Ingrown toenail
introduction
The ingrown nail, also called unguis incarnatus in Latin, is one of the mechanically induced changes in the nail. These occur more often on the big toe, less often on the fingers. Recurring inflammation often creates a vicious circle that should be broken with good and consistent treatment.
definition
The ingrowth of the Nail plate in the surrounding Nail wall, i.e. the skin on the side Unguis incarnatus ("ingrown nail") called. The damage to the pressure creates a portal of entry for bacteria, the one local inflammation can evoke. The pressure exerted by the nail on the skin and the inflammatory reactions change the surrounding tissue, which begins to proliferate. One speaks of Granulation tissue.
Causes and Risk Factors
The most common cause of an ingrown toenail is this Wearing shoes that are too tight. The nail is bent by the pressure on the side.
Likewise can orthopedic malpositions of the feet lead to this pressure load and cause it.
Since the big toe is exposed to more mechanical conditions than the fingernails, this leads to more frequent ingrowth.
However, a wrong technique of cutting nails also lead to it. Cutting the corners of the nails too rounded can cause the nail to grow into the nail wall and skin, leading to localized inflammation.
Airtight shoes, wearing airtight gloves and other causes of increased sweating on the hands or feet soften the skin and offer good conditions for recurring inflammation.
As well Circulatory disorders any cause and trauma are causes for the development of an ingrown nail.
When combining a young patient who sweats more and has the problem of ingrown nails, one should consider Diabetes mellitus make you think.
Another risk factor, which is less common, is a certain drug in the Cancer therapy, the so-called EGFR receptor antagonist, dar.
Symptoms of an ingrown toenail
An ingrown toenail is very uncomfortable for those affected and causes local stabbing pain, which can be aggravated by external pressure. Along with the pain, there is reddening and swelling of the toe. With advanced inflammation, pus develops.
You might also be interested in: Toenail pain.
Ingrown toenail with pus
The inflammation caused by an ingrown toenail causes the skin around the nail to appear tight and shiny. This is typical of the appearance of pus.
When pressure is applied, pus can drain from the swollen area. This is usually white to slightly yellowish. The cause of the pus formation is often a bacterial infection, which can develop as a result of an ingrown nail. The inflamed tissue can also bleed, so that blood can also be mixed in with the pus. However, you shouldn't try to express or cut open the pus on your own.
Read more on this topic: Pus on toe
"Wild meat"
An ingrown nail causes inflammation in the surrounding tissue. This inflammation causes the tissue to swell and become red. The strong inflammatory stimulus leads to a reaction in the tissue. This tries to close the wound and forms an excessive amount of granulation tissue, a kind of "transitional tissue" in the course of wound healing arises from.
It covers the nail and doesn't look particularly comfortable to the person. It is popularly referred to as "wild meat". You should refrain from removing it yourself or manipulating it in any way. It can also bleed easily over time.
Diagnosing an ingrown toenail
The diagnosis is made from the combination of symptoms and the patient's history. The risk factors that promote this change should be found out in a medical consultation.
In addition, swabs for a bacterial examination or to rule out fungal infections may be performed.
In advanced stages, but especially with diabetics, an X-ray of the affected area can also be requested in order to be able to rule out the inflammation spreading to the bones.
What to do about a waxed toenail
The basis of the therapy is the elimination of risk factors that cause the disease. This includes wearing suitable, non-oppressive footwear and information about proper nail clippingto prevent nail ingrowth.
In the case of orthopedic misalignments, suitable Shoe insoles be thought.
One should be on a good one Foot care pay attention, especially diabetics. This is why it is advisable to attend a medical foot care, a diabetic Podiatriststo connect. These measures are not only used for therapy, but also for prevention.
If the inflammation is not yet advanced, you can try using home remedies to stop the progression. Help with this lukewarm baths with the addition of curd soap. These soften the tissue so that the nail can be better treated with cotton wool or ointments. The Lining the nail with cotton wool, which one with disinfectants can soak and attached with plasters, creates a space between the nail and skin, so that the latter is relieved of the pressure.
