During daily activities, both hand and foot nails are frequently subjected to trauma. In the case of hand nails, disorders and ingrowth mostly occur due to small traumas such as biting and tearing of nails and cuticles, finger-sucking, and manicures applied to nail plates and folds. Traumas like detachment of the nail plate from its bed, bleeding under the nail, and burns can also lead to ingrown nails.
For foot nails, factors such as structural changes in the foot after trauma, shoe selection, and environmental factors play a role. Inappropriate work shoe selection, excessive moisture, fungal infections, and traumatic bleeding under the toenail can cause ingrown toenails. Additionally, horned nails and pincer nail deformities can be triggered by trauma. Walking barefoot or wearing thin sandals can also lead to spoon-shaped nails.
Ingrown Toenail
It is a disease that significantly hinders daily activities due to the pain it causes. The most commonly affected are the big toes of young men during adolescence. This is because the pressure applied to the big toes is mostly concentrated along the inner side edge when lifting the foot off the ground while walking. The outer side nail wall is more frequently affected because the pressure on the big toe can disperse along the free inner side edge, but it becomes trapped in the outer side curve restricted by the second toe.
Three Key Anatomical Disorders Causing Ingrown Nails
- Width of the nail curves
- Thickness of the nail plate
- Inward movement of the big toe
Factors such as rounding the edges of toenails, obesity, excessive sweating, wearing narrow and high-heeled shoes, treating nail fungus (the fungal nail plate contracts and expands after treatment), diseases of the tissues around the nails, and deformities of the big toe make ingrown toenails more likely.
The most common reason for a patient with ingrown nails to seek medical attention is infection. Infection leads to inflammation-related swelling of the nail curves, increased pressure on the nail, and ultimately the continuity of the condition. In the acute phase, the nail curves are red, sensitive, and swollen. In the chronic phase, if the symptoms persist for six weeks or more, the curves are considered chronic, and they become red, swollen, and sensitive. Additionally, an abscess may begin to develop, and pressing on the abscess may produce a fluctuation sensation.
Stages of Ingrown Toenail
Ingrown toenail has three stages:
- Stage: Redness, swelling, and pain on the outer side of the toenail curves.
- Stage: Intensified pain, and the infection at the nail edge has now turned into a bacterial infection.
- Stage: In addition to all this, hypertrophic granulation tissue has developed. The clinical picture peaks with granulation tissue, making treatment more challenging.
Which Doctor to Consult for Ingrown Toenail?
In cases of ingrown toenails, doctors to consult may include dermatologists, general surgeons, and if accompanied by toe deformities, orthopedic doctors.
How to Treat Ingrown Toenail?
We perform ingrown toenail treatment with regional anesthesia, meaning only a part of the toe is anesthetized. We apply methods that prevent the recurrence of ingrown nails. The treatment process takes 15-20 minutes, and there is no medical objection to returning to your routine after the procedure. We recommend painkillers for acceptable levels of pain that may start a few hours after the procedure and continue for a few days.
How is Ingrown Toenail Treated?
In the acute phase without the development of an abscess, appropriate nail cutting is taught to the patient. Toenails should be cut straight across. First, the ingrown nail piece, which we call “spicule,” should be removed by the surgeon. Afterward, wet compresses can be applied 2-3 times a day. If an infection has developed, oral antibiotics and topical antimicrobial drugs can be used. If there is an abscess, it should be drained, and if there is accumulation along the side nail curve, they should be freed. The dressing on the treated area is opened 48 hours later, and wet dressing should be applied for 15 minutes several times a day.
The effectiveness of these approaches depends on the patient’s compliance with the treatment. The recurrence rate in these treatments is approximately 35-40%. Generally, a non-surgical approach can be attempted in the first and second stages of ingrown toenails. However, in the third stage and some second stages where conservative approaches are not effective, surgical methods can be used.
Ingrown Toenail Treatment Cost The treatment cost starts from 2500 TL for a single side of a single toe. If there are multiple sides or multiple ingrown nails, it will be determined during the examination.
Chronic Ingrown Toenail Treatment Ingrown toenail cases lasting more than six weeks are considered chronic. Candida (fungus) has been found positive in 95% of chronic ingrown toenails. Therefore, regional antifungal drugs, antibacterial swabs for secondary bacterial infections, acetic acid application (1:1 ratio of vinegar and water), or oral antibiotics can be prescribed.
In chronic ingrown toenails, redness, pain, and swelling occur after contact with water or a moist environment. Eventually, the toenail thickens, and linear ridges (Beau’s lines) appear.
Methods Applied in Ingrown Toenail Surgery
Nail Removal
- Not a highly preferred method.
- Shows recurrence rates between 40-80%.
- The presence of infection during the procedure increases the recurrence rates. Therefore, if such a procedure becomes necessary, infection must be eliminated with local or systemic treatment before the procedure.
Partial Removal
- In this procedure, diseased parts are removed down to the periosteum.
- The disease recurs in 15-30% of cases.
Partial Matricectomy
- A modification of the Zadik surgery applied to the ingrown side.
- The lateral nail fold is not touched in this method.
- Recurrence rates in this method range from 0-28%.
Total Matricectomy
- Applied in cases of recurring ingrown toenails and keratinized nail treatment.
- The most commonly used technique is the Zadik technique, with a recurrence probability of 14-28%.
Chemical Cauterization
- Lateral matrix phenolization
- Chemical cauterization with sodium hydroxide
