An ingrown toenail, or onychocryptosis, is a common painful condition that most often affects the outer edge of the big toe.
The symptoms of onychocryptosis develop as a reaction to a foreign body, when the toenail pierces and enters the flesh (the ungual labia folds) surrounding it. Considering the progress of symptoms, Jonathan D. Mozena (Podiatr Med Assoc. 2002 Mar;92(3):131-5) had classified onychocryptosis into stages I, IIa, IIb and III. Martínez-Nova A et al. added a new stage IV.
Symptoms in early stage of ingrown toenailEarly stage is an inflammatory stage with the following symptoms:
- Erythema (reddening of skin) is caused by the increase of blood flow to superficial capillaries, mostly as an immune reaction.
- Mild edema (swelling) occurs due abnormal accumulation of fluid as an immune reaction.
- Pain is experienced when pressure is applied to the lateral toenail fold.
- In this stage the lateral fold does not extend over the ungual plate.
- There is no pus or discharge and the affected area may feel warm to touch.
Abscess stage of ingrown toenail
- There is increase in erythema, swelling and pain. Hyperesthesia (increased sensitivity) is experienced by the patient.
- The patient may experience continuous throbbing, stabbing pain.
- There is hypertrophy of toenail fold. It extends over the ungual plate, but measures less than 3 mm.
- Clear, thin, watery serous drainage may begin.
- Next, it may progress into serosanguineous exudate, which is thin, watery, and pale red to pink in color. The pink tinge is due red blood cells leaking from damaged capillaries.
- In this stage, infection may set in, causing seropurulent exudate of thin, watery, cloudy, and yellow to tan in color.
|Infected ingrown toenail|
Advanced abscess stage of ingrown toenail
- There is further increase in erythema, swelling, excruciating pain and hyperesthesia.
- The hypertrophy of toenail fold extends over the ungual plate and measures more than 3 mm.
- Paronychia, an infection of the paronychium (soft tissue surrounding the border of the toenail), caused by Staphylococcus, Pseudomonas, Candida or superficial dermatophytes occurs.
- Thick, opaque, purulent, foul smelling exudate of tan, yellow, green, or brown in color may discharge from the infected wound.
- The affected area may feel hot to touch.
Symptoms in hypertrophic stage of ingrown toenail
- In hypertrophic stage, the earlier symptoms like erythema, swelling, excruciating pain, hyperesthesia and pus discharge continue.
- The hypertrophy becomes chronic with the increase in the volume of lateral fold tissue due to the enlargement of its component cells.
- The hypertrophic fold tissue widely covers the lateral ungual plate.
- Granulation tissue composed of new connective tissue and tiny blood vessels forms on the surfaces of the wound.
Symptoms in distal hypertrophic stage of ingrown toenail
- The hypertrophic tissue completely covers the lateral, medial and distal ungual plate.
- The toenail and the lateral and distal skin folds undergo chronic deformity.
- If untreated cellulitis and osteomyelitis can occur.
References on symptoms of ingrown toenails:|
1.Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2.Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrown toenails? Arch Fam Med. 2000;9(9):930–932.