How is the ingrown toenail formed?
1, improper manicure
This is one of the most common reasons. If the side of the nail is cut irregularly, too short and too deep, the side nail will have to be inserted into the perinail tissue like a "hard thorn".
2. The shoes are not suitable
Inlaid toenails are extremely rare among people without shoes. The most likely explanation is that toenails are not under external pressure, but are limited by the upper when wearing shoes. The big toe pushes in the direction of the second toe, which forms pressure on the outside of the toenail, while the shoe itself forms pressure on the inside of the toenail. This external pressure presses the nail fold against the sharp edge of the toenail formed after improper trimming, resulting in local skin ulcers, and bacteria and fungi on the skin surface enter the open wound.
3. Trauma
Kicking injury or being trampled by others causes the deck to tear, which leads to the side edge of the deck being closer to the nail groove soft tissue, forming ingrown nails, which is more common in young students.
4. Other factors
Congenital local malformation, such as obvious hallux valgus, nail malnutrition, onychomycosis or related to onychomycosis. Others believe that the curvature and axial direction of toenails are related to ingrown toenails. There is also a certain relationship between ingrown toenails and occupations, which are more common in service occupations, construction industries or ballet dancers and athletes who work standing.
Types and stages of ingrown toenails
1, type of ingrown toenails
According to the clinical manifestations, it can be divided into mild, moderate and severe.
Mild: the ingrown toenail pierces the nail groove soft tissue, causing mild edema and tenderness, especially when walking or toenails are compressed;
Moderate: After the toenail grows in, the nail groove soft tissue can form a tough white membrane-like object, which is closely embedded with the nail groove soft tissue. When the toenail is pressed against this white membranous object, the pain is severe, showing inflammatory reaction, local skin swelling, no pus and granulation;
Severe: The nail groove soft tissue is ulcerated or red and swollen, inflammation can spread to the nail root, granulation tissue is formed, serous purulent secretion overflows, odor is generated due to bacterial infection, and walking is often affected by severe pain.
2. Clinical stages of ingrown toenails
Generally, it can be divided into three stages, namely, stage I (inflammatory stage), stage II (abscess stage) and stage III (granuloma stage). However, in many cases, the poor drainage of abscess is due to granulation, and granulation hyperplasia is more obvious in turn. Granulation and abscess coexist, so it is difficult to stage and really guide clinical practice.
Treatment of ingrown toenails
1, conservative treatment
For mild ingrown toenails (only redness but no secretion), the doctor may put a cotton swab on the edge of your toenail to separate the toenail from the underlying skin, which will help the toenail grow above the skin edge.
The nail groove is red, swollen and painful, with no or no obvious overflow, no abnormal nail groove or abnormal nail groove surface, which can be treated conservatively. After local disinfection, the surgical blade can be slowly tilted along the nail groove side, and the ingrown nail part can be taken out obliquely. Patients are required to reduce their activities at an early stage, wet compress with alcohol, add oral antibiotics, and slowly tilt the affected nail with an ear spoon every day until the nail grows above the abnormal nail groove, so as to guide them to get a correct manicure and avoid recurrence.
2. Traditional nail extraction
Advantages: simple and easy, mild postoperative pain, less bleeding and quick recovery. Disadvantages: it can be cured temporarily, with high recurrence rate, and it is easy to be complicated with finger suppurative inflammation and osteomyelitis if it is not handled properly.
3. Radical treatment of ingrown toenails
The basic principle is to remove the abnormal nail groove and proximal nail matrix, and there are different surgical methods according to the patient's situation and the doctor's personal habits.
(1) Cut off some decks and abnormal nail grooves.
① No suture, only oil gauze packing, gauze dressing, external self-adhesive tape compression to stop bleeding, no dressing change within 5 days after operation. Advantages: simple operation, no need to remove stitches, open wound and easy control of infection. Disadvantages: excessive bleeding, outpatient surgery is not conducive to observation.
② Suture, advantages: less bleeding, faster wound healing, early dressing change to observe infection control; Disadvantages: the suture needs to be stitched on the deck, and it is troublesome and painful to remove the suture after operation.
(2) After pulling out the nail, take out the abnormal nail groove and sew it. Advantages: no deck, simple suture, less bleeding, less pain of suture removal after operation, and the new nail is closely attached to the new nail groove after operation, which is more beautiful. Disadvantages: lack of postoperative deck (about 3-6 months) is not easy for patients to accept.
4. Surgical therapy
If the ingrown toenail can't be cured for a long time, it will be red, swollen, painful and purulent, causing severe pain, then consider surgical treatment. The purpose of the operation is to relieve the pain, trim the deformed toenail and avoid the recurrence of the pain. The surgical method is usually nail bed shaping, and the deformed nail bed and mucosa are trimmed to ensure that the regrowth of nails will not stimulate the surrounding soft tissues. It usually takes two weeks to recuperate after surgery, and suture is needed after surgery, and stitches are removed after two weeks. Too thick dressing after operation will affect wearing shoes. Usually, the operation is to go home on the same day, change the dressing in the clinic regularly, and observe the wound. Those who have been infected cannot be operated, and regular antibiotic treatment is needed before operation.
Complications of ingrown toenails
Inlaid toenails can be accompanied by paronychia, peritoenail inflammation, parathyroid granuloma, chronic osteomyelitis and fungal infection. Therefore, for cases with long course of disease or severe swelling and pain, X-ray examination is recommended to rule out chronic osteomyelitis of toenails. In addition, only 5% after nail removal can cause nail malnutrition.
Preventive measures for ingrowth of toenails
1, the best way to bury nails is to pull them out, which can be cured at one time; Small operation and safety; Although pedicurists can achieve their goals by cutting their nails properly, it is more troublesome, and some people have not solved the problem for half a year;
2. After nail removal, nails grow completely, usually in about three months; Be careful not to damage your nails during this period;
3, within a week after pulling out the nail, you can't drink alcohol and eat less food that is easy to get angry, such as pepper.
How to prevent ingrown toenails 1, pruning methods
Straighten with a flat nail clipper, and the toenails repaired with a flat nail clipper are relatively flat without sharp nails; Never trim the toe into a circle, which will easily cause the toenails to grow inward; Keep the toenail length moderate, do not cut into the meat, just below the front end of the toe; It is recommended to trim your toenails every 2-3 weeks.
2, shoes fit
Wear shoes of the right size and avoid shoes that are too sharp. These shoes tend to squeeze the toenails, causing them to grow inward.
Step 3 prevent recurrence
If you have ever had ingrown toenails, it may recur in the future, so you need to pay special attention to avoid recurrence.
4. Diabetic patients
If you have diabetes, your hands and feet may be numb, and it is easy to cut your toenails too much or your toes. You can have someone else cut it for you.