A temporary immobilization or elevation of the leg for a few days can also help to alleviate the symptoms.
Local application of ointments, such as Povidone iodine (Braunovidone®) or Ichtholan®, which contain an antiseptic, i.e. disinfectant, and anti-inflammatory component, can help the area to heal.
These conservative measures can be taken with the help of a medical foot care, the podiatrist, be initiated. If this does not bring about any improvement within a few days or if the inflammation continues, a doctor should be visited.
Depending on the evidence of bacteria or pus Antibiotics help.
Metal braces that are placed horizontally on the nail can remove excessive bending of the nail by pulling them so that the nail no longer presses against the side skin.
But if these conservative measures fail or the Infections keep recurring, surgery should be used to control the ingrown toenail. The changed inflamed tissue is removed. Likewise, make a vertical cut through the nail and remove it so that the Narrowed nail and this can no longer press (Emmert plastic). Finally, you desolate this with a Phenol solution.
diabetic should with such a noticeable ingrown nail see a doctor as soon as possibleto avoid further complications such as amputation.
You might also be interested in: Nail bed inflammation treatment.
Home remedies for an ingrown toenail
If you have an ingrown toenail, home remedies can help at the beginning. At an advanced stage, however, medical treatment is unfortunately unavoidable.
The following sections list helpful home remedies that can help with an ingrown toenail.
Proper foot care is very important with an ingrown toenail. Dirt, sweat and dead skin should be removed under running water every day. The inflamed nail can be carefully cleaned with a damp compress. After cleaning the inflamed nail, applying ointment can help. Hamamelis, for example, is a good addition to a wound ointment.
Read more on this topic: Tips for proper foot care
Foot baths with beneficial herbal additives can also alleviate the symptoms of an ingrown toenail. Suitable additives are, for example, chamomile, tea tree oil, sea buckthorn, calendula or comfrey.
Treat ingrown toenail with cotton wool
An ingrown toenail can be treated conservatively if it is not yet severely inflamed. This means that you can do without an operation. However should one to conservative treatment one medical podiatrist or but one See a doctor. Self-experiments are to be viewed critically.
One of those widely used methods is that Insert a cotton swab between the toenail and the skin. This is to prevent further ingrowth of the toenail and relieve the pressure of the nail on the skin. In preparation you should use a warm Foot bath with Epsom salts soften the nail and the skin of the toe. This will make it easier for the toenail to lift off the skin. With aids such as tweezers you have to pay close attention to hygiene, otherwise bacteria can easily be carried into the wound.
Subsequently a small piece of cotton wool, shaped into a roll, is placed between the raised toenail and the skin. Then you can apply an ointment that prevents infection to the area and bandage the toe afterwards. Performing this method every day can have a positive effect on the healing process. You always pay attention to possible signs of inflammation, such as redness, swelling and pain. If possible, the treated toe should also get air.
However, as described above, self-directed manipulative methods of this kind are not recommended.
Nail correction braces
Nail correction braces are usually treated by a medical podiatrist (Podolgen) instead of. There are more than 10 different types of nail correction braces available from one Podiatrists specially adapted to the affected nail. After the adjustment, the brace is inserted into the nail fold on both sides and fixed in the middle of the nail. So will a crooked growth of the nail and thus the ingrowth prevented. The procedure is painless and most of those affected find it pleasant. Sports activities are also possible with a nail correction brace.
The duration of a treatment with a nail correction brace varies and usually takes several months. The costs for this treatment are not currently covered by all health insurance companies. However, a cost estimate, which is decided on individually, can be submitted. Inserting the brace usually costs between 35 and 50 euros. There are also costs for appointments for follow-up checks and further foot care.
Treatment using tapes
With a slight ingrowth of the toenail and an early start of therapy, taping can already help to get the symptoms under control. To do this, the Nail wall glued downwards and outwards under tensionso that the nail has more space. The pain will improve immediately. The adhesive strips should changed every two hours become. Dirt and residue should be removed under running water.
