When you get an ingrown toenail it can really be painful, to a point where even the bed sheets can be painful when placed on the toe.
This is a very common condition that affects all ages, from babies to the elderly, no-one is immune.
Teenage boys and teens are a prime age for this condition. The main reasons why are:
The skin becomes damp and macerated and with increased sport and rapid growth the nail works its way into the skin, again mid to the lower portion of the side of the nail, and usually both sides of the nail.
What exactly is an ingrown toenail? It is where the nail is excessive, natural or mechanically altered to cause pain resonating from the sulci (side skin of the nail)...a lot of words :)
I have split this condition up into 2 sections. Pseudo and True.
Most patients believe they have an ingrown nail because of poor nail cutting but that is not always true and usually re-education is needed to reassure the patient and to explain that this could be a reoccurring problem.
Many clinicians do not state this and this leads to the patients believing the clinician caused the problem or failed to fix their problem.
Pseudo nails are not really ingrown toenails, but with the above definition, fall into that category.
The main culprits are involuted and wide nails. Sometimes you find that a nail is just too wide for the toe. As the nail grows, it jostles for position through the toe and any mild amounts of trauma can cause a problem. Unfortunately this type of nail is hard to maintain because you will note that the actual redness and pain radiates from the middle part of the sulci (sides of the toe- where the nail meets the skin) all the way down to the eponicium (base of the nail).
Here is an involuted nail (sometimes called a pincer nail. The picture is quite severe). However the nail is hard to cut and could be uncomfortable, but notice that the skin hasn't been broken.
If some patients have venous problems or are quite large that also causes swelling, overlapping of the skin causes an ingrown toenail. This is where you have a normal nail but because the toe itself grows and overlaps the area to which the nail grows reduces causing ingrown toenails. This is very similar to nails that are too wide for the toe itself.
The below picture is a good example:
Then you have the traditional toenail that has been cut poorly and a small spike of nail is left, as seen in the picture below:
Just by looking at this nail you can easily see that a spike is present...if you go up from the purple cross you can see very slight whiter skin around the scab- which means that a spike is pushing up under the skin.
The signs are quite easy to spot:
1. A lump on the side of the nail. This is where the war is going on. The body is fighting off bacteria and nail that are present. However it can not attack the nail, so as the nail grows it presses more into the skin, causing more swelling...and the cycle continues.
2. It can be painful to the touch especially if there is a spike. What you are doing is basically pressing the spike into the skin which causes pain.
3. Bleeding can be more prominent because of the very vascular nature of the bump on the side of the nail.
4. Smell. The area, after some time, can start to smell. This is because dead blood, white cells and bacteria are building up. Usually antibiotics takes care of the infection, but they will not take care of the nail. We have seen patients on antibiotics for some weeks with the Doctors failure to refer on to get the nail sorted out.
5. It sticks to socks...because of the discharge and fluid that is being released. When you rip off your socks you irritate the area even more.