Symptoms

Ingrown toenail

Ingrown toenail


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Ingrown toenails or toenails (medically "Unguis incarnatus") are a relatively common phenomenon and in most cases very uncomfortable for those affected. In principle, the problem can affect any person of any age and can therefore also arise in babies, for example due to incorrect nail cutting. An ingrown toenail usually occurs on the two big toes and can have various causes such as diabetes or so-called "roller nails" - however, pressure on the nails (e.g. due to shoes that are too tight) and incorrectly maintained nails are the reason. If there is an ingrown nail, it should not be "doctored" about it yourself, because this usually increases the symptoms. Instead, you need to see a doctor or podiatrist immediately to have the cause and necessary treatment steps clarified. Quite a few patients suffer from very severe foot pain.

The toenail: structure and function

The toenail or toenail is usually the curved, translucent to whitish keratin plate that is located on the top of the toes. The nails are so-called "horns" because they are formed from the hard, horny (i.e. filled with keratin) cells of the epidermis (in technical terms: "skin appendages"). The thickness of the nails normally varies from 0.05 mm (baby) to 0.75 mm (adult) - although the thickness of the nail can vary greatly from person to person. Accordingly, the growth of the nail is not always the same, but on average a nail grows about 0.5 to 1.2 mm per week in healthy people, but significantly less in older people and as a result of certain diseases and injuries.

The structure of the toenails is multi-layered: the area of ​​the nail anchored to the skin is referred to as the "nail root", which is located at the bottom of the so-called "nail pocket". Here the nails are formed from the horn plates described, the substance of the nail plate being provided by the so-called "matrix", which is often recognizable at the lower nail edge as a light, crescent-shaped part, which is therefore referred to as the "nail moon" or "lunula". The nail plate is the visible part of the nail, which is transparent on its own - the light pink color that is typical of healthy nails only arises when the blood vessels of the nail bed underneath shine through the transparent plate. The connective tissue nail bed is in turn firmly attached to the periosteum of the toe bone underneath (phalanx distalis). The toenail is bordered on the side by a skin fold (nail wall or nail fold) which surrounds the invisible parts of the toenail and thus provides grip and protection against lateral tears. Finally, “cuticle” (perionychium) is the visible portion of the skin that directly adjoins the nail wall and rests on the top of the fingernail.

Since the nail itself mainly consists of cornified or dead skin cells filled with keratin, it is not sensitive to pain in itself - but the skin at the tip of the toe is, because there are special sensory cells for touch stimuli (Merkel cells) through which the nails can perform their function as a "touch probe". In addition to this, toenails also have other important tasks: on the one hand, they protect the top of the extremely sensitive toe tips and also ensure that pathogens cannot penetrate the nail bed underneath.

Definition

With a "ingrown toenail" (medically "Unguis incarnatus"), the nail grows laterally into the nail fold (also called "nail wall"), which refers to the skin fold that covers the edges of the nail plate on fingers and toes. As a result, the nail wall presses on the nail, in many cases this irritation leads to inflammation and proliferation of the tissue, the so-called “wild meat”. This grows over the edge of the nail to protect the wound, which in turn causes the toenail to grow further into the nail bed.

This problem mostly affects the "big toe", but the small toes and fingernails are rarely affected. Typical of an ingrown nail is stinging pain, which can be so severe that even walking or walking is hardly possible. Even in a resting position, those affected often experience severe pain and throbbing in the foot.Additional symptoms such as pus formation, swelling and reddening on the affected nail often result from accompanying nail bed inflammation. If a suppuration moves deep, it can spread to the nearby bones in an emergency.

Causes and symptoms

Wrong cutting technique

In most cases, incorrect nail cutting is the cause of an ingrown toenail. This happens quickly, because it is important for toenails to be cut or filed straight to prevent the edge of the nail from pushing into the nail bed. Often, however, the toenails - like fingernails too - are incorrectly cut round, which means that the nail grows quickly into the nail wall due to the pressure in the shoe, causing severe pain. In addition, the toenails are often cut too deep at the corners, which reduces the size of the nail bed and there is no longer enough space for the renewable nail. The result: the newly grown nail corners grow into the surrounding flesh, causing severe pain. In addition, inflammation often occurs, because if the skin is injured by the ingrowing nail, bacteria (usually streptococci or staphylococci) can penetrate into the tissue and multiply at this point. The inflammation then leads to redness and swelling of the tissue, which is often very painful. In addition, pus forms after some time.

Other causes

In addition to that, an ingrown toenail on the foot can also have other reasons - in many cases, tight shoes are the cause. These can quickly become a problem because the nail and nail bed are pressed strongly against each other and the nail is pushed into the nail wall - especially if it has been cut incorrectly. This is especially true when shoes and socks are too tight at the front of the toes, which means that they are “pressed” from both the front and the side.

