Most people who have an ingrown toenail do so on their big toe (the 'thumb' of the foot). One or both sides of the toe can be affected.
Most cases of ingrown toenails can be self-treated. However, if the pain is severe or spreading, a health care provider may have to intervene to prevent complications and provide relief of symptoms. People with poor circulation, such as those with diabetes or peripheral vascular disease, are more likely to suffer from complications.
What are the causes of ingrown toenails?
- Footwear that crowds the toes and toenails. This may include shoes that are too short, too narrow at the end, or too flat at the end - shoes that are too tight. Tight-fitting socks or tights (stockings) may cause ingrown toenails.
- Not cutting the toenails straight across. Cutting the toenails too short, or cutting the edges of the toenail encourages the surrounding skin to fold over the nail, and the nail to push into that skin and pierce it.
- Toenail injury - such as dropping something on your toe or kicking something hard.
- Toenails with an unusual curvature.
- Posture - the way somebody walks and/or stands can influence his/her chances of developing ingrown toenails.
- Poor foot hygiene or excessive sweating - if the skin on the toes and feet are moist and warm there is a higher risk of developing an ingrown toenail.
What are the signs and symptoms of an ingrown toenail?A symptom is something the patient feels or reports, while a sign is something other people, including a doctor may detect. For example, a pain is usually a symptom while a rash could be a sign.
Early signs and symptoms may include:
- Tender skin adjacent to the nail
- Swollen skin adjacent to the nail
- Hard skin adjacent to the nail.
- Red skin
- Area is swollen
- Area is warm
- Area is painful
- Area bleeds
- Area oozes pus which is sometimes smelly.
What are the treatment options for ingrown toenail?Ingrown toenails should be treated as soon as symptoms are felt. Most health care providers will advise self-treatment (listed below) if the condition has not had a chance to progress and cause complications.
Self-care for ingrown toenails
- Soak the foot in warm water three to four times a day. While soaking, use a cotton bud to push the skin away from the toenail - this must be done gently.
- Make sure your footwear gives your toes plenty of space to wiggle.
- For pain, OTC medications, such as acetaminophen (Tylenol, paracetamol) or ibuprofen may help. Do not give aspirin to children under the age of 16.
If the area is infected the doctor may prescribe antibiotics.
If the problem does not respond to treatment the doctor or podiatrist may recommend the surgical removal of part of the nail - a toenail avulsion. The edges of the toenail are cut away, making it narrower. The doctor may also remove the folds of skin on either side of the toenail. A local anesthetic will be used - the patient is awake but the area is numbed so that nothing is felt during the procedure.
If the nail has become very thick or distorted the whole nail may be taken out. A local anesthetic will be used.
This involves removing the cells in the nail bed so that the toenail cannot grow back. The cells may be destroyed using phenol, a chemical. They may also be removed with laser, or some other method.
This procedure will usually be recommended if the ingrown toenail is a recurrent problem.
A local anesthetic will be used, but the patient's toe may feel tender when it wears off. If there is some pain afterwards some ibuprofen or acetaminophen (Tylenol, paracetamol) may help. For about one or two weeks the patient will have to wear either very soft and spacious footwear or open-toed sandals.
Prevention of ingrown toenails
- Cut your nails properly - This means cutting them across in a straight line; and NOT cutting around the corners to give them a rounded appearance - tell the pedicurist at a nail salon that is how you want your toenails cut. If you cut your nails after a bath or a shower you will probably find it easier to do.
If you have circulation problems in your feet, see a podiatrist regularly to have your nails professionally trimmed if you cannot do so yourself; this may apply especially to patients with diabetes or peripheral vascular disease.
Don't cut your toenails too short.
- Footwear - make sure your shoes, socks, tight/stockings are the right fit. Shoes must be the right length and width so that the toes do not crowd. If shoes are too loose your toes may hit against the tip of the shoe, which adds pressure and could cause an ingrown toenail. In other words, not too tight and not too loose.
- Hygiene and dryness - if you keep your feet clean and dry your chances of developing an ingrown toenail may be significantly reduced; compared to somebody with sweaty feet.