An ingrown toenail occurs when the toenail grows into the skin next to the nail. It most commonly affects the big toe.
Although an ingrown toenail will not go away without treatment, people can usually treat it at home.
In this article, we examine the symptoms and causes of ingrown toenails. We also look at how to treat and prevent them.
Ingrown toenails are common and mostly affect adolescents and young adults. People at these ages experience increased perspiration, which can lead to the nail fold becoming soft. Also, participating in sport can result in a small piece of the nail embedding itself in the skin.
Older adults may also be more likely to develop ingrown toenails. This is because impaired vision and reduced mobility make it more difficult to care for nails, which tend to become thicker and more challenging with age.
The most common causes of an ingrown toenail include:
- Wearing poorly fitting shoes: Tight footwear or narrow shoes can place pressure on the nail wall when the big toe pushes into the second toe.
- Trimming toenails incorrectly: A toenail needs to be cut straight across above the nail bed. If it is cut too short, bulging tissue may lead to inflammation.
- Excessive sweating: Too much perspiration can cause the nail bed to become soft, so the nail penetrates the skin easily.
- Injuring the toe: Injuries may include stubbing the toe or dropping something on the foot.
- Taking part in sports: Sports, such as running or activities that involve repeatedly kicking a ball, may damage the toenails and increase the risk of ingrown toenails.
- Nail problems: Fungal infections, or losing a nail due to trauma, can cause ingrown toenails.
- Genetic predisposition: Some people inherit the tendency to develop ingrown toenails.
Ingrown toenails can be painful. The pain might range from mild to severe, and tends to get worse in stages.
Initial symptoms may include:
- redness around the toenail
- tenderness or pain along the sides of the toenail
- the skin around the nail becoming swollen or hard
- a buildup of fluid around the toe
- pain when putting pressure on the toe
If the nail is cutting into the skin, bacteria can get into the toe, which may cause an infection.
How to tell if it is infected
Symptoms of a toe infection may include:
- red, inflamed skin
- pus discharge
- the skin of the nail fold grows over the nail
A person needs to treat their ingrown toenail as soon as possible to prevent symptoms from worsening.
How to check an ingrowing toenail
An ingrowing toenail might curve downwards into the skin, or the skin might look as though it is growing over the toenail.
A doctor will be able to diagnose an ingrown toenail with a physical exam. It is essential to seek advice from a doctor if the symptoms are severe, as several types of tumors can mimic the presentation of an ingrown toenail.
According to the American Academy of Orthopaedic Surgeons, people should treat an ingrown toenail as soon as they notice it.
They can help treat an ingrown toenail at home by:
- soaking the foot in warm water 3 or 4 times a day
- keeping the foot clean and dry at all other times
- wearing comfortable shoes that have enough room for the toes, such as sandals
- taking ibuprofen or acetaminophen to help relieve pain
People could also add Epsom salt to the water while soaking. They can also gently massage the side of the nail fold to reduce swelling.
What not to do
The American College of Foot and Ankle Surgeons offer advice on what not to do with an ingrown toenail. They recommend:
- never cutting a notch in the nail, as it does not stop it from curving downwards into the skin
- not repeatedly trimming the nail around the borders, as it can make the condition worse
- not placing cotton under the nail, as it creates the perfect environment for bacteria to grow, which increases the chance of infection
- avoiding over-the-counter ingrown toenail medications, as they may mask the pain, but do not treat the problem
When to see a doctor
Anyone who follows home care advice for ingrown toenails, but does not see any improvement within 2–3 days should speak to a doctor. It is also important to seek medical attention if there are signs of an infection.
People with underlying medical conditions, such as diabetes, nerve damage in the feet, or poor circulation, should see a doctor as soon as they notice an ingrown toenail.
Treatment and aftercare
Doctors will usually prescribe antibiotics if someone has an infected ingrown toenail.
They may also recommend further treatment, such as a minor surgical procedure, where they take away part of the nail’s side border. Doctors tend to perform this surgery under local anesthetic.
After the procedure, a doctor may apply a bandage and advise the person to rest until the following day. Most people say they have little or no pain afterward.
If someone treats an ingrown toenail before infection takes hold, the condition is usually harmless.
Most people can manage an ingrown toenail at home. Sometimes, nails may become ingrown again. If this is the case, a doctor may recommend a nail root removal procedure.
Most cases of ingrown toenails can be prevented by:
- Properly trimming nails: People should cut their nails in a straight line, taking care not to cut them too short. They should be able to get their fingernail under the sides and the end of the nail.
- Wearing shoes and socks that fit well: Ill-fitting shoes and socks can put pressure on the toes, particularly when walking fast or running, which can lead to ingrown toenails.
- Never picking at the toenails or tearing them off.
- Keeping the feet clean.
Ingrown toenails can be painful. They occur when the toenail grows into the toe, or when the skin grows over the nail. The condition usually affects big toes, but it can develop with any toe.
Ill-fitting shoes, improper nail trimming, and foot conditions can cause ingrown toenails.
They will not go away without intervention, but people can usually treat them at home over a few days.
A person should speak to a doctor if:
- the ingrown toenail does not improve with home care
- they have an underlying health condition that affects the feet, such as diabetes
- there are signs of infection
To avoid ingrown toenails, people should use footwear that gives their toes lots of space. They should also use proper nail trimming techniques.