Taping allows the nail to grow straight again. At an advanced stage, however, taping is not a therapeutic option and does not improve the condition.
When do you have to operate?
An operation is necessary if the inflammation is already very severe or chronic from an ingrown toenail. An operation can usually be prevented by acting early. However, since many sufferers do not see a doctor until very late, there is often only one surgical treatment option left. Surgery is also advisable for very frequent relapses, i.e. relapses of the disease.
The standard procedure in the surgical therapy of an ingrown toenail is the so-called Emmert plastic. During a local anesthetic, a piece of the lateral nail is removed in a wedge shape along with the nail fold and the nail wall. Most of the time, after careful hemostasis, the wound is left open and not sutured. It heals under a sterile bandage. The symptoms are gone immediately after the operation. This is followed by regular wound checks and dressing changes. The entire healing process usually takes two weeks.
Which doctor treats the ingrown toenail?
If you have an ingrown toenail, the first thing to do is to look at his Family doctor turn. This can make an initial assessment of the condition. Mild inflammation can be caused by a medical podiatrist treated and do not require medical treatment. However, more severe inflammation requires treatment. Conservative treatment is usually carried out by a Dermatologist (Dermatologist). In the case of chronic inflammation, however, usually only a small surgical procedure helps, usually by one General surgeons is carried out.
Prognosis for an ingrown toenail
Even if this clinical picture often leads to a vicious circle, the chances of recovery are good even with conservative therapy, especially if you pay attention to the preventive measures and the patient works well. Otherwise the therapy can be very tedious or lead to complications.
Complications
If the inflammation is not contained in time, this can lead to deeper and deeper inflammation that extends to the bone can grab what you call Osteomyelitis designated. Especially with diabetic patients Poor foot care and not timely therapy can lead to one Amputation of the big toe come.
Ingrown toenail pain, healing, and sick leave
An ingrown toenail can be a very painful affair for those affected. How severe the pain is, however, depends on the extent of the inflammation and the pain sensation. In some cases, even wearing socks or putting on a blanket at night can be unbearable for the person concerned. Lighter inflammations usually don't hurt that much and are quickly overlooked or neglected in everyday life. Therefore, many sufferers do not see a doctor until the inflammation has progressed.
The healing is also dependent on the extent of the inflammation. Conservative treatment, especially nail brace treatment, can take several months. During an operation, healing occurs within a few weeks.
A sick leave is usually not necessary. However, this depends on individual factors such as the type of job and the exact activity.
How long does it take to heal?
The time it takes for an ingrown toenail to heal can vary widely. The course of the disease depends on various factors such as the extent of the inflammation. The type of treatment also plays a role. Some infections in an ingrown toenail persist for months before people see a doctor. Conservative treatment, for example with nail braces, can also take several months. Surgical therapy in the form of toenail surgery provides immediate relief. The healing is usually uncomplicated within a few weeks.
Special features for babies and toddlers
In babies, the ingrown toenail can not only be caused by a false nail care caused, but also comes innate in front. This is created by an applied excessive bending of the nail platewhere the nail grows outwards rather than upwards. Also the increased growth of the Nail walls during the child's development can lead to it.
If there is evidence that it is a congenital phenomenon, family history can shed light on it.
Another clue could be that multiple nails are affected. It should then make you think of syndromic diseases. This suspicion is reinforced if, apart from the nail, other malformations, for example on the hair, are noticeable.
It is recommended to use the nail by the age of two operational to supply. In the case of innate facts, the basic disease determines the course and prognosis.
Further topics from this area
Foot care
Feet are often heavily stressed due to their permanent strain. The skin and toenails in particular suffer from constant stress and therefore require extensive care.
Here you get to the topic: Foot care
Inflammation toe
Inflammation on the toe can be extremely painful. The inflammatory process can be based on different causes.
Here you get to the topic: Inflammation toe
