Ingrown nail
| Ingrown toenail | |
|---|---|
 |
|
| An ingrown toenail | |
| Classification and external resources | |
| Specialty | Orthopedics |
| ICD-10 | L60.0 |
| ICD-9-CM | 703.0 |
| DiseasesDB | 29440 |
| MedlinePlus | 001237 |
| eMedicine | emerg/593 ped/942 |
Onychocryptosis (from Greek ὄνυξ onyx "nail" + κρυπτός kryptos "hidden"), also known as an ingrown toenail, or unguis incarnates, is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed.
The common opinion is that the nail enters inside the paronychium, but an ingrown toenail can simply be overgrown toe skin. The condition starts from a microbial inflammation of the paronychium, then a granuloma, which results in a nail buried inside of the granuloma. While ingrown nails can occur in the nails of both the hands and the feet, they occur most commonly with the toenails.
A true ingrown toenail, or onychocryptosis, is caused by the actual penetration of flesh by a sliver of nail.
Symptoms of an ingrown nail include pain along the margins of the nail (caused by hypergranulation that occurs around the aforementioned margins), worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind, even the weight of bedsheets. Bumping of an affected toe can produce sharp and even excruciating pain as the tissue is punctured further by the nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken early to treat the condition by keeping the area clean. Signs of infection include redness and swelling of the area around the nail, drainage of pus, and watery discharge tinged with blood. The main symptom is swelling at the base of the nail on the side the nail is ingrowing (may be both sides).
Ingrown nail should not be confused with a similar nail disorder: convex nail, named onychocyrtosis (from Greek ὄνυξ onyx "nail" + κυρτός kyrtos "convex"). Nor with other painful nail conditions such as involuted nails, or the presence of small corns, callus or debris down the nail sulci (grooves on either side of the nail plate) or under the nail plate itself.
The main cause of onychocryptosis is footwear, particularly ill-fitting, that includes shoes with inadequate toe-box room and tight stockings that apply pressure to the top or side of the foot. Other causes may include the damp atmosphere of enclosed shoes, which soften the nail-plate and cause swelling on the epidermal keratin, which eventually increases the convex arch permanently, genetics, trauma, and disease. Improper cutting of the nail may cause the nail to cut into the side-fold skin from growth and impact, whether or not the nail is "ingrown" (true onychocryptosis). The nail bends inwards or upwards depending on the angle of its cut. If the cutting tool, such as scissors, is in an attitude where the lower blade is closer to the toe than the upper blade, that will cause the toenail to grow upwards from its base, and vice versa. The process is visible along the nail as it grows, appearing as a warp advancing to the end of the nail. The upper corners turn more easily than the center of the nail tip. As people cut their nails by holding the tool always at the same angle, they induce these conditions by accident; as the nail turns closer to the skin, it becomes harder to fit the lower blade in the right attitude under the nail. When cutting a nail, it is not just the correct angle that is important, but also how short it is cut. A shorter cut will bend the nail more, unless the cut is even on both top and bottom of the nail.
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