Ingrown Toe Nail

Important items to consider in the history:

• Etiology

  • Improper nail trimming (nails should be cut straight across)

  • Improper shoe gear (a narrow or tight toe box)

  • Trauma (resulting in irregular growth)

  • Genetic predisposition (check family history)

  • Painful nail fold due to incurvated nail border.

  • Previous occurrence and recurrence after procedure

• Differential diagnosis:

  • Paronychia - Infection of nail fold due to irritation without presence of incurving nail.

  • Onychomycosis (fungal nails) - Thickening of nail due to fungal infection, bacterial infection uncommon.

Physical exam will show:

• Edema

• Erythema

• Warmth of the nail fold, usually the lateral nail fold.  

• If present for a period of time, localized infection may produce serosanguanous or purulent drainage.  

• Lymphangitis is uncommon but may be present in very neglected situations.  

• Granulomatous tissue (proud flesh) may be present chronic cases.

Treatment:

If unable to perform procedure, use soaks and antibiotics

Procedure.  This is a clean but not sterile procedure.

• Set up equipment

• Scrub the foot

• Digital block (1% or 2% xylocaine without epinephrine)

• Inject the proximal digit on medial and lateral aspect with 3cc

• Loosen the skin overlying the nail fold

• Use thin elevator to free the nail from the nail bed

• Use nail cutter (English anvil) to cut the nail to matrix

• Use hemostat to remove nail

• Phenol (89%) application if permanent ablation of nail matrix (root) is desired in

• Intractable cases - 2 applications for 30 sec., then neutralize with alcohol

• Place topical antibiotic, dressing

• Daily dressing changes for 5 days (longer with phenol procedure)

• Domeboro or Epsom salts soaks for 1 week (longer with phenol procedure)

Christopher Kardohely, DPM, HM2 (FMF) George Pugh,  and Scott D. Flinn, MD

For further information, read:

Operational Podiatry, in the General Medical Officer Manual

Home  ·  Military Medicine  ·  Sick Call  ·  Basic Exams  ·  Medical Procedures  ·  Lab and X-ray  ·  The Pharmacy  ·  The Library  ·  Equipment  ·  Patient Transport  ·  Medical Force Protection  ·  Operational Safety  ·  Operational Settings  ·  Special Operations  ·  Humanitarian Missions  ·  Instructions/Orders  ·  Other Agencies  ·  Video Gallery  ·  Forms  ·  Web Links  ·  Acknowledgements  ·  Help  ·  Feedback

Approved for public release; Distribution is unlimited.

*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

© 2015, Brookside Associates, LLC. All rights reserved

Other Brookside Products