An ingrown nail, or onychocryptosis, is a nail plate that grows into the nail shaft. Even if the ingrowth has occurred by several millimeters, a very severe pain occurs, which simply does not allow life. The roller is inflamed and suppurates. Nail ingrowth can be on any toe, but the problem is often talked about in relation to the big toe.
95% of people suffer from this phenomenon. Most often, the nail grows into the side roller. Here the data is different - someone points to touching the inner edge, others - to the outer. Infectious complications occur frequently. In this regard, onychocryptosis takes the 2nd place.
Among patients, 60% of adults and 40% are children. There is no sexual gradation. It is interesting that only 10% of people turn to surgeons about this. Others try to be treated with folk remedies, bringing the situation to extremes.
Onychocryptosis is a chronic process. The methods of treatment are conservative and surgical.
Finger nail anatomy
Nails - keratinized skin. They not only end with themselves end phalanges, but also have their own functions:
- protection of sensitive finger pads;
- help in grabbing and picking small items;
- help in touch;
- aesthetic function - well-groomed nails improve the overall appearance.
Nail parts
What is visually called a nail is just its visible part, the nail plate. It has no capillaries and nerve endings.
The nail plate lies on the nail bed - actually the back surface of the phalanx. The plate and the bed are tightly connected, except for the upper edge.
Nail root - part of the nail plate covered with skin. This is the matrix of the nail, due to which its growth occurs. The crescent, or “moon,” is the part of the nail visible under the skin. Her color is whitish. It is especially noticeable on the thumbs and least on the little fingers.
The cuticle, or peel, is a layer of skin covering part of the root of the nail. When it grows, it grows on the nail and forms barbs.
Nail rollers - pads of skin that limit the nail on the back and sides
Growth direction
Nail growth occurs due to the matrix (root). Its cells, dividing and growing, gradually move forward.
Here they keratinize, are pressed and become dense. Nail growth depends on the season - in the summer they grow faster. A complete change of the nail occurs in 3-5 months.
Causes of ingrowth
The reasons include the following:
- Improper nail cutting - the edge of the nail should be flat, without rounding.
- A short cut is also not true.
- Wearing narrow shoes - this puts pressure on the nail, and its growth is impaired.
- Longitudinal and transverse flat feet - the foot is deformed, and the first finger is bent under the action of the second.
- Nail fungi - cause a thickening of the nails and deform them. This is a direct path to growth.
- Injuries (especially bruises) and frostbite of the toes - the nail is disturbed, and it is deformed, the direction of growth is disturbed. This usually occurs after nail peeling off. A new plate is often deformed.
- For genetic reasons, the nail can grow incorrectly - a congenital pathology.
- Skin diseases can also deform nails - psoriasis, lichen, warts.
- Increased sweating feet - increases the risk of ingrown.
- Diseases with malnutrition of tissues - diabetes, endarteritis, atherosclerosis, varicose veins.
- Obesity - increased load on the feet.
- Radiation and chemotherapy - they activate the growth of the nail, and it often grows into a roller.
- Hereditary predisposition - it is inherited.
The degree of ingrown toenail
There are 3 degrees of development of pathology:
- Hyperemia (redness of the skin) at the site of ingrowth of the nail plate. She is already showing throbbing pain when walking or putting on shoes. If there is no pressure, the pain goes away. No wounds yet.
- The next stage occurs 2-3 weeks later. It is characterized by the addition of inflammation. The nail is already beginning to dig into the skin of the roller. A bleeding wound forms. The finger turns red and swollen, pus forms.
- The peak of the development of inflammation is that the skin of the wound breaks and bleeds, oozing pus. Granulation tissue grows - wild meat. It is difficult to care for such a finger, because dust and dirt constantly get here.
Symptomatology
The main symptom is pain from the start. It becomes constant and intensifies. At the beginning, the periungual roller swells and turns red. Over time, an ulcer appears on the roller.
Infection in the leg penetrates very quickly. The roller becomes more and more swollen, the color is cyanotic or crimson. Pus oozes from it.
In response to such inflammation, the tissue of the cushion grows and outwardly they resemble the color of raw meat - granulation. Its popular name is wild meat.
