The mechanism of this disorder is the growth of the lateral edge of the nail plate, usually of the big toes, into the adjacent lateral nail fold. Congenital malalignment of the great toenail is a condition in which the nail plate is deviated laterally with respect to the longitudinal axis of the distal phalanx and may play a causative role of ingrown nails in some children. External pressure from shoes that fit too tightly and improper cutting of the nails are among common causes of this condition. Some people have overcurvature of the nail plate or hypertrophy of the lateral nail fold predisposing them to this condition.
Prophylactic management is simple: The toenail, especially the big toenail, should never be trimmed in a semilunar manner but should be trimmed straight across, so that the corner lies above the skin groove.
Treatment of an acute process consists of hot soaks and local application of an antiseptic tincture. After the pain has lessened, the placement of a pledget of cotton gently under the lateral nail plate may be sufficient to raise the pointed corner above the skin surface. More resistant cases are treated by removing the overlying skin by excision, or by removing the lateral section of the nail back to the nail matrix with destruction of the nail matrix with phenol or surgery.
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