Ingrown Toenail

A 15-year-old experienced pain in her toe, particularly when pressure was applied to the foot. An ingrown toenail was the cause of her discomfort.

Chronically ingrown toenail, or onychocryptosis, is typically caused by a rough or sharp edge (spicule) of an incorrectly trimmed nail. As the nail grows, the spicule digs into paronychial tissue and provokes a foreign-body response. Here, both the medial and lateral aspects of the toenail were affected.

Joe Monroe, PA-C, of Vancouver, Wash, includes cellulitis, neoplasm (glomus cell tumor and squamous cell carcinoma), extraneous true foreign body, and osteomyelitis in the differential diagnosis of ingrown toenail. He explains that this condition is a great imitator of cellulitis, with its redness, swelling, tenderness, and purulent drainage.

These features often promote the appearance of inappropriate granulation tissue, or "proud flesh," but bacterial infection is seldom involved. Hence, antibiotic therapy is unnecessary, unless "home surgery" has caused an infection.

Surgical removal of the offending nail segment, with permanent surgical and/or chemical matricectomy to prevent recurrence, is the standard treatment. No treatment is needed for the granulation tissue, since its appearance is secondary to the foreign-body response.