Ingrown toenails

Ingrown toenails are a painful disease of the forefoot that mainly affect the big toe.

Ingrown toenails are a painful disease of the forefoot that mainly affect the big toe. It starts with a structural cause in the nail plate, which is often curved at the sides, or a curved or overly broad conformation. Repeated micro-traumas such as excessive pressure from shoes are an important aggravating factor.

Unghia incarnitaWhat happens when you have an ingrown toenail? The skin that surrounds the nail becomes inflamed, the nail plate penetrates into the skin and it becomes infected; to protect itself it then grows above the nail and the latter becomes buried within the inflamed flesh. This often leads to the formation of a granuloma.

This is an incredible, spontaneous pain which increases in response to the slightest pressure, continuously produces pus, swelling, redness, difficulty or impossibility to wear shoes. These are the most typical consequences of this disease.

First non-invasive therapy is attempted: nail rehabilitation is performed with correct cuts, the side of the toe is protected with interdigital orthotics if it is in contact with the next toe, the patient is asked to wear wide-toed shoes and shown how to correctly clean the nail daily. This process causes the nail to grow away from the flesh with appropriate dressings so that the edge of the nail emerges and the irritation ceases.

However, if the infection is already too deep and the attempt to treat it with dressings is unsuccessful, the only solution is surgery performed by an orthopaedic surgeon. The safest surgery is currently a partial matricectomy: the removal of a small flap of the nail with its matrix while assuring that the toe maintains an aesthetically valid appearance. This operation takes place under local anaesthesia through two small injections of an anaesthetic at the base of the toe; it does not require hospitalisation and is done on an outpatient basis. Patients can walk immediately after the surgery with a suitable shoe, and it completely heals in an average of just 14 days.

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