Ingrown nail – a nail plate, often C or O-shaped, growing into the nail fold. Ingrown nail can be caused by an injury, a disease process or prolonged improper trimming of the nail which leads to achiness, bleeding and purulent fluid at mechanical contact. When the condition is left with no intervention for too long it leads to hypergranulation tissue (proud flesh)formation. When the nail edge breaks through the skin it produces inflammation, infection and swelling.
Ingrown nail, a painful inflammatory condition of the nail wall which most commonly occurs in the large toes, can affect both children and elderly people. The pain associated with this condition results in discomfort, causes oedema and purulent exudate. Walking and tenderness on even a delicate touch of the duvet cause pain and impair everyday functioning. Ingrown nail treatment is therefore a complicated and chronic process. Trimming the nail too short round the fingertip, wearing high -heeled or narrow tip shoes are the main causes of the ingrown nail but they may also result from trauma, for example after skiing in too tight skiing boots, hitting the toe against the stairs or being trodden by someone.
Ingrown toenail predisposing factors:
- improper, too deep trimming of the nail sides,
- improper shoe fitting (too tight, too narrow, high-heeled)
- mechanical injury ( having been trodden, heavy object falling on the foot)
- prolonged fungus infection (which deforms, weakens and alters the nail shape)
- some kinds of sport (football, ballet)
- sudden body weight gain (pregnancy)
- genetic predisposition
- sensor for oxygen saturation placed usually on an infant’s foot ( causing pressure on the matrix)
CAUTION! The purulent-blood fluid secreted in ingrown nail is infectious for the environment and for the patient himself!!!
Wound sampling for laboratory analysis is a significant element of ingrown nail treatment as the wound culture will provide the antibiogram to determine a subsequent antibiotic therapy.
Most commonly detected bacteria include:
- Staphylococcus aureus
- Pseudomonas aeruginosa
It is essential that the patient should use disposable towels or should not share their own towels with others. It is highly inadvisable to go to swimming pools and other public places where others can be put at risk of infection. Treatment time can be reduced by the use of disinfectants and locally applied antibiotics selected according to the antibiogram.
So far wedged resection or a complete nail removal have been the most commonly performed treatments. These invasive kinds of surgery, however, do not produce good results as the ingrown nail reoccurs and the procedures often have to be repeated. Cosmetologists, for a change, trim sides of the nail and cover the nail plate with acrylic, which does not prove effective either, moreover, the outcome can be even worse when the condition is accompanied by inflammation and hypergranulation.
Traditional postsurgical treatments after complete nail plate removal, one-side or two-side wedge resection.
The excessive healing flesh (hypergranulation tissue) left on the side of the nail fold without nail separating causes its more intense ingrowth, purulent fluid secretion and prolonged achiness.
How to prevent ingrown nail?
- trim nails properly (cut nails straight across, do not cut too low at the edge or down the side)
- wear well-fitting shoes
- do not remove cuticle (to avoid the risk of infection)
- take proper foot care
- use suitable foot care products
- rely on experienced podologists’ advice
Effective treatment with lasting effects is largely dependent on medical expertise as well as a specialist medical center. What is currently the most effective method of ingrown nail treatment is a specialist corrective brace. Additional tamponade i.e. long-term dressing under the side edges of the nail separates the nail more quickly and enhances the healing.
Nail wire barcing of the ingrown toenail
Ingrown nail with granulation tissue- hypergranulation of the nail fold
Ingrown nail with a wire brace and tamponade of long-term dressing
The following types of braces and treatments can be selected with regard to the nail condition:
- wire brace – the most effective method of ingrown nail correction, applied also when the inflammatory process is already highly advanced and granulation tissue, purulent fluid and severe pain occur. It is intended for deeply ingrown, thick and involuted nails. The wire brace does not only pull away the ingrowing nail edge but it will also correct the nail matrix. Our Foot Center offers the wire brace application with local anaesthetic. The brace function can be compared to dental braces. When attached to the nail it corrects the natural growth of the nail and by applying appropriate pressure on the edges it pulls the nail out of the nail fold.
- plastic brace – the type is applied on soft nail plate, but not on nails ingrowing deeply and when there is purulent fluid.
- 3TO brace – adhesive brace with activation wire is particularly recommended for children but also for adults with their nail plates pressed deeply into the nail fold
- wound tamponade – applied only with medical dressings adjusted to the phase of the nail ingrowth. It is waterproof so during the treatment everyday activities, sports and water activities are not affected.
The experience we have gained so far makes us the leaders on Polish market of ingrown nail correction and nail wound healing. The treatments performed with local anaestethic which are intended for advanced inflammatory conditions bring comfort to our patients whereas a wide range of long-term wound dressings and wound healing agents quickly control the inflammation and facilitate everyday functioning.
Photo gallery of cases:
Patient 1. Big toes ingrown nails in both feet
Nail plates were previously removed surgically, in the right foot the regrown nail required additional wedged resection. However, after several interventions the ingrown nails recurred even more seriously. The patient’s body weight was quite substantial and his occupation involved a lot of standing and walking.
We designed the most effective method of ingrown nail correction with simultaneous inflammation reduction. Wire braces fitted to the nails redirected them thanks to proper regulation and tamponade. Regular big toes care eventually relieved the pain and prevented further nail ingrowth.
Patient 2. Attempted self-treatment of ingrown nails several times.
The patient used over-the-counter remedies as he was terrified of medical care. After several months of ineffective methods intense hypergranulation occurred both on the nail fold and under the nail. The hypergranulated tissue was resected, metal brace was attached and long-term tampon wound dressing was applied. Post-surgical wound was completely healed and the nail fold was lastingly straightened.
Pacjent 3. – A pregnant patient with badly swollen legs.
The patient was unable to trim her toe nails which she had cut deeply down the sides for many years. During pregnancy and after childbirth she was helped by her husband who cut the nail sides to such a degree that the patient was not able to walk.
Despite dermatological treatment, home-made remedies and pharmaceutical products, the inflammation and swelling of 8 toes did not diminish. The patient started the treatment at our Center where we applied ingrown nail correction with orthonyxia i.e. wire braces and tampon wound dressing. Owing to severe inflammation and deep ingrowth the initial phase of treatment was conducted with infiltration anaesthesia. Local anitibiotic determined by the antybiogram was applied and this was completed with herbal therapy and wound healing agents. In the later treatment the patient was given proper self-care guidance which largely contributed to final positive outcomes. The instructions how to correctly trim the nails proved to be the best prevention which resulted in no further relapses.
Patient 4. – Deeply ingrown nails in both big toes.
The patient with inflammation, hypergranulated nail folds and hypergranulated tissue under the nail plate. Severe purulent discharge was found in the wounds and culture fluid identified Streptococcus aureus.