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An ingrown toenail is an extremely painful condition. It occurs when the edge of a nail penetrates the surrounding tissues of the toe (usually the big toe) and causes swelling, inflammation and infection. Ingrown toenails are commonly caused by poorly fitting shoes, but they can also be caused by improper trimming or by trauma. 
When an individual experiences an ingrown toenail, it is not uncommon for them to attempt to rectify the problem themselves to alleviate their discomfort. In the vast majority of cases this serves only to irritate the nail wall, cause infection and worsen the condition.  
Painful nails can also occur without the nail penetrating the toe. Shoe pressure on the nail wall can result in callous (hard skin formation) in the nail groove. If untreated this can build up and cause inflammation and infection. With this condition many people believe they have an ingrown toenail and frequently dig down into the groove to cut the nail, which in turn causes an ingrown toenail. Below are some examples of typical ingrown toenails.
Curved Toenail
This photo shows a curved nail, which is known as an involuted nail. The compression of the nail pinches the nail bed resulting in pain or discomfort along the nail groove.
Nail Penetration
This toe shows inflammation, swelling and hypergranulation (excessive growth) of the skin along the nail wall. The nail penetrating the skin causes this condition. Ill-fitting footwear is a primary factor in its development.
This is an infected ingrown toenail, which has been allowed to deteriorate. This condition requires an immediate course of antibiotics, followed by treatment to remove the offending splinter.
In this example the nail is cutting into the nail wall causing inflammation of the nail bed and surrounding tissues.
The treatment of ingrown toe nails is initially centred on conservative management. This means the practitioner removes the offending splinter of nail and the toe is dressed. Review appointments are made to ensure the nail does not penetrate the nail wall upon re-growth. Frequently ingrown toenails can be persistent and troublesome. In such cases nail surgery is recommended.
Nail surgery is the removal of a nail splinter, partial removal of a nail or the removal of the complete nail under local anaesthesia. This can be arranged through your GP. One injection is given to each side of the toe. This numbs the toe and the splinter is removed. With partial or total nail avulsion a chemical may be employed to prevent further re-growth of the nail.
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Kirkintilloch foot clinic
Biomechanical Assessment and Orthotic Centre