Ingrown toenails

Ingrown nail {unguis incarnatus) or onycryptosis is a very common problem, which can be caused by both external and internal factors, as well as genetic factors. So what is an ingrown toenail? It is the penetration of the side of the nail plate under the nail plate or into the nail plate, causing inflammation there - paronychia, which is characterized by marked redness, swelling, local pain and increased temperature.

An ingrown toenail causes quite a lot of inconvenience, in more severe cases, even movement restrictions, thus worsening the quality of life. People cannot wear the chosen shoes, spend a longer time on their feet, because ingrown nails cause severe pain, injure soft tissues, provoking inflammation. In more severe cases, inflammation of soft tissues - phlegmon, inflammation of bone marrow of finger phalanges, osteomyelitis and even blood poisoning - sepsis can occur. These pathological processes need to be treated in time.

People often try to fight this problem on their own at home, using various folk remedies or inappropriate medications, as a result of which the irritation of the skin around the nail intensifies and, as the inflammatory process progresses rapidly, very severe pain, local swelling, the wound collapses, and hypergranulation develops. Unfortunately, only then is help sought from a specialist.

In the past, the problem of ingrown nails was treated with surgical methods, followed by slow tissue healing and post-operative pain, which in turn made it difficult to move during the wound healing period. In addition, surgical intervention did not always provide a successful solution to the problem in the long term, the risk of recurrence remained high.

With the development of podiatry, it was possible to solve the problems of ingrown nails with more gentle treatment methods, reducing the possibility of recurrence. A medical foot care specialist - a podiatrist - evaluates a specific case, taking into account the patient's state of health, activity load, orthopedic changes in the feet, etc., using ingrown toenail correction methods. In addition, the person has the opportunity to maintain their mobility throughout the therapy. An effective method of nail correction is orthonyxia - a non-surgical method of correction of deformed and ingrown nails, which uses corrective clamps, which, similar to dental braces, relieve unpleasant pressure and help to straighten the nail.

Causes of ingrown nails

Internal factors:

• nail diseases, such as fungal infections, nail psoriasis, etc., which cause nail deformation;

• internal diseases such as arthritis, circulatory disorders, leg vein diseases, as well as metabolic disorders that could be related to the use of medication;

• genetic changes in the shape of nails, congenitally incorrect shape of fingers, nails, rollers;

• increased sweating of the feet - hyperhidrosis.

External factors:

• foot deformities, such as transverse arch deformity, clubfoot, crooked big toe, crossed toe, hammer toe, excessive length of a toe;

• traumatization - incorrect treatment of nails and cutting corners, choosing inappropriate shoes, trauma;

• overweight - overweight people have increased pressure on the feet, which can cause additional foot deformities. In addition, under the influence of adiposity, swelling of the legs occurs, so the chosen shoes are often too narrow.

• lifestyle - active sports, dancing. For lovers of active sports and professional dancers, there is constant trauma to the nails, so for them ingrown nails are a major foot problem.

Podological nail correction methods in the treatment of ingrown nails

• On a daily basis, it is not allowed to cut the corners of healthy nails, they must be cut straight, according to the shape of the nails and fingers. On the other hand, in podiatry, a specialist performs cutting of nail corners in cases when:

- due to an ingrown nail, the nail plate is inflamed and even rotten - a paronychia has formed with massive exudate and granulation tissue under the nail in the lateral part;

- in the case of nail deformation, if it is not possible to separate the under-nail overgrowth otherwise;

- if a correction clamp is to be used, excision is necessary to release the lateral ridge from the part of the ingrown nail to align the lateral edge and find the remaining part of the nail.

(See Figure 2.)

• In patients with a long-term ingrown nail, a severe and persistent inflammatory process is often observed. In such situations, the inflammation is treated first, because the high degree of humidity in the shoes creates a favorable environment for the development of fungi and the reproduction process of bacteria. This is done with the help of specially prepared tamponases, thus cleaning and drying the wound.

• Plastic protectors can be used in the early stages of ingrown toenails or for preventive purposes. With the help of treads, the pressure in the side wall of the nail is reduced, the side edge of the nail is broken off and traumatization of the soft tissues is prevented, and the tread performs a protective function if the nails are cut incorrectly.

• As a method of choice, nail correction with corrective clamps is used. There are about 30 different clamp modifications designed for both unilateral and bilateral nail correction. One-component clips and plastic adhesive clips are not suitable for severely inflamed and granulating nails. No anesthesia is required during the clamp application procedure. After applying the clamp, the traumatic pressure on the nail plate decreases or disappears completely, so the pain and inflammation decrease, the edema decreases, which facilitates the further treatment of the process. Thanks to the structure of the clamp, the nail grows forward evenly and the pressure caused by the nail and the clamp is equalized, the nail takes its physiological shape. It should be noted that the treatment of ingrown nails with a nail correction clamp will have an excellent result that will last for a long time, provided that the patient follows the instructions for proper nail care and the selection of suitable shoes and does not observe any type of nail growth disorder.

