Onychocryptosis : Treatment, Procedure, Cost And Side Effects

Onychocryptosis is a type of nail disorder where the nail grows in an abnormal way and starts cutting into the nail bed on one or both sides. Thein grown nail can grow into the flesh of the finger and it can occur due to wearing too tight shoes around a toe, or by cutting toenails with too much of curve or due to a nail injury or due to any fungal infection or due to a naturally grown curve. This condition can affect the nails of both hands and feet, but it occurs mostly in the toenails. It can cause a lot of pain and discomfort, along with redness and swelling. Ingrown nails affect the toes more than fingers as they are mainly caused by wearing ill-fitting footwear over prolonged periods. Genetics is another cause, as some people are born with naturally curved or bent nails. Other causes that lead to this condition are damage and deformation of nails by external factors, improper trimming of nails and underlying health conditions such as obesity. Also, people with diabetes have higher chances of suffering from this condition. Ingrown nails eventually cut into the skin, which then leads to infection and inflammation if not treated properly.

Surgical treatment is available for the removal of ingrown nails and it requires the use of local of anaesthesia. It is a self-diagnosable condition, and the main symptoms are sharp and intense pain, swelling and inflammation near the area where the abnormal growth of nails have occurred. Due to the possibility of serious infection, it is best to seek medical care for the treatment. Surgery is very effective, and deals with the removal of either the entire nail or just a part of it.

The surgical treatment for ingrown nails is performed by a podiatrist. The surgical procedure can vary for different cases, depending on the type and nature of the ingrown nail. But the basic procedure is called matrixectomy. The procedure is done as described below:

1. The affected toe or finger is thoroughly cleaned after being checked for signs of infection. An elastic band is placed around it to reduce the flow of blood.
2. Local anaesthesia is administered to the toe, and this process can be quite painful.
3. Once the anaesthesia comes into effect, the nail is gently lifted and a wedge may be placed in between the nail and the nail bed.
4. A line is cut through the ingrown part of the nail all the way to the root, and this cut portion is carefully removed from the skin.
5. To prevent the condition from recurring, the base of the nail is then treated with a chemical agent. Phenol is the most commonly used solution, and another widely used agent is Sodium Hydroxide.
6. Finally, the elastic band is removed and the toe/finger is dressed and bandaged properly.

This entire procedure takes about thirty minutes to an hour, and the patient can be discharged on the same day of surgery. The doctor may prescribe necessary medications such as painkillers and antibiotics. However, antibiotics are not generally recommended because they can cause delay in healing. With proper care, complete recovery can be expected within a few weeks.

People who have ingrown nails can easily identify the condition. Once identified, it is advisable to seek medical care as soon as possible. If the condition is not severe, some conservative measures can be suggested to be followed at home. If the situation persists even after applying conservative measures, then surgery will be required to stop the abnormal growth of the nail. Once the nail starts penetrating the skin, it causes pain and redness. If the pain intensifies, or if there are signs of pus, blood or other fluids, then it suggests that infection has occurred. In such cases, patients must seek treatment from a medical professional without any delay.

Any person having an ingrown nail can avail the treatment. But since it is a surgical procedure that requires the use of anaesthesia, some people may have to undergo extra procedures before the surgery can be performed on them. The doctor or podiatrist will go through the medical history of the patient and make necessary arrangements regarding this. Generally, people with diabetes, high blood pressure, pregnant women and those consuming certain medications may have to take some extra measures before surgery.

This procedure does not lead to much side effects. Even then, a few percentage of patients may experience mild side effects as mentioned below:

Anaesthetic side effects

Some people may experience numbness and loss of sensation, dizziness or difficulty in breathing due to the use of local anaesthesia.

Unpredictable tissue damage

During surgery, the nails are treated with chemical solutions like phenol to burn the nail tissue and prevent regrowth. This may lead to unpredictable tissue damage, though the chances are very rare.

Poor cosmetic results

After the surgery for an ingrown nail, it may not always look perfect, and there may be some minor deformations. As such, the nail can lose its aesthetic value.

Hyperalgesia

This is a condition where the body feels increased sensitivity to pain. The finger/toe where surgery was done may become extremely sensitive to pain for some time, so that a slight touch will also hurt. However, this will certainly go away with time.

The patient can walk after the operation, but it is advisable to get a soft and flexible footwear, possibly something that doesn’t have a hard toe-box. The following instructions are often advised to the patients after the surgery:

1. Rest with feet elevated if pain or discomfort persists in first few days.
2. Soak the feet in warm Epsom water or clean it with povidone-iodine solution for 15 minutes, then let the feet dry and apply antibiotic cream at the surgery site. Cover the wounds with gauge after that. The patient may need to do this on a daily basis.
3. Take medications as per the doctor’s prescription.
4. Keep the wound clean and covered until it dries.
5. Follow up with the doctor as per the consultation.
6. Maintain a healthy diet and refrain from working for a week or more.
7. Do not put pressure on the finger or toe at all.

The recovery period differs between individuals, but the average recovery period is four to six weeks if partial nail removal is done, and ten to twelve weeks if the entire nail has been removed. Following the postoperative guidelines properly will help in faster recovery of the wounds. The doctor will also monitor the recovery process closely with follow up visits.The recovery time varies from person to person complexity and the medical condition. There is a possibility of nail regrowth. In this case, one should quickly rush to the clinic and meet their surgeon.

The cost of ingrown nail surgery varies in different regions of India, but it is safe to say that the average cost of surgery is within the range of INR 3000 – 6000. Many factors will influence the final cost. For example, government hospitals and institutions are usually cheaper than private institutions. Also, other expenses like cost of medications, pre and post-operative consultation charges need to be taken into account.

There is possibility of recurrence of ingrown nails even after surgery. In such cases, the nail will once again be examined and further treatment options will be discussed accordingly. But in most cases, the surgery provides a permanent solution.

Some of the alternative treatment available for the treatement of the Onychocryptosis are:

Some good habits and proper hygeine can avoid this disease. Firstly, it is better to take preventive measures beforehand to avoid getting ingrown nails. For this, it is advised to soak the feet every now and then, wear comfortable shoes, avoid nail injuries and maintain good hygiene.

In case an ingrown nail is identified, following conservative measures can help in reducing pain and preventing infection:

1. Soaking the feet in warm water with Epsom salts
2. Applying ointment that prevents infection
3. Inserting a cotton wick in between the nail and skin at the region where abnormal growth or deformation has occurred.

Nail bracing is an alternative, where the ingrown nail is gently uplifted by specifically designed nail braces and held in that position. This prevents the nail from penetrating the skin. It may also treat the condition permanently, but it can take as long as 18 months to get the result.

Even with these alternate measures, surgical procedure is far more effective for the treatment and prevention of ingrown nails.