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Ingrown Toenail
Aka: Ingrown Toenail, Onychocryptosis, Unguis Incarnatus, Unguis Aduncus, Ingrown Nail, Ingrowing Great Toenail, Ingrowing Toenail
- Epidemiology
- Unilateral in 80% of cases
- Usually affects hallux (great toe)
- Risk Factors
- Improper nail cutting (nail incurves into nail fold)
- Poorly fitting shoes, especially if constrictive (callus forms in nail fold)
- Impaired nail self-care
- Obesity
- Hyperhidrosis
- Foot Trauma
- Altered gait
- Congenital disorders
- Pachyonychia congenita
- Trisomy 13
- Unna-Thost Syndrome
- Comorbid conditions
- Pityriasis
- Hyperthyroidism
- Diabetes Mellitus (Dystrophic Nails)
- Acromegaly
- Signs: Ingrown Toenail
- Stage 1 Ingrown Nail
- Erythema, trace edema and pain at lateral nail fold
- Stage 2 Ingrown Nail
- Increased pain and foul discharge from nail edge
- Signs of Bacterial Paronychia
- Stage 3 Ingrown Nail
- Most significant symptoms of Ingrown Nail
- Lateral nail fold hypertrophy and chronic granulation tissue
- Management: Non-surgical (mild cases with minimal pain or erythema)
- Expect resolution over 2-12 weeks
- Warm soapy water soaks for 15-20 minutes nightly and
- Raise lateral nail margins
- Insert cotton-wisp or dental floss under nail at Ingrown Nail groove edge or
- Use intravenous drip tubing as an improvised gutter splint
- Split intravenous drip tubing lengthwise, so can be inserted over the nail edge
- Tape, glue (cyanoacrylate) or wound-closure strips in place
- Arai (2004) In J Dermatol 43(10):759-65 [PubMed]
- Adjunctive
- Apply Corticosteroid cream or ointment to the affected area three times daily for 2-14 days
- Apply topical antibiotic (bacitacin) and/or Corticosteroid to ingrown margin twice daily
- General measures
- Wear shoes with open toe or with wide toe box
- Manage Hyperhydrosis
- Treat Onychomycosis
- Management: Antibiotics
- Not routinely recommended
- Has been used when matrix destruction is performed but without good evidence
- Paronychia may be the only indication for systemic antibiotics
- Management: Surgical Nail Avulsion (moderate to severe pain, inflammation, purulent drainage)
- See Toenail Removal
- Complications
- Bacterial Paronychia
- Treat Paronychia with antibiotics if present
- Onychogryposis
- Hypertrophic shape changes of nail
- Prevention
- Trim nail flat (not too short, not rounded, not V-Shaped)
- References
- Mandracchia (July, 1998) Hospital Medicine, p. 36-43
- Peggs in Pfenninger (1994) Procedures, Mosby, p. 28-43
- Mayeaux (2019) Am Fam Physician 100(3): 158-64 [PubMed]
- Heidelbaugh (2009) Am Fam Physician 79(4): 303-12 [PubMed]
- Zuber (2002) Am Fam Physician 65(2):2547-58 [PubMed]