"Ingrowing Nail"

 

UNGUIS INCARNATUM

 

Unguis Incarnatum--otherwise commonly known as an "ingrowing nail" is a relatively common condition in which the nail (most frequently that of the great toe)  pierces the lateral nailfold and enters the dermis of the skin, where it initiates a foreign body reaction and possible infection.  The initial pain and swelling that results proceeds to a  purulent and edematous state that is extremely irritating and uncomfortable for the patient, and may also serve as a nidus for infection. The majority of ingrown toenails result from the wearing of tight fitting footwear that apply lateral pressure to the toes.  Other causes include improper or excessive trimming of the lateral nail plate, or changes following trauma to the toe.

As for treatment, the most commonly used and efficacious method employed  is the removal of the infiltrating portion of the nail.  This is done be first anesthetizing  the toe with 1% or 2% lidocaine without epinephrine injected directly into the lateral nailfold or by digital nerve block.  Nail-splitting scissors are then inserted under the ingrown nail approximately 3-4 milimeters medial to, and parallel to the lateral nail fold, and eased forward until resistence is met at the base of the nail.  The nail is then cut and the wedge is removed.  After the wedge is removed, the granulation tissue should be curetted and the bleeding controlled with Monsel's solution or other methods of hemostasis. To prevent the new nail from also infiltrating the nail fold, shoes should be worn that allow the toes to lie naturally without compression.  Also, if desired, cotton inserted under the lateral nail margin and left in place for several weeks will force the new nail upwards and over the lateral nail fold.  If the ingrown nail becomes a recurrent problem, the lateral portions of the nail bed may be permanently destroyed by the use of phenol (88%) following wedge excision.