Introduction
Onychocryptosis is otherwise known as an ingrown toenail. It occurs when part of the nail penetrates or increases pressure on the skin which causes pain, inflammation, hyper granulated tissue and commonly infections.
Etiology
The many causes of developing onychocryptosis including:
•   Improper cutting of the nail – too short, leaving sharp edges, cutting down the sides
•   Pronation of the hallux and Hallux Valgus Deformity – causing skin to ‘bulge’ on one side of the nail leading to an increase in pressure
•   Involuted nails – where the nail is curved at each edge rather than lying straight across the nail bed
•   Ill fitting footwear – tight shoes causing increased pressure on the nail and skin
•   Trauma - deforming the nail growth will increase the chances of developing into an ingrown nail
•   Swollen toes – chubby digits or during pregnancy can increase the skin bulging around the nail leading to an ingrown nail
•   Fungal nail infections – deformed, brittle or thick nails increase the chances of developing an ingrown nail
How a Podiatrist can help?
Pending on any nail deformity, severity or presence of infection to the ingrown nail we can help by:
•   Referring to a Doctor for treatment if an infection is present - antibiotics
•   Corrective trimming of the nail – cutting straight across
•   Packing the nail sulci with gauze and antiseptic solution - will allow the nail & skin to be separated so inflammation can reduce
•   Removing the nail spike – if it is too painful we can administer a local anesthetic. If this nail spike is not removed, the infection will likely continue with the irritant still in place
•   Nail Braces – clear small strips are applied across the nail which then acts as a ‘spring back’ to lift up the sides of the nail creating a nail that lies straight across the nail bed. This is a painless procedure but can only be applied to certain nails once infection has been removed. The nail brace is worn for a few weeks to insure the nail sides do not fall back down
•   Persistent occurrences of ingrown nails – A Partial Nail Avulsion will be needed. Where the digit is under local anesthetic and only a part of the nail, the irritating side is removed from the nail root. No skin is cut, so no stitches are required. We can administer Phenol Acid to the nail bed to ensure re-growth does not occur if the problem lies at the nail bed. Patients can continue with their normal lives that same day but rest and foot elevation is advised. We ask that constrictive footwear or sporting activities are not carried out for at least 10 days while the toe is healing.
•   Patient information – corrective self trimming, not wearing tight footwear or socks, check digits daily, keep feet clean, treat fungi infections.
•   It is advised if patients have poor circulation or Diabetes that they get their nails trimmed by a Podiatrist to ensure corrective trimming and lessens the chances of cutting the skin, ingrown nails and infections.
•   Assess foot alignment for deformities such as Hallux Valgus - correct this with Orthoses Devices which will offload the pressure being exerted from the nail into the skin
