members or friends have the manifestation of ingrown nail, please visit the specialized foot and ankle surgery in time to make a personalized treatment plan.