Pincer nails (pin-sir): excessive curvature of the nail plate that causes the nail to pinch into the soft tissue of the surrounding skin

A pincer nail, also called a trumpet nail, is one of four types of an ingrown nail; it’s often viewed as the most painful. A couple of factors separate the pincer nail from the classic, more familiar ingrown nail. First, the term “ingrown nail” is often associated with an ingrown toenail, and we may visualize only one side of the big toe being affected. A pincer nail, on the other hand, can form on any nail — fingernail or toenail. Second, by definition, a pincer nail rolls into the skin on both sides of the nail plate. Techs will notice an exaggerated arch when they examine the C-curve of the nail, and the ends of the nail will visibly push into the skin. Clients who have the beginning stages of a pincer nail may complain that they feel like something is caught under their nail. When techs investigate, they will notice the nail pinching into the skin and be able to relieve the pressure by “unrolling” the nail.

Symptoms

In early stages, pincer nails can cause discomfort, but as the condition worsens and the nail digs deeper into the skin, the body begins to respond as it would to any irritation, such as a splinter or a piece of glass. The area becomes red, tender, and inflamed. The nail thickens, and the skin becomes cracked where the nail pushes into it. At times the curve can get so severe, the side edges of the nails will almost touch, causing significant pain. Left untreated, infection can develop.

Causes

A number of factors can cause pincer nails to evolve. Genetics can play a role, since the natural shape of the nail plate determines how a nail grows. However, many times a pincer nail can develop because of shoes that pinch the toes together or improper maintenance of the nail through cutting or filing. Pincer nails are more common in the elderly, as factors such as diabetes, liver problems, and medication can affect the growth and health of a nail. The elderly and women who are pregnant also pose a higher risk for pincer nails because they may find it difficult bending over to file their nails at a correct angle. Dr. Darren Weinheimer, a podiatrist in Binghamton, N.Y., says a pincer nail could also develop as a complication to a primary problem such as degenerative arthritis or inflamed joints.

Treatment

Treatment for pincer nails ranges from corrective filing to surgery. Once the nail is cut below the free edge, there is a chance of the nail growing into the skin, especially if the corners of the nail have been filed away or if a small spur is left on the edge of the nail. Corrective filing allows the nail to grow and widen so the edges don’t dig into the skin. Beyond filing, doctors may choose from a number of other corrective techniques including finding ways to widen the nail. One technique is to cut a “V” out of the center of the free edge. This removes the severe arch of the nail and the hope is that the nail will grow out flatter and wider. Another technique is to drill a very small hole on each side of the nail and thread a piece of wire up one hole, across the nail and down through the other hole. Once the wire is tightened and secured, it forces the high arch of the nail to flatten, causing the edges of the nail to flair. Again, the theory is that over time, the nail will begin to naturally flatten and widen.

If patients don’t respond to non-invasive corrections, doctors may choose laser surgery or a technique called phenol matricectomy. This surgery can be performed right in the doctor’s office and requires only a local anesthesia. The outer edges of the nail are removed and then a substance called phenol is applied. Phenol contains acid that will destroy the cells of the matrix, preventing regrowth of the nail. In any treatment of pincer nails, doctors may prescribe an emollient, such as Urea 40, to treat dry, cracked, itchy skin or an antibiotic to fight off or prevent infection.

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