The presence of the keratinaceous material of the nail in the flesh of the toe sets up a foreign body reaction. However, it can be the initiating pathway for more serious disorders in certain patients at risk, especially those with diabetes or arterial insufficiency. Particular attention must be paid to high-risk patients. No direct mortality for this disorder exists. Rare in preteens, it is more common in teenagers, and its occurrence increases throughout life.
Patients have a painful, swollen and tender toe.
When infection is present, the patient may have local discharge. Important components of the history include a previous history of risk factors for diabetes and arterial insufficiency. Lymphangitis is rare. The affected side is readily apparent. Inspection for other contributing causes, particularly mycoses, is important.