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The
Condition
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.
-
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:
o
Avulsing the whole nail
o
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
re-growth.
·
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.
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Treatments Available
- A. Nonpermanent treatment- The initial treatment may
consist of:
1. A simple nail avulsion with or without the use of antibiotic
treatment.
2. Incision and drainage (I&D) of the soft tissue next to the nail.
3. 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:
1. Surgical removal of the matrix.
2. use of chemicals such as phenol or sodium hydroxide in
treatment.
3. 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.
4. Laser and/or radiowave matricectomy
5. Repair of hypertrophic ungualabia.
6. 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.
C. The patient may be instructed to the following:
7. Proper shoe wear.
8. Home soaks.
9. use of topical antibiotics.
10. use of oral antibiotics.
11. Proper nail trimming technique.
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Frequently Asked
Questions
Q:
What are the symptoms of ingrown nails?
A:
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.
Q:
What causes ingrown nails?
A:
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.
Q:
What will happen if an ingrown nail is not treated right
away?
A:
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.
Q:
What should I do if I have ingrown nails?
A:
There are a lot of ways to treat ingrown nails. They range
from having soaks to surgery. Appropriate treatment is
dependent on the condition’s severity. Consult with a
podiatrist if drainage of blood or watery discharge is
present. Waiting out the condition leads to nothing and is
usually just agonizing.
Q:
Where do ingrown nails usually occur?
A:
Ingrown nails can actually occur anywhere but it is most
common in the big toe (hallux).
Q:
How can I prevent getting ingrown nails?
A:
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.
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