An ingrown toenail is typically the result of the nail plate growing into the adjacent nail fold or skin next to the toenail. The break in the skin allows bacteria to enter and an infection occurs. 

Sometimes a toenail can acquire a bacterial infection under the nail plate itself. Examples of this can be due to a deformed toenail (which could be from nail fungus or trauma to the toe) causing the toenail to become loose and allowing bacteria to collect under the nail plate and eventual form an abscess. The abscess usually occurs in the eponycium or “cutical” area. 

Here is an example of a nail deformity in which the patient presented with severe pain and drainage from the toenail. Under these circumstances the nail needs to be removed to allow the infection to be drained.  An antibiotic is initiated and recovery is usually two weeks. It’s is important to catch this soon as neglect can lead to a bone infection in the toe. 

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