eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Toenails, Ingrown
Updated: Jul 24, 2008
Introduction
Background
Ingrown toenails (unguis incarnatus) are a common toenail problem of uncertain etiology. Various causes include poorly fit (tight) footwear, infection, improperly trimmed toenails, trauma, and heredity. The great toe is the most commonly involved. The lateral side is involved more commonly than the medial side.
Pathophysiology
The underlying cause of this condition is a foreign body reaction. When the nail bed is compressed from the side, the edge of the nail then penetrates the cuticle. The presence of the keratinaceous material of the nail in the flesh of the toe sets up a foreign body reaction.
Frequency
United States
The occurrence of this common disorder is poorly measured, because many instances are not brought to the attention of the medical community.
International
The frequency is unknown.
Mortality/Morbidity
The principle morbid condition of this disorder is pain. However, it can be the initiating pathway for more serious disorders in certain patients at risk, especially those with diabetes or arterial insufficiency.
- Particular attention must be paid to high-risk patients. Referral to specialty clinics for follow-up (eg, surgeon, podiatrist) is recommended.
- No direct mortality for this disorder exists.
Race
No racial predilection.
Sex
No sexual predilection.
Age
This disorder is not found in the preambulatory stages. Rare in preteens, it is more common in teenagers, and its occurrence increases throughout life.
Clinical
History
- Patients with an ingrown toenail have a painful, swollen, and tender toe.
- When infection is present, the patient may have local discharge.
- Important components of the history include a previous history of risk factors for diabetes and arterial insufficiency.
Physical
- The affected toe has all the classic signs of infection: edema, erythema, and warmth.
- Lymphangitis is rare.
- The affected side is readily apparent.
- Inspection for other contributing causes, particularly mycoses, is important.
Causes
Ingrowth of the toenail is generally thought to be multifactorial.
- Nail length: Cutting the nail so short that it is not constrained by the distal portion of the cuticles, allowing side slippage and penetration of the lateral nail bed by the nail substance.
- External pressure: Wearing shoes that are so tight they compress the ridges of the cuticles against the relatively stiff nail material, turning the nail into a cutting surface.
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References
Barker LR, Burton JR, Zieve PD. Principles of Ambulatory Medicine. 3rd ed. Williams & Wilkins; 1991.
Bossers AM, Jansen IM, Eggink WF. Rational therapy for ingrown toenails. A prospective study. Acta Orthop Belg. 1992;58(3):325-9. [Medline].
Fulton GJ, O'Donohoe MK, Reynolds JV, Keane FB, Tanner WA. Wedge resection alone or combined with segmental phenolization for the treatment of ingrowing toenail. Br J Surg. Jul 1994;81(7):1074-5. [Medline].
Giacalone VF. Phenol matricectomy in patients with diabetes. J Foot Ankle Surg. Jul-Aug 1997;36(4):264-7; discussion 328. [Medline].
Ingrown toenails. Last updated May 2007. Familydoctor.org. Available at http://familydoctor.org/online/famdocen/home/common/skin/disorders/208.html.
Kimata Y, Uetake M, Tsukada S, Harii K. Follow-up study of patients treated for ingrown nails with the nail matrix phenolization method. Plast Reconstr Surg. Apr 1995;95(4):719-24. [Medline].
Mori H, Umeda T, Nishioka K, et al. Ingrown nails: a comparison of the nail matrix phenolization method with the elevation of the nail bed-periosteal flap procedure. J Dermatol. Jan 1998;25(1):1-4. [Medline].
Ozdemir E, Bostanci S, Ekmekci P, Gurgey E. Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrowing toenails. Dermatol Surg. Jan 2004;30(1):26-31. [Medline].
Sauer GC. Manual of Skin Diseases. JB Lippincott; 1985.
Wollina U. Modified Emmet's operation for ingrown nails using the Er:YAG laser. J Cosmet Laser Ther. May 2004;6(1):38-40. [Medline].
Zaborszky Z, Fekete L, Tauzin F, Orgovan G. Treatment of ingrowing toenail with segmental chemical ablation. Acta Chir Hung. 1997;36(1-4):398-400. [Medline].
Further Reading
Keywords
ingrown toenail, sore toe, sore toenail, painful toe, swollen toe, unguis incarnatus, mycoses, chemical cautery, tender toe, diabetes, arterial insufficiency, lymphangitis