Pain occurs at the slightest touch of a finger, even with a blanket in a dream. With prolonged inflammation, the edge of the nail partially exfoliates, the color changes, and a putrefactive odor appears.
Easy to develop fungus. With trophic pathologies, phlegmon and gangrene of the foot may occur. If the nail has grown, surgery is necessary for suppuration and growth of granulations.
Risk of ingrown
Dangerous consequences include the following:
- constant pain, which dramatically reduces the quality of life;
- abscesses;
- inflammation of the periosteum;
- gangrene
- phlegmon of the foot.
With gangrene, leg amputation can be performed.
First aid at first sign
It is necessary to raise the cutting corner of the nail. To do this, the finger must be steamed and softened. This can be done with warm water for 20 minutes or cream. Then moisten a piece of fleece with an antiseptic and place between the roller and the nail so that the nail is raised. This procedure is painful. Change fleece daily. If there is no result, you will have to consult a doctor.
Foot baths
They can help when there is no suppuration and overgrowth of granulations. For baths, you can use:
- saline solution;
- soda solution;
- potassium permanganate;
- ointments.
With a grown nail, ointments are used: Nogtinorm, Uroderm, Vishnevsky, ichthyol, Levomekol.
Treatment Methods Without Surgery
This refers to various devices for straightening the direction of growth.
- Laying between the edge of the nail plate and the nail bed of a gauze strip moistened with an antiseptic. The gauze should be constantly wet.
- Laying a narrow strip of X-ray film between the nail and the roller. The film prevents the skin from being injured, and the nail gradually extends.
One of the modern methods of conservative treatment, which came from Germany, is the use of corrective plates or staples that correct the shape of the nail plate and eliminate ingrowth. The method is called orthonix, it is bloodless, and of course, this is the dream of any patient. Among such devices, one can name the Fraser bracket, 3TO, Goldspang plate, "Podofiks". The effectiveness of their use is 95%.
The advantages of this method:
- no need for surgery;
- devices do not interfere with walking;
- the shape of the nail is corrected;
- there are no complications;
- helps unambiguously;
- good for women, because it allows you to paint your nails with varnish.
There is also a minus, this treatment duration is 2-6 months.
Removing the nail plate with a patch
It can be used when joining an inflammation of the fungus when a normal operation does not help. This is a keratolytic patch for removing the affected nail. Its constituents slowly corrode and soften the nail. After a few days, he leaves himself. At the 3rd stage of ingrowth, the method cannot be used.
Classic way of operation
If the nail has grown, the operation today is carried out in dozens of methods. Each of them has its own characteristics, the type of treatment of the bed and the rehabilitation period.
Ingrown nail removal operations are performed using local anesthesia. Often performed on an outpatient basis in the clinic.
A way to simply remove the nail plate on the thumb with an ingrown nail is Dupuytren's operation. It is used although widely, but gives relapse in 90% of cases. Her stages:
- Anesthesia of the soft tissues of the finger.
- The nail plate is dissected, and each half is twisted with a clamp.
- Granulation tissue is removed.
- The nail bed is not touched, but the rollers are removed and cosmetically modeled.
Photos of operations on an ingrown nail are presented below.
The postoperative period lasts from several weeks to months. At this time, severe pains are felt, it is impossible to walk, and a sick leave is required.
Another minus is a cosmetic defect. A new nail grows narrower and denser, it is deformed like animal claws. Currently, this method is used only for purulent processes and osteomyelitis and phlegmon phalanx.
The type of surgery for an ingrown toenail, when the nail plate remains in place, is Barlett surgery, proposed in the first half of the 20th century. At the same time, on the ingrowth side, 5-7 mm down from the edge of the nail roller, a longitudinal incision is made through which all the underlying tissues to the bone are removed.
The skin incision is sutured with a silk suture. The tension of the threads does not allow a new nail to grow into the roller. The recurrence rate for Barlett's surgery is about 30%.
In 2004, a method was developed for the surgical operation of an ingrown toenail on the big toe, in which the matrix does not move, but the compression by the roller due to the expansion of the bed is eliminated. The method gives only 11% of relapses.
Meleshevich’s operation, proposed back in 1985, was rather progressive. So do the operation of the ingrown nail according to this method:
- The trapezoidal section of the periungual roller is resected.
- The nail bed expands.
