Ingrown Toenail

Causes of an Ingrown Toenail

An ingrown toenail are the result of having too much pressure on the edge of the nail bed and poorly trimming the nails so that the nail grows into the soft tissue on the side of the nail. When this happens, the toe begins to hurt and can become inflamed. If left untreated, the toenail can become infected, causing a collection of pus in the nail fold next to the nail.

Ingrown toenails can be partially hereditary so if you have a relative with the condition, you are more likely to have it yourself. People who trim their toenails the wrong way can cause the nail to grow into the nail fold. Having a pedicure that is too aggressive and that trims the nail too far back can cause an ingrown toenail to occur. Proper skin and nail care is essential to prevention.

Risk Factors for Ingrown Toenails

Things that predispose a person to developing ingrown toenails include the following:

• Having shoes that are too big or too small.
• Being in a sport that involves many stops and starts, like basketball, soccer, or tennis.
• Trauma to the foot. This can involve a single trauma or many small traumas over time.
• Walking the wrong way.
• Not keeping the feet clean and dry.
• Having bunions, hammertoes or other foot problems.
• Being born with an abnormal great toe.
• Having great toes that are too long.
• Suffering from diabetes.
• Being overweight or obese, which means there is more soft tissue in the toes.
• Having arthritis in the foot or toes.
• Having a fungal infection of the great toe.
• Having feet that sweat too much.
• Having excessive swelling of the tissues of the feet.

Signs and Symptoms of an Ingrown Nail

Ingrown toenails are obvious to look at. They involve a reddened nail fold that is tender to the touch and swollen. If the nail is infected, it can drain purulent drainage. If it is not infected, clear yellow drainage can come out of the nail fold. If they are not infected, they can resolve on their own if the nail grows up and out of the tissue. If they do not resolve on their own, you probably need to see a podiatrist.

Infections of the Ingrown Toenails

Ingrown toenails are especially uncomfortable when they become infected. If you have a nail that has ingrown and the foot is warm and sweaty, this can cause bacteria and fungi to grow. The most common organisms causing infection of the ingrown nail is Staphylococcus aureus (which forms pockets of pus), Pseudomonas, yeast, and dermatophytes.

Any time there is a cut in the skin along the nail fold, the above organisms can grow into the tissues, resulting in an infection. The infection needs to be treated in order to allow the ingrown toenail to heal.

Diagnosis of an Ingrown Toenail

Ingrown toenails are fairly obvious. They look like a reddened swollen area in the nail fold of the great toe. The tip of the toenail can be seen imbedded in the soft tissue if the nail fold. This is called a spicule. There can be a pocket of pus within the nail fold and drainage coming up out from beneath the fold itself. If the nail is infected, it can smell bad.

Complications of an Ingrown Nail

If the nail is allowed to grow within the nail fold for too long, an infection can grow in that area and can spread to involve the entire tissue on one side of the nail. This is called cellulitis. If this is not treated, the bone itself can become infected. This is known as osteomyelitis and can be very serious and difficult to treat. The infection can cause scar tissue to grow in the area of the nail fold and a secondary fungal infection of the entire nail can ensue.