What to do for an ingrown nail?

Ingrown toenail: small cause, great pain?

👣 Does this sound familiar? A patient comes in with a slightly reddened toe, and you think, "It's probably nothing." But on closer inspection, it turns out: the nail is growing into the surrounding tissue, the skin is irritated, maybe even inflamed. And suddenly, a supposedly harmless problem becomes a case for the podiatrist.

What's actually happening?

An ingrown nail, medically known as Unguis incarnatus, occurs when the side edge of the nail grows into the surrounding tissue. This can happen due to incorrect nail trimming, tight shoes, genetic predisposition, or even mechanical stress.

The consequence:

Pain, redness, swelling, and in advanced stages, even purulent inflammation.

The big toe is particularly often affected.

Why treatment is important

What starts as a minor tweak can quickly become a serious problem. This is because the ingrown nail piece permanently irritates the tissue, leading to inflammation, the formation of granulation tissue ("proud flesh"), and in the worst case, chronic wounds that, in high-risk patients (e.g., diabetics), heal poorly or not at all.

Early action saves the patient a lot of suffering and us costly treatments.

Treatment approaches – individual and stage-appropriate

The treatment of an ingrown toenail strongly depends on the stage. Therefore, a good podiatric diagnosis is the first step. The classification is usually divided into three stages:

🟢 Stage I – Irritation without inflammation

Symptoms: Pressure sensation, slight redness, pain when wearing tight shoes.
Treatment: Relief through gentle tamponade, professional trimming of the nail.
Goal: Relieve pressure on the tissue, prevent ingrowth.

🟡 Stage II – Inflammation with secretion (pus)

Symptoms: Swelling, pain, purulent secretion.
Treatment: Intensive cleaning, anti-inflammatory care (Ichtolan 20%), relief using nail brace technique (e.g., BS brace).
Goal: Contain inflammation, gently guide nail growth.

🔴 Stage III – Granulation tissue and chronic inflammation

Symptoms: "Proud flesh," severe pain, open sores.
Treatment: Close cooperation with the doctor necessary (possibly antibiotic therapy or surgical intervention), podiatric aftercare with regular tamponade, long-term use of nail braces.
Goal: Regression of tissue, restoration of nail shape and function.

Conclusion

An ingrown toenail is not a "minor ailment" but belongs in expert hands, and as early as possible. With the right knowledge, the appropriate tools, and a lot of sensitivity, you can effectively help your patients and often prevent surgery.

Stay vigilant for the first signs, because early detection is half the battle. 😉

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