When the whole or part the nail is removed from its bed, it is called a nail avulsion injury. But as long as the germinal matrix or the root of the nail is intact, re-growth is possible. The nail should be re-sited on its bed to serve as a splint if it is available. On the other hand, if the bed is split, a thorough realignment of the wound is recommended. With the use of partial-thickness skin grafts, loss of tissue from the nail bed can be made good.
Nail avulsion is a common problem in adolescents and young adults. Although all the nails may be affected, it is usually the hallux (big toe) that is involved. Nail avulsion is usually caused by lateral edge nail cutting and growing into adjacent soft tissue. Superimposition of bacterial or fungal infection may also occur. Over-granulation of the nail bed may happen during attempted healing.
The ingrown toenail syndrome can be surgically treated and is usually performed in the doctor’s office. An ambulatory center or a hospital is utilized if this procedure is going to be carried out in combination with other surgical procedures or if the patient has some underlying problems.
The possible etiological factors are the following:
- Improper foot care
- Inappropriate nail cutting
- Ill-fitting shoes
Conservative management should be attempted in the early stages.
- This should include the following:
- Well-fitting shoes.
- Regular soaking and washing of feet.
- Careful and proper drying of the feet after washing.
- The Proper way of cutting nails transversely.
- Proper application of cotton wool pledgets under the nail to encourage growing out.
In the event that conservative measures fail, surgery may be necessary.
The nail can be removed by:
- Avulsing the whole nail
- Wedge resection of the affected side of the nail
Ablation (removal of the entire nail and the germinal matrix) of the nail bed may also be considered if simple avulsion does not work. This can be achieved chemically or surgically. Phenol is used when doing a chemical ablation.
A Zadek’s procedure is usually utilized during surgical removal of the nail. This is the removing of the entire edge or edges of the offending nail and removing the nail-forming tissue at the core of the nail to prevent its regrowth.
The combination of avulsion and phenolization (removal of the edge of the nail growing into the flesh and cauterizing the matrix area with phenol to destroy the matrix producing the ingrown portion of the nail) is more effective than surgical procedures.
- Nonpermanent treatment- The initial treatment may consist of:
- A simple nail avulsion with or without the use of antibiotic treatment.
- Incision and drainage (I&D) of the soft tissue next to the nail.
- A simple nail avulsion combined with debridement of the nearby soft tissue.
B. Surgical procedure for ingrown toenails – The following may be used alone or in combination:
- Surgical removal of the matrix.
- Use of chemicals such as phenol or sodium hydroxide in treatment.
- Bone surgery is indicated when treating ingrown toenails with pain upon putting downward pressure. It is also utilized in the presence of subungual exostosis (benign tumor of the distal phalanx occurring beneath or adjacent to the nail) or when there is osteomyelitis.
- Laser and/or radiowave matricectomy
- Repair of hypertrophic ungualabia.
- Treatment of mild to moderate non-infected nail by utilizing avulsion of the offending portion of the nail and if the nail is thick, debridement of this.
- The patient may be instructed to the following:
- Proper shoe wear.
- Home soaks.
- Use of topical antibiotics.
- Use of oral antibiotics.
- Proper nail trimming technique.
What are the symptoms of ingrown nails?
Some of the symptoms include pain felt along the margins of the nail as caused by hyper granulation, increased pain upon wearing shoes or other tight articles, and sensitivity with pressure of any kind. Redness, swelling of the area around the nail, and drainage of pus and watery discharge with a hint of blood are some signs of infection. Formation of an ingrown nail occurs when there is swelling at the base of the nail.
What causes ingrown nails?
This is usually caused by concussion, the most common injury to the nail, wherein the flesh is pressed against the nail resulting in a small cut that swells. A nail may grow abnormally, making it thicker or wider than normal or bulged or crooked when it is injured. Other common injuries to the digits include stubbing the toenail, dropping things on the toe, and going through the end of your shoes in sports. These injuries can be avoided by wearing shoes all the time if possible most especially when working or playing.
What will happen if an ingrown nail is not treated right away?
There may be a high risk of dangerous infection if an ingrown nail is left untreated. Swelling occurs when the skin adjacent to the nail gets infected, which puts more pressure against the nail. A spear-shaped wedge of nail can be produced by ingrown nails on the lateral side of the toe, which pushes into the toe tissue as the nail grows forward. Worst case scenario is that the nail may grow at a slant as the swelling puts sideways pressure on it causing both sides of the nail to become eventually ingrown and swollen. When this happens, the parts of the skin that are swollen will begin to harden and fold over the nail. When this is left untreated, a person ends up walking with a limp, which over a long period of time may result in foot, leg, and back injury because of the inappropriate distribution of weight.
What should I do if I have ingrown nails?
Where do ingrown nails usually occur?
Ingrown nails can be avoided by a proper trimming technique. Cut nails straight across and not along a curve or cut too short. Exacerbation of any underlying problem with a toenail may occur with improper footwear, that is, footwear which is too small either in size or width or those with a too shallow toe box.