Ingrown toenails usually affect the big toe and most commonly occur in people in their 30s. The cause is often trauma due to incorrect nail care, whereby the corners of the nail are cut too short, or local pressure caused by tight footwear.
Hyperhidrosis can also influence the development of ingrown toenails. The inflammatory reaction occurs when the sharp edge of the nail grows into the skin. Subsequently, a granuloma often forms.
There are three stages:
- Redness with a painful nail edge (paronychia).
- Presence of pus under the nail.
- Granulation tissue in the nail wall (granuloma).
The vast range of therapeutic options and variety in wedge excisions would suggest that an equally high incidence of suboptimal results and recurrences are seen.
Treatment options for ingrown toenail include the following:
Stage 1
- Treat paronychia conservatively with soda baths.
- Reduce the pressure on the nail by filing a groove in the curve of the nail.
- Continue this for three months.
Stage 2
- Nail extraction and, at a later stage, wedge excision.
- Partial nail extraction followed by dabbing with phenol 80% in water and rinsing with alcohol 70%.
- Phenol treatment is contra-indicated in patients with poor peripheral circulation.
Stage 3
- Partial nail extraction followed by dabbing with phenol 80% in water and rinsing with alcohol 70%.
- Wedge excision.