ingrowing toenail (IGTN)

Last reviewed 01/2018

In this condition the nail burrows into the nail groove. The nail groove ulcerates and its wall grows over the nail. The nail becomes embedded.

Ingrowing toenail also known as onychocryptosis, is a common condition which results in pain and disability in the foot.

• in this condition a sharp spike of the nail grows into an overlapping nail fold
• frequently occurs in the great toe but can also affect the lesser toes
• occurs more in males between the ages of 15 and 40 years
• condition commonly affects the big toe rather than other toes. May affect one or both sides of the nail
• incidence is approximately 8 cases per 1,000 patients per year. Males and females are affected equally. Most commonly affects young men and elderly women. The incidence in UK general practice has doubled in the last 20 years
• a combination of extrinsic and intrinsic factors may be responsible for the condition e.g. - poorly fitting shoes, improperly trimmed nails, tight socks, excessive sweating, soft tissue abnormalities of the toe, and inherent nail deformity.

Ingrowing toenails may occur in the context of

• normal nail shape
• tend to present in younger people
• nail spike created by improper nail trimming of the lateral edge may cause trauma to the soft tissue allowing bacteria and fungal skin flora to enter and cause infection
• poorly fitting shoes may worsen the situation
• abnormal nail shape e.g. patients with incurvated nails or a wide nail plate (1).

Aetiology:

• unclear
• may be more common in families
• an important cause may be the wearing of shoes that are too tight

Reference:

1. Doctor (April 26th 2005):21.
2. Park DH, Singh D. The management of ingrowing toenails. BMJ. 2012;344:e2089