eMedicine Specialties > Pediatrics: General Medicine > Dermatology
Ingrown Nails
Updated: Jul 19, 2006
Introduction
Background
Ingrown toenails are a fairly frequent cause of discomfort. Although often thought to be synonymous, the terms ingrown nail and paronychia refer to different conditions. Both can cause significant discomfort. Ingrown toenails may cause pain with ambulation.
Pathophysiology
Ingrown nails result from an alteration in the proper fit of the nail plate in the usual nail groove. Sharp spicules of the lateral nail margin develop and are gradually driven into the dermis of the nail groove. The nail acts as a foreign body. An inflammatory response occurs in the area of penetration, leading to erythema, edema, purulence, and development of granulation tissue.
Development of ingrown nails is divided into 3 stages: (1) erythema, edema, and focal tenderness; (2) crusting and expressible purulence at the nail fold and nail plate junction; and (3) chronic infection with protuberant granulation tissue extending over the nail plate.
Ingrown nails generally occur as the result of poorly fitted footgear. However, this may be caused by prior trauma to or abnormal shape of the nail margin.
Frequency
United States
Of all nail problems, this is the most common. Toenails are affected much more commonly than fingernails. The lateral margins of the great toe are most frequently affected.
International
In the United Kingdom, 10,000 cases per year have been reported.
Mortality/Morbidity
In general, mortality is not associated with ingrown nails. Morbidity is chiefly the result of infection of the tissues. If neglected, abscess formation (paronychia) may occur or spread and lead to osteomyelitis, systemic infection, sepsis, or amputation.
Race
No racial bias appears to exist.
Sex
The prevalence of ingrown nail has a reported male-to-female ratio of 3:1.
Age
The condition is observed in people of all ages but is most common in the second decade of life.
Ingrown nails become much more common as children begin bearing weight on their feet and wearing shoes.
Clinical
History
Patients present for care of ingrown nails due to discomfort. Ingrown nails may cause significant pain.
If a toenail is involved, the discomfort worsens with weightbearing and ambulation.
- The patient with an ingrown nail presents with a sharp, focal pain adjacent to the nail bed of the affected digit.
- The patient or parents may typically describe crusting, purulence, and friable granulation tissue at the site.
Physical
On examination, the following may be present:
- Edema or inflammation of tissue surrounding the nail bed
- Erythema of the same tissue
- Macerated or friable granulation tissue
- Crusting
- Drainage
- Hypertrophy of the nail margin
- Hypertrophy of the surrounding epidermis
Causes
The nail plate can be forced out of the nail groove by footgear that has a toe box that is too small for the forefoot, by trauma, or by cutting the nail back in a curvilinear fashion.
- Other causes include the following:
- Heredity - Some people are genetically predisposed to inwardly curved nails with distortion of one or both nail margins.
- Underlying bony pathology causing deformation of the nail
- Obesity causing deepening of the nail groove
- Antiviral therapy for HIV has also been reported to have an association with increased incidence of ingrown nails.
- Prior trauma resulting in an irregularly shaped nail
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References
Edlich RF, Winters KL, Britt LD. Bacterial diseases of the skin. J Long Term Eff Med Implants. 2005;15(5):499-510. [Medline].
Gross RH. Foot pain in children. Pediatr Clin North Am. Dec 1986;33(6):1395-409. [Medline].
Ilfeld FW. Ingrown toenail treated with cotton collodion insert. Foot Ankle. Apr 1991;11(5):312-3. [Medline].
Manusov EG, Lillegard WA, Raspa RF. Evaluation of pediatric foot problems: Part I. The forefoot and the midfoot. Am Fam Physician. Aug 1996;54(2):592-606. [Medline].
Noronha PA, Zubkov B. Nails and nail disorders in children and adults. Am Fam Physician. May 1 1997;55(6):2129-40. [Medline].
Rich P. Nail disorders. Diagnosis and treatment of infectious, inflammatory, and neoplastic nail conditions. Med Clin North Am. Sep 1998;82(5):1171-83, vii. [Medline].
Robbins JM. Recognizing, treating, and preventing common foot problems. Cleve Clin J Med. Jan 2000;67(1):45-7, 51-2, 55-6. [Medline].
Rockwell PG. Acute and chronic paronychia. Am Fam Physician. Mar 15 2001;63(6):1113-6. [Medline].
Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. Cochrane Database of Systematic Reviews. 2004;1.
Zuber TJ. Ingrown toenail removal. Am Fam Physician. Jun 15 2002;65(12):2547-52, 2554. [Medline].
Further Reading
Keywords
ingrown nails, ingrown fingernail, ingrown toenail, acronyx, onychocryptosis, unguis incarnatus, unguis aduncus
