What is an ingrown toenail?
An ingrown toenail, also known as onychocryptosis, is a common condition, where the edges or corners of the nail grow into the skin next to the nail. This condition most frequently affects the big toe and can cause pain, discomfort, and difficulty in walking [1, 2, 3]. It is most common in young men, with factors such as nail care habits and choice of footwear playing a role in the development of the condition.
Although ingrown toenails are common, they can progress to a more serious condition. Therefore, early intervention is important.
Treating an ingrown toenail
Treating an ingrown toenail involves both surgical and non-surgical approaches. Non-surgical approaches are used for mild to moderately-complicated cases - these include correcting footwear, managing hyperhidrosis (excessive sweating) and fungal infections (onychomycosis), soaking the affected toe and maintaining appropriate foot care, using a mid- to high-potency topical steroid, or placing wisps of cotton or dental floss under the ingrown lateral nail edge [1].
The surgical approach is used in moderate and severe cases. The aim is to remove the part of the nail that is ingrown from the nail plate to minimise local trauma and inflammation. It is worth noting that a surgical intervention is superior to non-surgical in preventing recurrence of the ingrown toenail. The most common surgery approach is removal of the ingrown parts (partial avulsion of the lateral edge) and damaging parts of the nail bed matrix (matrixectomy) so that the part of the nail doesn't grow back. This is usually done chemically with phenol, or electrocautery can be used.
Post-surgical care is very important to prevent complications. This includes taking prescribed antibiotics and analgesics, as well as appropriate wound care and attending any follow-up sessions indicated by the doctor.
Complications Associated with Ingrown Toenail
If left untreated, an ingrown toenail can lead to serious complications, some of which, if left untreated, may eventually lead to death.
One of the primary concerns is infection. An ingrown toenail can cause a bacterial or fungal infection, which can spread to the bone as well, requiring an intense course of intravenous antibiotics and sometimes surgery [4, 5].
People with conditions altering the blloodflow or causing nerve damage to the feet are at a higher risk of complications from an ingrown toenail - this includes diabetic patients for example [4].
Mortality of ingrown toenails
While the evidence directly establishing the mortality of an ingrown toenail is limited, the evidence for gangrene and sepsis, complications that can arise from an ingrown toenail.
Sepsis
Sepsis is a life-threatening condition, where the body responds to infection so aggressively it injures its own organs. Sepsis is a major health concern, especially in the older population [6, 7].
The mortality of sepsis varies, however, it is well established that sepsis can be deadly. For severe sepsis, mortality rates range between 25% to 30%. The most extreme form of sepsis, septic shock, which presents with a lowering of the blood pressure, can approach 50% [8, 9, 10].
The treatment of sepsis relies on early intervention, resuscitation with fluids to stabilise the cardiovascular and respiratory functions, and aggressive treatment of the infection with appropriate antibiotics [8, 11]. In some cases, therapy with corticosteroids may improve outcomes [8].
However, it is important that even after sepsis is resolved, patients can continue to face long-term impairments, such as cognitive and functional deficits [9].
It's important to note that even after surviving the acute phase of sepsis, patients continue to face risks of mortality after discharge, as well as long-term cognitive and functional deficits [9].
Gangrene
Gangrene is another serious condition which can arise as a result of an ingrown nail getting infected. It develops when tissue dies due to lack of blood supply, or as a result of bacterial infection. This is typically most common on the extremities. If left untreated, gangrene can progress and spread throughout the body, and can lead to sepsis and septic shock [12].
The mortality of gangrene depends on the severity of the condition. However, broadly, in a study of patients with infectious foot gangrene, the 5-year survival rate was 40% [13]. Some advanced forms of gangrene can have an overall mortality reaching 25% [14].
To treat the gangrene arising from an ingrown toenail, the first step is to remove the infected tissue. This is referred to as debridement, and involves cutting away or scraping the gangrenous tissue. In some cases, a skin graft may be used [15]. This is done in combination with antibiotic treatment.
However, in severe cases, amputation of the toe or foot may be recommended - this depends on the extent and severity of the infection [16].
Summary
While ingrown toenails can be managed with appropriate foot care and/or a minor surgical intervention, if left untreated and not cared for, can progress to conditions such as gangrene or sepsis, which can be life-threatening.