From the Guidelines
Several overgrowths of the nail can be sensitive to touch, including ingrown toenails, subungual exostosis, onychomycosis (fungal nail infection), and pyogenic granulomas. These conditions can cause significant discomfort and affect the quality of life of patients, as approximately half of all patients with onychomycosis experience pain or discomfort 1. Some key points to consider include:
- Ingrown toenails occur when the nail edge grows into the surrounding skin, causing inflammation, pain, and sometimes infection.
- Subungual exostosis is a bony growth under the nail that can create pressure and tenderness.
- Fungal nail infections can cause thickening and distortion of the nail, making it sensitive when pressure is applied, and can have a significant impact on the quality of life of patients, including discomfort, difficulty in wearing footwear and walking, cosmetic embarrassment, and lowered self-esteem 1.
- Pyogenic granulomas are small, vascular growths that often develop in response to trauma or infection and can be extremely tender. Treatment depends on the specific condition, but may include proper nail trimming techniques, topical or oral antifungals for fungal infections (such as terbinafine 250mg daily for 6-12 weeks), partial or complete nail removal for severe ingrown nails, or surgical excision for subungual exostosis, and in some cases, the use of doxycycline at 100 mg twice daily can be used for recurrent, severe, or treatment-refractory paronychia 1. It is essential to prioritize the management of these conditions to prevent further complications, such as the development of foot ulcers, osteomyelitis, cellulitis, and gangrene in diabetic patients, and to improve the quality of life of patients 1. In terms of management, a clinical treatment algorithm for the management of acute paronychia and periungual pyogenic granulomas has been recommended, including the use of a 50:50 dilution for vinegar soaking and the placement of a plastic tube with a lengthwise incision on the lateral edge of the nail to encapsulate it 1. Overall, the management of nail overgrowths should prioritize the reduction of morbidity, mortality, and improvement of quality of life, and treatment should be tailored to the specific condition and patient needs, with consideration of the potential complications and impact on quality of life 1.
From the Research
Overgrowths of the Nail
- Ingrown toenails can be sensitive to touch, as they can cause pain, swelling, and discharge 2, 3, 4, 5, 6.
Characteristics of Ingrown Toenails
- They are one of the most common diseases of the nail, often affecting the great toe 2, 3, 4, 5, 6.
- Ingrown toenails can occur at any age, but are more common in young men 3, 5.
- They can be caused by various factors, including improper nail cutting technique, tight-fitting footwear, trauma, and anatomical factors such as thickening of the nail plate 3, 4, 5, 6.
Symptoms and Treatment
- The extent of inflammation does not necessarily correlate with subjective symptoms, so patients may describe severe pain even with low levels of inflammation 4.
- Treatment approaches include conservative methods such as soaking the foot, applying topical steroids, and using a gutter splint, as well as surgical methods such as partial avulsion of the lateral edge of the nail plate and matrixectomy 2, 3, 4, 5, 6.