Wednesday, June 10

Ingrown toenail symptoms

  ›     ›     ›   Symptoms of ingrown toenails
An ingrown toenail, or onychocryptosis, is a common painful condition that most often affects the outer edge of the big toe.
However, ingrown toenail can occur on any toe and also on both sides of the toe. The initial symptoms of ingrown toenail are mild pain, reddened skin and swelling at the corner of the toenail.

The symptoms of onychocryptosis develop as a reaction to a foreign body, when the toenail pierces and enters the flesh (the ungual labia folds) surrounding it. Considering the progress of symptoms, Jonathan D. Mozena (Podiatr Med Assoc. 2002 Mar;92(3):131-5) had classified onychocryptosis into stages I, IIa, IIb and III. Martínez-Nova A et al. added a new stage IV.

Symptoms in early stage of ingrown toenail

Early stage is an inflammatory stage with the following symptoms:

Abscess stage of ingrown toenail

  • There is increase in erythema, swelling and pain. Hyperesthesia (increased sensitivity) is experienced by the patient.
  • The patient may experience continuous throbbing, stabbing pain.
  • There is hypertrophy of toenail fold. It extends over the ungual plate, but measures less than 3 mm.
  • Clear, thin, watery serous drainage may begin.
  • Next, it may progress into serosanguineous exudate, which is thin, watery, and pale red to pink in color. The pink tinge is due red blood cells leaking from damaged capillaries.
  • In this stage, infection may set in, causing seropurulent exudate of thin, watery, cloudy, and yellow to tan in color.
image of wounded infected toenail
Infected ingrown toenail

Advanced abscess stage of ingrown toenail

  • There is further increase in erythema, swelling, excruciating pain and hyperesthesia.
  • The hypertrophy of toenail fold extends over the ungual plate and measures more than 3 mm.
  • Paronychia, an infection of the paronychium (soft tissue surrounding the border of the toenail), caused by Staphylococcus, Pseudomonas, Candida or superficial dermatophytes occurs.
  • Thick, opaque, purulent, foul smelling exudate of tan, yellow, green, or brown in color may discharge from the infected wound.
  • The affected area may feel hot to touch.

Symptoms in hypertrophic stage of ingrown toenail

  • In hypertrophic stage, the earlier symptoms like erythema, swelling, excruciating pain, hyperesthesia and pus discharge continue.
  • The hypertrophy becomes chronic with the increase in the volume of lateral fold tissue due to the enlargement of its component cells.
  • The hypertrophic fold tissue widely covers the lateral ungual plate.
  • Granulation tissue composed of new connective tissue and tiny blood vessels forms on the surfaces of the wound.

Symptoms in distal hypertrophic stage of ingrown toenail

  • The hypertrophic tissue completely covers the lateral, medial and distal ungual plate.
  • The toenail and the lateral and distal skin folds undergo chronic deformity.
  • If untreated cellulitis and osteomyelitis can occur.
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References on symptoms of ingrown toenails:
1.Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2.Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrown toenails? Arch Fam Med. 2000;9(9):930–932.
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