Ingrown Toenails Clinical Presentation

Updated: Apr 05, 2016
  • Author: Thomas E Benzoni, DO, MT(ASCP); Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

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.

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Physical

The affected toe has all the classic signs of infection: pain, edema, erythema, and warmth.

Lymphangitis is rare.

The affected side is readily apparent.

Inspection for other contributing causes, particularly mycoses, is important.

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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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