onychocryptosis (on’-e-ko-crip-to’-sis) when a fingernail or toenail grows into the surrounding skin, often resulting in infection.

Of all the different definitions people give to describe an ingrown nail, the easiest to understand is found at medterms.com. There we are offered a breakdown of the term onychocryptosis: from onycho (nail) + crypto (hidden or buried) + sis (condition). So, an ingrown nail is literally a condition where the nail is “hidden or buried” in the skin. Another condition where the nail penetrates the skin is pincer nails, but in that case, the entire nail becomes curved, causing the nail on both sides to cut into the surrounding skin. An ingrown nail usually affects only one side of the finger or toe. Once the nail has penetrated the skin, bacteria can get into the cut and the area is at risk for infection. Clients may complain of warmth, tenderness, swelling, or redness.

Ingrown nails can be caused by incorrect shaping or filing. Often what happens is that part of the nail is filed, but a pointed edge remains on the outside of the nail. That edge acts as an irritant, causing the body to respond to what it perceives as an invader. The body responds first by sending blood to the area, which creates heat and swelling. Left untreated, the nail will grow into the swelled skin that surrounds it. Anytime a nail is cut inside the natural framework of the nail bed, whether a point remains as an irritant or not, the potential for an ingrown nail is created. Ingrown nails can occur when clients are persistent nail biters. Biting nails below the free edge or along the sides of the nail creates a perfect environment for an ingrown nail. Trauma, injury, or constant pressure can also cause an ingrown toenail. For example, pressure from shoes that are too tight or too small, or the repeated pressure on toes caused from activities such as running can result in an ingrown nail. Finally, some people are predisposed to ingrown toes because of the natural shape of their nails or due to the “fleshy” nature of their toes and fingers.

The best way to avoid ingrown nails is to wear shoes that fit properly and trim nails to a length not below or more narrow than the natural nail bed. Clients with a predisposition for ingrown nails should leave them a little bit longer to prevent nails from cutting in the skin.

If an ingrown nail is caught in the early stages and is not yet infected, it may respond to at-home or salon care. However, if a person with poor circulation, a heart condition, or diabetes has an ingrown nail, she should see a doctor immediately, without waiting to see if the area will become infected. On a person without medical conditions, doctors recommend a foot soak to relieve some of the pain from the ingrown nail, and an application of a topical antibacterial cream.

If the area is infected, a doctor’s visit is required. The doctor may prescribe a topical or oral antibiotic, or in severe cases, she may need to perform surgery. Some people suffer from recurring ingrown nails, and permanent removal of the nail may be necessary.

What’s a Tech To Do?

A nail tech can play an important role in the prevention of ingrown nails. Educate clients how to file their own nails, explaining how important it is to avoid trimming the nails below the free edge. Avoid trimming or filing away the corners of the nails, which is one of the main causes of ingrown nails. Techs may see an ingrown nail developing on a new client, or on a client who has over-used her file between visits. The first thing to do is to ask the client about her medical history. If the client has diabetes, is on heart medication, or says she is prone to ingrown nails, send her to the doctor for treatment. If the area is infected, do not touch the nail and refer the client to a doctor immediately.

If it’s a clean, uninfected area, soak the nail in warm water mixed with antibacterial soap and gently push the skin away from the nail. Try to find the end of the nail to make sure no small point remains at the edge. If you see a small point, clip or file it away. Shape the nails to reflect the nail bed’s natural shape. Assess the damage. Has the nail penetrated and broken the skin? If so, “apply a topical antibiotic like Neosporin and a Band-Aid. Instruct clients to avoid wearing tight shoes that are narrow in the toe until the irritation resolves,” suggests Dr. Colleen Schwartz, D.P.M. of Pleasanton, Calif. Clients can soak ingrown nails at home a couple of times a day, and the nail should heal within a couple of weeks. If the client returns to the next appointment with no relief, send her to the doctor.

Signs of Infection
Dr. Colleen Schwartz, D.P.M., of Pleasanton, Calif., provides a list of the signs of infection of ingrown nails.
• redness
• increased temperature /warmth of area
• swelling
• pain
• drainage