That painful toe may be an “ingrown toenail”

Ingrown toenail, especially or the big toenail, is a common chronic infective process of the nail fold and the sulcus between it and the nail.

It occurs usually between 15 and 40 years and the male/female ratio is 3/1 .

There are usually wide fleshy nail folds probably familial, with thin nail plates. Shoe pressure on the lateral wall of the nail may lead to erosion of the nail fold by the nail plate and subsequent local infection.

With recurrent sepsis and formation of granulations and ulceration extending along the sulcus between the nail and lateral fold,the lateral fold swells and overlaps the nail.

The embedded nail, therefore, gives the appearance of “growing” into the swollenlateral fold; hence the term “ingrowing toenail”.
The patient has pain especially on walking. There is recurrent infection often with swelling and discharge from the nail fold.

People at risk of ingrown toenail are athletes, obese, diabetics, persons with poor nail hygiene, persons with long toes, persons who wear inappropriate shoe sizes, and persons with leg edema

Differential diagnoses of ingrown toenail include melanoma, glomus tumour and subungual exostosis.

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TREATMENT

Excision(surgery) of a wedge of the nail and application of phenol to the adjacent germinal matrix to destroy it gives the best result- recurrence of 2-3 percent.

With a ring block of local anaesthesia and a tourniquet at the base of the toe, any granulation tissue is excised and a sliver of the ingrown nail down to the base removed. A swab soaked in phenol is applied to the nail fold for 3 minutes. The wound is then cleaned with spirit and dressing applied. The wound heals in 2 weeks.

COST OF SURGERY

Depending on the hospital and the location, the cost surgery for ingrowing toenail is around #15,000 to #25,000 Naira.

Read more on Medicinenet.com

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