Ingrown toenail

Background

Nailtip Anatomy

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

• The perionychium includes the nail bed and the paronychium.
• The paronychium is the lateral nail fold (soft tissue lateral to the nail bed).
• The hyponychium is the palmar surface skin distal to the nail.
• The lunula is that white semi-moon shaped proximal portion of the nail.
• The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
• The germinal portion is proximal to the matrix and is responsible for nail growth.
• Lateral nail edge grows deep into nail wall → cycle of inflammation and hypertrophic granulation tissue can lead to abscess

Clinical Features

Typical ingrown toenail

• Pain and swelling at distal nailbed, typically unilateral

Differential Diagnosis

Foot diagnoses

Acute

• Foot and toe fractures
• Subtalar dislocation
• Metatarsophalangeal joint sprain (turf toe)
• Acute arterial ischemia
• Calcaneal bursitis

Subacute/Chronic

• Diabetic foot infection
• Peripheral artery disease
• Plantar fasciitis
• Trench foot
• Ingrown toenail
• Paronychia
• Tinea pedis
• Morton's neuroma
• Diabetic neuropathy

Evaluation

Workup

• Typically does not require studies

Diagnosis

• Typically a clinical diagnosis

Management

• Minor cases can be treated non-surgically
• Others, preform partial ingrown toenail removal

Disposition

A toe following wedge resection with an image of the nail removed.

• Outpatient

See Also

• Ingrown toenail removal