• In cases of nail injury or infection damage, when a part of the nail or the whole nail is lost, a nail prosthesis is created, which is a substitute for the missing part of the nail plate with the aim of protecting the nail bed and the growing nail from external adverse effects. Nail prostheses are made with specially designed self-hardening mass for nails and/or a special polymerization gel. The mentioned materials have antimycotic ingredients that protect the nail bed from fungal infections. Nail prostheses are contraindicated in cases where:

- sensation, blood circulation disorders;

- oncological disease;

- unclear color changes of the nail plate;

- tendency to ingrown nails;

- for dancers, athletes;

- if wearing high heels.

In all cases of ingrown toenail treatment, an important condition is the prevention of external pressure from the side walls of the nails with the help of suitable orthoses. Such orthoses can be individually made by a podiatrist from different materials, or ready-made orthoses can be purchased at pharmacies. In cases of foot deformities, if there are ingrown nails, the front part of the foot should be supported with orthopedic insoles.

Recommendations in the case of an ingrown toenail, if inflammation has developed in the lateral valance

• First aid in case of inflammation - salt water or chamomile decoction compresses or baths. It will help reduce inflammation and relieve pain, but it should be understood that such a procedure will definitely not solve the problem of an ingrown toenail. In no case should 3% hydrogen peracid solution and potassium permanganate solution (blue grains) be used to reduce inflammation, as a chemical burn may occur in the wound.

• Narrow shoes and high heels should be avoided, as wearing inappropriate shoes creates pressure, which significantly worsens the situation.

• Try not to walk with wet shoes and socks to prevent additional infection.

• Physical activities should be avoided in order not to further traumatize the nails.

• As soon as possible, you should go to a foot care specialist - a podiatrist, who will evaluate the specific case and, if necessary, perform nail correction and determine the further treatment of the ingrown toenail with appropriate nail correction methods.

Prevention

Ingrown toenails are caused by several factors that add up over the years. It is important to be aware of them in order to successfully deal with this problem. It is even more important to prevent them in time to prevent ingrown nails.

Very important preventive measures are:

• choosing suitable shoes - they should not be too narrow or too wide. In shoes with narrow toes and shoes with too high heels, the toes are compressed, but in loose shoes, the toes are not fixed and injure each other. Shoes should be comfortable, suitable for different loads and conditions;

• correct treatment of toenails - often from childhood, nails are cut incorrectly, by cutting them too short or cutting the corners of the nails. Therefore, the nail grows incorrectly and begins to grow into the surrounding tissue. A foot care specialist - a podiatrist can provide information on correct nail cutting according to the shape of each person's fingers and nails;

« elementary personal hygiene both at home and when staying in shared spaces - shoes and socks must be changed regularly and kept dry. If necessary, shoes and feet should be disinfected, thus ensuring infection control;

• Deformations of the fingers and feet cause an incorrect distribution of the load on the feet, so it is recommended to put ready-made soft orthoses, half-soles, insoles or individual insoles made by an orthopedist into the shoes. If there are severe foot deformities, special orthopedic shoes must be used. In these cases, it is best to contact a technical orthopedist, who will perform a gait analysis, foot load measurements, in order to apply the individually necessary foot correction method.


Ingrown nails

The facts

• Research in Great Britain shows that in patients between the ages of 16 and 25, ingrown toenails are twice as common in men than in women. On the other hand, according to US data, in the age group up to 45, the ratio of men and women changes to 2:1.5; and over the age of 75, ingrown nails are 65% more common in women. According to more recent data (2012), the ratio of men to women among young patients is as high as 3:1.

• On average, in 20% of cases when a patient goes to a family doctor with complaints about foot pain, ingrown nails are diagnosed.

• Although ingrown toenails are most common in teenagers and young adults, cases have also been observed in infants.

• Ingrown nails are the most common nail problem. The nails of the first toes (thumbs) are most often affected. 10,000 cases are reported in the UK each year.

• Sports activities have a direct effect on causing ingrown toenails among professional male runners - 74% of men who regularly run have ingrown toenails.

Essential!

• It is a misconception that the nail is inflamed, because usually the nail plate is inflamed and painful.

The causes are seldom thought of, the effects are treated, but the causes are not eliminated.

• The most important question - why does the nail grow?

• Answer - the patient's health problems should be viewed as a whole!


Nail corner cutting technique in podiatry

RITA MOSS

• Podiatrist

* Derma Clinic Riga, Dr. Karl's clinic, Grebenščikova Street 1, Riga Reg. tel. 28301010 www.dermatologs.lv


Nail correction clamps


Nail cutting