Ingrown Toenail (Unguis incarnatus) and Treatment of an Ingrown Toenail

According to statistics, ingrown toenails occur slightly more frequently in men than in women. However, in both cases, it primarily involves a toenail that has grown into the nail bed or the nail fold.

The most common cause is improper nail-trimming. We generally tend to trim our toenails round, which regularly leads to injuries to the nail bed and also promotes ingrown toenails. In addition, ill-fitting shoes put pressure on the sides of the nails, causing pain when walking.

As a result, many people cut the sides of their toenails deeper. This often leaves small ridges that tend to grow deeper into the nail fold. This initially causes inflammation in the toe, which can later be exacerbated by a bacterial infection. Doctors refer to this as a Staphylococcus aureus superinfection.

What is often overlooked: Comorbidities, such as diabetes mellitus, can also cause inflammation and nail changes. People with diabetes often lose sensation in their feet over the course of years. As a result, pressure points are no longer noticed as quickly, which further exacerbates the problem of ingrown toenails. That is why regular foot examinations are very important for people with diabetes.

The main symptom of an ingrown toenail is pain. This pain can be so severe that the affected foot cannot fit into a sock or a shoe. This may be accompanied by signs of severe inflammation, such as swelling, redness, and, for example, pus discharge along the nail fold where the nail has grown into the skin.

The diagnosis is based on the patient’s medical history and the observable symptoms (clinical presentation). The primary findings are pain in the affected toe, accompanied by redness, swelling, and possible inflammatory changes. In cases of severe inflammation and infection, involvement of the deeper layers of the skin, bone, and joints—as can occur with advanced nail bed inflammation—must be ruled out. An X-ray may be necessary in some circumstances.

Doctors have both conservative and surgical options available for treating an ingrown toenail. But what exactly do these entail?

Conservative treatment measures include, for example, the application of nail splints and regular foot baths to soften the nail fold and separate it from the ingrown portion of the nail. In most cases, this is sufficient to significantly relieve the pain.

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Mildly antibacterial ointments can also soften the nail fold and expose the ingrown nail. At the same time, this helps prevent a bacterial superinfection.

However, if the nail cannot be exposed using conventional methods, or if the infection is too severe, the doctor must perform surgery. Surgery is the preferred option, particularly in cases of a bacterial superinfection or a recurrent (recurring) condition. Two surgical procedures are available: the Emmert plasty and the laser method:

Emmert procedure: Nail wedge excision, also known as the Emmert procedure, is a medical treatment used for ingrown toenails. Under local anesthesia, a wedge-shaped piece of the affected toe or fingernail is removed along with the corresponding portion of the nail bed and the nail matrix. 

Laser Method: In this procedure, only the nail matrix cells are selectively ablated with a laser beam, preventing the nail from regrowing laterally. Only a small wound cavity is created, which heals rapidly from the inside out. The surrounding tissue and skin are spared. The laser allows for contact-free, very precise, and, above all, highly targeted work.

However, it is important to note that patients with comorbidities, such as diabetes mellitus or peripheral arterial disease (PAD), are at a higher risk for complications and impaired wound healing. 

At first glance, an ingrown toenail appears to be an easily treatable condition. However, due to the high risk of complications in some people and the high likelihood of recurrence, ingrown toenails often pose challenges for both doctors and their patients.

The earlier an ingrown toenail is detected and treated, the better the chances of healing and the more likely it is that surgery can be avoided. Especially in cases requiring surgical treatment, it is also important to address the underlying cause of the ingrown toenail, as otherwise the regrowing nail may become ingrown again.

As a preventive measure, toenails should not be cut round or too short. It is also important to ensure that footwear does not cause pressure points on the foot or toes.

Toenails are considered skin appendages and are therefore treated by specialists in dermatology (skin diseases). In cases requiring surgical correction, specialists in surgery may also be consulted. The monitoring and prevention of ingrown toenails is also carried out by non-medical professionals as part of medical foot care (podiatry).