- Plastic is being produced.
Different types of surgery to remove an ingrown toenail and their modifications can be used on an outpatient basis.
Popular operations where a growth zone is maintained . There is a radical method - total removal of the nail and tissues to the periosteum. Apply with the most advanced cases and frequent relapses. There are many negative consequences with this method: the finger becomes unstable to mechanical stress, hurts in shoes, is deformed.
Plastic surgery in every third patient gives transplant necrosis, which further worsens the results.
One of the commonly used treatments for ingrown toenail surgery is Emmert-Schmiden intervention:
- The nail is longitudinally dissected indented half a centimeter from the place of ingrowth.
- The affected part is twisted.
- The incision is deepened to the periosteum, and the roller is wedge-shaped excised.
- The edges of the wound bring together and suture.
Relapses - 46%. As you can see, no method gives a 100% guarantee, so attempts to find the best option continue.
When all methods are powerless and constant relapses are observed, the phalanx is completely removed. The operation is unaesthetic, crippling, disfiguring the finger, but eliminates the pathology forever.
Radio wave treatment and electric shock
When the radio wave method is the removal of the matrix, which serves as the basis for re-ingrowth. Advantages - esthetics and minimal relapses.
Radio wave removal is performed by the Surgitron apparatus. Radio waves cut through tissues like a scalpel. Healing is not painful, radio waves enhance the regeneration process, serve as an antiseptic, and healing takes place faster - in 2 weeks. It is even more effective than laser, ultrasound and electric current. Nail removal can be partial or complete.
Laser correction
Laser surgery of an ingrown nail is less traumatic. The beam evaporates the ingrown plate and the edges of the growth zone of the diseased nail, eliminates all granulations of the pathology and foci of infection. He can get rid of the fungus. He cauterizes vessels immediately, therefore, there is no bleeding.
Soreness is minimal, relapse - 1%. The treatment is aesthetically pleasing since the germination zone is preserved. Healthy tissue is not affected.
The laser operation lasts about 20 minutes, is performed with anesthesia. After the intervention, the patient can immediately go home.
The new nail is flat, but narrower. Recommendations for choosing shoes are the same as for other operations.
Laser contraindications: severe diabetes mellitus, blood clotting disorder, acute infections, oncology. Complications of the laser operation of an ingrown nail are extremely rare and can occur only with a violation of surgical technique.
After the operation, suture removal is performed after 10 days. The rehabilitation period with classical methods lasts up to several months. You should strictly adhere to medical recommendations (below).
List of recommendations during the rehabilitation period
After the operation, it is recommended to adhere to the following rules:
- legs should be dry and clean;
- dressing change regularly - in the morning or in the evening;
- walk less;
- the first 2 weeks - only orthopedic shoes, later on the shoes are also wide and loose, without heels;
- during the month saunas, pools and baths are excluded;
- daily rest for 20 minutes, lifting them above the head - lying on the couch, for example;
- getting rid of old socks in case of infection before surgery, wearing cotton socks after surgery;
- taking antibiotics and analgesics as prescribed by a doctor.
And the most important thing is to properly trim the nail. The cut line should not be lower than the top of the finger. Scissors are washed with running water and soap.
Nail care in the early days
The bandage imposed by the surgeon is not touched in the first 2 days from the day of surgery. Then she is removed, and you need to take a shower. Steam skin and long wet your finger in water is impossible. When the leg dries, reapply the bandage.
Dressing Features
Hands should be clean. Spiral ankle bandage.
There is always pain in the early days, swelling is possible. To reduce such manifestations, you can drink analgin. Gauze for dressing should be moistened with an antibacterial solution.
If a nail has grown, removal operations are free. They can be carried out on an outpatient basis, in severe cases, a referral to the hospital is given.
Costly operating equipment is not required, a complex operation is not considered. Its cost is about 2-3 thousand rubles, sometimes 5-7. Laser treatment is about the same; radio wave therapy is the most expensive. The choice of operation, if the nail has grown, is determined by the solvency of the patient.
Reviews
Those who have undergone the removal operation claim that the operation itself is not so painful as the healing period - this is torment. To someone, if a nail has grown, the operation helps the first time, the appearance of the nail does not change. Others are forced to consult doctors about relapses.