An ingrown toenail happens when the edges or corners of the nail 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. It usually affects the big toe, either on one or both sides of the toe.
Ingrown toenails can usually 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.
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. Otherwise, complications can occur.
The American College of Foot and Ankle Surgeons (ACFAS) advise seeing a doctor rather than using over-the-counter (OTC) medications, as these may mask the pain, but they will not solve the problem.
Seeing a doctor
The patient should see a doctor if:
- they have diabetes or a circulatory problem
- symptoms do not go away
- an infection develops
A healthcare professional may remove some of the nail that is pushing into the skin.
They may need 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.
ACFAS do not recommend putting cotton under the nail as a home remedy because it increases the risk of infection.
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. They may also remove the folds of skin on either side of the toenail. If it is done under a local anesthetic, the patient will be awake but the area is numbed, so they will not feel anything. In some cases, a general anesthetic may be necessary.
If the nail has become very thick or distorted, the whole nail may be taken out, again under a local anesthetic.
This is not usually very painful, and most people can get back to normal activity the next day.
If the ingrown toenail keeps coming back, the cells in the nail bed may be removed so that the toenail cannot grow again.
These cells may be destroyed using a chemical called phenol, or another method, such as a laser.
Although the doctor will use a local anesthetic, the toe may feel tender when the anesthetic wears off. Ibuprofen or acetaminophen, for example, Tylenol, or paracetamol, may help.
For 1 to 2 weeks, the patient will have to wear either very soft and spacious footwear or open-toed sandals.
When the nail pierces the skin, bacteria can enter the wound.
This can result in infection. The area affected becomes red, swollen, warm, and painful. There may be bleeding and pus.
If you suspect that you may have an ingrowing toenail, it is important to keep the area clean and dry to prevent infection.
Anyone with symptoms of infection should seek medical help, either with a primary care physician, orthopedic surgeon, or a foot care specialist known as a podiatrist.
Most healthcare providers will advise the patient to treat the nail themselves.
Here are some tips:
- Soak 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. A doctor may advise you to add Epsom’s salt.
- Avoid repeatedly cutting the toenail, as this can make the problem worse.
- Wear footwear that leaves the toes plenty of room for movement.
The symptoms of an ingrowing toenail can be quite painful.
At first, the skin next to the nail may be tender, swollen, or hard.
The nail may feel painful in response to pressure, and there may be inflamed and overgrown skin at the tip of the toe. The ingrowing toenail may also leak blood and white or yellow pus.
Fluid may also build up in the area.
Here are some of the causes of ingrown toenails:
Footwear: Shoes and socks that crowd the toes and toenails increase the chance of an ingrown toenail. Shoes can be 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.
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. The nail can then push into that skin and pierce it.
Toenail injury: Dropping something on the toe, kicking something hard, and other accidents can lead to ingrown toenails.
An unusual curvature: This increases the risk that the toenail will grow into the soft tissue, causing inflammation and possible infection.
Posture: How a person walks or stands can affect the likelihood of developing ingrown toenails.
Poor foot hygiene or excessive sweating: If the skin on the toes and feet is moist and warm, there is a higher chance of developing an ingrown toenail. A fungal infection can increase the risk.
Heredity: ingrown toenails can run in families.
Genetic factors: Some people are born with larger toenails.
To prevent ingrown toenails from developing:
Cut the nails 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.
See a podiatrist regularly for professional trimming, especially if you have circulatory problems in the feet, or cannot cut your own nails. Patients with diabetes or peripheral vascular disease need to be particularly careful.
Maintain hygiene and dryness, because an ingrown toenail is less likely if the feet are clean and dry.
Choose footwear that fits properly, including shoes, socks, tights and stockings. 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.