If a toenail becomes ingrown, the edges or corners grow into the skin next to the nail and break the skin. It is a common condition, and it can be painful, causing swelling, redness, and sometimes infection.
An ingrown toenail usually happens on the big toe, the "thumb" of the foot. It can affect one or both sides of the toe.
Most ingrown toenails can be treated at home, but if the pain is severe or spreading, it may be necessary to see a health care provider, to prevent complications and relieve symptoms.
Contents of this article:
What causes ingrown toenails?
Footwear that crowds the toes and toenails can increase the chance of an ingrown toenail. This includes shoes that are too tight because they are too short, too narrow at the end, or too flat at the end. Tight-fitting socks, tights or stockings may cause ingrown toenails.
An ingrown toenail can be painful, and it can lead to infection.
Cutting the toenails too short, not cutting straight across, or cutting the edges of the toenail can encourage 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 the toe or kicking something, hard can lead to ingrown toenails.
If the toenails have an unusual curvature, they are more likely to grow into the soft tissue, causing inflammation and possible infection.
A person's posture, or how they walk or stand, can affect the chances of developing ingrown toenails.
Poor foot hygiene or excessive sweating are risk factors. If the skin on the toes and feet are moist and warm, there is a higher chance of developing an ingrown toenail.
What does an ingrown toenail look like?
In the early stages, the skin next to the nail may be tender, swollen, or hard.
When the nail pierces the skin, bacteria can get in, resulting in infection. The area affected becomes red, swollen, warm, and painful. There may be bleeding and pus.
Anyone with symptoms of infection should seek medical help, either a primary care physician, orthopedic surgeon, or foot care specialist, known as a podiatrist.
What is the treatment for an ingrown toenail?
Ingrown toenails should be treated as soon as symptoms appear, especially if the person has diabetes, nerve damage in the foot or leg, or poor circulation in the foot,
Treatment at home
Most health care providers will advise the patient to treat the nail themselves. Steps include:
Following treatment, the toenail may be painful.
- Soaking the foot in warm water three to four times a day, while using a cotton bud to gently push the skin away from the toenail
- Wearing footwear that leaves the toes plenty of room to move
- Over-the-counter (OTC) medications, such as acetaminophen, for example Tylenol or paracetamol, or ibuprofen for pain.
If symptoms do not go away, a healthcare professional may remove some of the nail that is pushing into the skin. It may be necessary to remove a portion of the nail and the underlying nail bed to prevent the problem from coming back.
As the nail grows back, the healthcare provider may place a piece of cotton wool under the nail to stop it from digging into the skin again. It is important to change the cotton wool every day.
If the area is infected, the doctor may prescribe antibiotics.
If the problem remains, the doctor or podiatrist may recommend removing part of the nail through surgery. This is called a toenail avulsion.
The doctor will cut away the edges of the toenail, to make it narrower. The doctor may also remove the folds of skin on either side of the toenail. If they use a local anesthetic, the patient will be awake but the area is numbed, so they will not feel anything. Some cases may need a general anesthetic.
If the nail has become very thick or distorted, the whole nail may be taken out, again under a local anesthetic.
If the ingrown toenail keeps coming back, the cells in the nail bed may be removed so that the toenail cannot grow back.
The cells may be destroyed using a chemical called phenol, or another method, such as laser.
Although the doctor will use a local anesthetic, the patient's toe may feel tender when the anesthetic wears off. Ibuprofen or acetaminophen, for example Tylenol, paracetamol, may help.
For 1 to 2 weeks, the patient will have to wear either very soft and spacious footwear or open-toed sandals.
How to prevent ingrown toenails
The nails should be cut across in a straight line, not rounded at the corners, and not too short. It is easier to cut the nails after a bath or a shower.
People with circulatory problems in the feet, and who are unable to cut their own nails, should see a podiatrist regularly to have the nails professionally trimmed. Patients with diabetes or peripheral vascular disease need to be particularly careful.
Footwear, including shoes, socks, tights and stockings, should always fit properly. Shoes must be the right length and width so that the toes do not crowd. Tight shoes cause pressure, but if shoes are too loose, the toes may hit against the tip of the shoe. This, too, adds pressure and could cause an ingrown toenail.
Hygiene and dryness are important. If the feet are clean and dry, there is a lower chance of developing an ingrown toenail.