Ingrown Toenail

What Is It?

An ingrown toenail is a toenail with an edge that pushes into the skin and soft tissue at the side of the nail. This causes redness, swelling and pain, and can lead to infection. Symptoms can be worse when you are wearing a shoe, which puts pressure on the nail. The nail on the big toe becomes ingrown more often than other toenails.

Ingrown toenails can be caused by cutting toenails improperly, by wearing shoes that fit poorly or by injuring the nail bed. Ingrown toenails also can run in the family. 

Symptoms

The most common symptom of an ingrown toenail is pain, especially if the area becomes infected. The surrounding skin might be deep pink and release a discharge or pus, or it might appear raw with a red moist lump overlapping the nail edge. 

Diagnosis

Your doctor can diagnose an ingrown toenail by examining the area. 

Expected Duration

Ingrown toenails sometimes correct themselves as they grow out, but more advanced cases may need to be corrected with surgery. 

Prevention

You can do several things to prevent ingrown toenails from forming:  

• Cut your toenails straight across so that the corner of the nail is visible to you, not buried under skin at the side of your nail. If you are not able to see the corner of your nail as you trim it, your nail might have a jagged corner after it is trimmed, with a "forked" edge that can extend under your skin as it grows. Use clippers that are designed to cut toenails, or a nail file.  
• Wear shoes that are large enough that they don't push your toes together.  

If you are elderly, have diabetes or have other conditions that affect your circulation, be especially careful about how you cut your toenails and manage your foot health. 

Treatment

In the early stages of an ingrown toenail, soak your foot in warm water containing antibacterial soap or a few tablespoons of salt. Dry your foot and apply an over-the-counter hydrocortisone or antibiotic ointment and a clean dressing for one to two weeks. Do not cut your nail. As much as possible, wear open-toed or loose-fitting shoes. When the nail grows out, cut it straight across. If you are not making any progress, your doctor can prescribe a stronger prescription strength corticosteroid ointment to apply to the nail fold.

More advanced ingrown toenails require the attention of a health care professional. If the nail is not deeply ingrown, the edge of the nail can be lifted from the skin edge that it is irritating. There are multiple ways to help stop the nail from growing into the nail fold. For example, a small piece of clean cotton can be used to prop the nail's corner up and over the skin edge until the skin heals. Your doctor may cut open infected areas with a blade or a needle to allow the pus to drain.  

For a more deeply ingrown nail, your doctor may numb your toe with local anesthetic and then remove a vertical strip of nail from the affected side of your toe. After this piece of nail is removed, the nail has a chance to regrow without an ingrown edge. If you continue to get an ingrown toenail, your doctor might also treat the cuticle with a medicine called phenol. Phenol will prevent that area of your cuticle from producing new nail, so your toenail will be narrower than it was previously.  

When To Call a Professional

Contact your doctor or foot care specialist if ingrown nail symptoms do not go away on their own in a reasonable period, if you are in pain or if you notice an infection. If you have diabetes or another health problem that affects your circulation, contact your doctor for treatment of your ingrown nail even if your symptoms are mild. 

Prognosis

Once you learn the proper technique for cutting your nails, you may never have another ingrown toenail. If you need to have a vertical strip of your toenail removed, this side of your nail will take several months to replace itself. Usually, the new nail will not be an ingrown nail. 

Additional Info

American Podiatric Medical Association (APMA)
https://www.apma.org/