Ingrown toenail causes & prevention

Looks at the toenail anatomy, there are 3 key parts involved in ingrown toenail.

1. Nail bed: The skin under the nail plate
2. Lateral Nail fold: The skin that encloses the edge side of the nail plate
3. Nail plate: The nail edge that were surrounded by lateral nail fold.

What is ingrown toenail?

An ingrown toenail is a common foot problem. It happens when the nail plate bends more and grows into the lateral nail fold, sometimes the nail would even bend into the nail bed. Usually happens on the big toe. There are many different toenail shapes in ingrown toenails.

1. The Mild version, that the nail edge bends less than 90 degrees,  and the nail edge grow into lateral nail fold
2. The Moderate version, that the nail bends to over 90 degrees, looks like a staple and the nail edge start to grow into the nail bed
3. The Severe version, that the nail bends like a closed staple, and the nail edge grow into the nail bed
4. The very Severe version, that the nail bends so much that it fold again. This can happen to one side or both side of the nail.

1. First stage: It would have redness, swelling. You would feel pain when you press your toe. When you walk, your toe would feel like stung
2. Second stage: The pain would increase a lot. A lof fluid and pus would build up around your toenail. When you touch your toe, pus would come out. It also starts to have a foul smell.
3. Third stage: Every step you move would feel like someone step on your toe badly, and granulation tissue would grow and enclose your toenai. Has a lot of pus, and foul smell increases. 

ingrown toenail different stages

If your ingrown toenail is in the first stage or the early second stage, you can still consider conservative treatment at home. while if you are in the third stage, you need to go to the hospital before it gets worse. You can find more details and pictures of the three-stage of the ingrown toenail here.

1. Inheritance, some people have more curved nail
2. Trauma, Mechanical injury on the toe, normally happens to athletes and teenagers. (Such as former NBA player Yao Ming)
3. The nail grows abnormally caused by some other disease. (such as nail fungus)
4. Gained weight
5. Relevant to occupations that need long time standing, and our walking habit
6. Tight shoes, high heels, that compress the nail to become more curved. and the compression also causes a lot of friction on the nail edge and the soft tissue. more easily to cause swelling.
7. Improper nail cutting. Did not cut the nail to the nail edge and left a pointing nail edge Or cut the nail too short  (Most of the cases)

Causes 4-7 are the most common causes. As we know, An ingrown toenail happens when the edge of the nail grows into the lateral nail fold’s soft tissue. So either the nail becomes more curved and grows into the soft tissue or the nail fold area becomes bigger and trapped the nail edge to grow inside.

Why would toenail become more curved?

Cause 4-6: As you can see in the photo. there are two forces in our toenail, the horizontal forces that are marked with red arrows, that compress the toenail to become more curved, is normally come from tight shoes, high heels or things that suppress your toe. And the vertical forces that are marked with blue arrows are coming from the ground when our toes support our weight. Hence if you gained weight recently or your job needs a long time standing. The lateral nail fold’s skin would against and compress the nail edge, which would cause the skin to be broken easily. And that’s how the pain starts. That’s also the reason that sometimes, you feel the side toenail hurts while the nail is not ingrown. If you feel such pain, be sure to make your toenail clean to avoid infection, disinfectant would be helpful.

Cause 7: Most ingrown toenails are caused by improper nail cutting, combined with tight shoes. When we cut our toenails, the normal nail clipper can not reach the nail edge surrounded by the lateral nail fold (especially when your toenail has curves). So it becomes easy that we would leave a pointing nail edge (Spike). When the toenail continues to grow, the spike would grow inside the soft tissue. While make a wound on your toe edge. 

 

You would feel the pain on the toe edge, and the toe would become red, swollen. The pain grows every day, as the nail keeps growing more into the soft tissue. And the open wound of the lateral nail fold is also easy to be infected. 

 

Without the pointing edge (spike), sometimes even if your nail curves a lot, the nail can still grow out and no pain felt.