Onychocryptosis,' commonly known as ingrown toenail, is the most frequent cause of toenail pain. Here we will describe the condition as seen in adults and adolescents. In the most common form, the big toe is affected. Four main categories of toenail

Very first, is subcutaneous ingrown nail, which often appears as a result of improper trimming. A sharp spicule of nail at the edge, grows into the soft tissue of the lateral fold. In another condition, hypertrophy of the lateral nail fold causes long-standing trauma between the nail and lateral fold. This may result in the overgrowth of the soft tissues, forming a lip that overrides it..

Pincer, or involuted nail, is caused from over-curvature of the lateral nail edges towards the nail bed. The excess curvature is seen most commonly in the big toe, where it may lead to chronic pain and inflammation as the subungual tissues are compressed. In pincer nail, the most frequent cause is pressure on the plate from footwear or deformed digits. Although, when many nails are affected, a family history may exist.

The management of acute ingrown toenails is described here in detail. If infection is suspected, a swab should be taken and appropriate antibiotics given. Initial episodes may be treated by skilled conservative resection and retrieval of the offending nail spike, followed by daily hypertonic saline foot-baths until resolution occurs. Patients should also be advised to cut nails straight across, avoiding the corners. Footwear should be assessed and modified appropriately.

However chronic ingrown toenails require detailed management. If conservative treatment fails, or the condition is recurrent, nail surgery should be considered. As much as possible, the nail plate should be preserved. There is seldom need to remove the entire nail. The treatment of choice is partial nail avulsion, removal of the lateral quarter of the nail, including the associated matrix. The procedure of removing ingrown nail includes giving anesthesia with ring block of the toe, then clipping away the lateral part of the nail growing in the skin. Removal of debris, and applying phenol on the matrix, is also done. Finally, a dressing is applied. The nail usually recovers in two to three weeks. When wound healing may be a problem, other excisional techniques should be considered. Cryosurgery of the exuberant lateral fold can be successful in treating ingrown toenail, and alleviating toenail pain.