Even people who sweat quickly or heavily on their feet are generally at higher risk. Because the increased perspiration in air-impermeable shoes or sports shoes can quickly cause the skin on the nail to soften and the nail to push into the nail fold more easily when subjected to pressure. In addition to the softened skin, bacteria also facilitate the penetration into the tissue, which also increases the risk of inflammation. In particular, with chronically ingrown toenails, inheritance can also be the cause, vascular diseases, nail fungus or diabetes can also be considered. Misalignments of the toe bones can also be the reason, for example after an operation in this area or in the case of "hallux valgus", which is a deformation of the big toe.

Treatment options

If the toenail is ingrown, a doctor or a medical podiatrist (podiatrist) should always be consulted first, because only a specialist can ultimately decide which treatment is the most sensible for the individual case or whether surgery is necessary. It is important here that the doctor is visited immediately and not first tried to “push around” on the nail on your own, because this increases the risk of inflammation and the complaints being exacerbated.

If the nail has not yet grown too deep into the nail wall or has not yet ignited, the specialist can treat it with a so-called “tamponade”, for example. In this case, a narrow strip of cotton or fleece is inserted between the nail and the nail wall, which immediately significantly reduces the nail pressure and alleviates the pain or, in the best case, can even be completely eliminated. Alternatively, the pressure can also be released using a spacer ("butterfly technique"), a plastic tube slit open on one side, which is inserted into the nail wall by the podiatrist using a special instrument.

Another non-operative treatment technique is the so-called "nail correction brace" (also called orthonyxia). This is used above all when a nail is rounder than normal ("roller nail") and therefore - even after treatment - again and again ingrows. The podiatrist places the brace on the toenail from above, which immediately reduces the pressure on the nail fold, the pain subsides and the inflammation caused by the pressure usually improves quickly. In addition to this, the nail correction clip also corrects the growth of the nail by gradually pulling it upwards, thereby reducing the curvature. There are various techniques here, but in all cases the treatment usually lasts a few months, sometimes even up to a year. The treatment at the podiatrist, however, usually has to be paid for and usually costs around 30 and 35 euros.

Ingrown toenail surgery

However, if the treatment is given late, the nail has often already grown deep into the nail bed and the inflammation has progressed to such an extent that the pain becomes unbearable and surgery becomes inevitable. Various surgical procedures also exist here, one possibility is the so-called "wedge resection" (also called "wedge resection"), in which the general practitioner or surgeon removes as small a part of the toe plate as possible as part of a mini-operation to remove a lot of the nail to obtain. Although this procedure provides immediate relief from the complaints, this is usually only of short duration, since the cause of the ingrowth cannot be eliminated in this way. Accordingly, the standard surgical procedure, especially for chronically ingrown toenails, is the so-called "Emmert plastic", in which part of the nail root and the inflamed, thickened nail wall are removed to avoid further relapses.

After the operation, the affected foot must first be spared for about two weeks. Therefore, sports should be avoided during this time and the foot should only be washed with clear water without any additives, and the application of ointments should also be avoided, as this inhibits the outflow of secretions. In addition to that, it makes sense to go to medical foot care regularly after a full recovery to prevent further foot problems. In contrast to the surgical intervention, however, this basically has to be paid for yourself - because podiatric treatment is usually only provided by the health insurance companies for severe diabetes.

Naturopathy with an ingrown toenail

In the case of an ingrown toenail, a visit to the doctor or podiatrist is the only option, because "doctoring around" or possibly even cutting around the injured toe can massively intensify the symptoms and quickly lead to a chronic problem with severe impairments. Accordingly, a specialist should be consulted immediately in the case of an existing condition so that the cause can be clarified and appropriate treatment steps initiated. In addition, you should always try to prevent the ingrowth of the nails as much as possible by taking appropriate measures. Accordingly, it is important to avoid tight, unsuitable shoes and to ensure that the nails are straight and that the corners are not cut too short. Therefore, regular appointments for foot care are recommended, especially for sensitive feet, where the nails are professionally cleaned and cut. In addition, misalignment of the feet should be taken seriously and corrected (for example, with insoles).

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Sigurd Kessler, Christoph Volkering: Unguis incarnatus, basic surgery training, Springer Verlag, 2nd edition, 2013
  • Hans-Dietmar Strube, Bruno Wasserscheid: Emmert-Plastik at Unguis incarnatus, Operative Orthopedie und Traumatologie, February 1990, Volume 2, Issue 1, pp 39–45, (accessed 03.10.2019), Springer
  • Anke Niederau: The big book of nail diseases: cause, podiatric diagnosis, therapy, prophylaxis, Neuer Merkur Verlag, 3rd edition, 2016
  • Thomas Dirschka, Roland Hartwig, Claus Oster-Schmidt: Clinic Guide Dermatology, Urban & Fischer Verlag, Elsevier GmbH, 3rd edition 2010
  • H. Zaun, D. Dill: Pathological changes in the nail, spitta Verlag, 10th edition, 2013

ICD codes for this disease: L60.0ICD codes are internationally valid encryption codes for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: TWO INFECTED INGROWN TOENAILS VERY GRAPHIC (May 2022).