Ingrown Toenail

An ingrown toenail is a nail that grows in a curved fashion, digging into the skin, usually at the nail borders (sides of the nail). The digging of the nail irritates the skin, often creating the painful sensation, characteristic of an ingrown site.

In severe cases, the nail can break the skin, allowing bacteria to enter and cultivate an infection. It is important to stop the incorrect growth pattern of an ingrown toenail to prevent a severe infection within the toe.

Prevention

Proper trimming: Cut toenails in a fairly straight line, and do not cut them too short. You should be able to get your fingernail under the sides and end of the nail.

Well-fitting shoes and socks: Do not wear shoes that are short or tight in the toe area. Avoid shoes that are loose because they too cause pressure on the toes, especially when running or walking briskly.

Tips for At Home Trimming:

  • Do not cut a notch in the nail. Contrary to what some people believe, this does not reduce the tendency for the nail to curve downward.
  • Do not repeatedly trim nail borders. Repeated trimming does not change the way the nail grows and can make the condition worse.
  • Do not place cotton under the nail. Not only does this not relieve the pain, it provides a place for harmful bacteria to grow, resulting in infection.
  • Over-the-counter medications are ineffective. Topical medications may mask the pain, but they do not correct the underlying problem.
  • Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it is time to see a foot and ankle surgeon.

Symptoms

  • Pain
  • Redness
  • Swelling
  • Warmth
  • Drainage *
  • Foul odor *

*These are signs of an infection. If you are experiencing these symptoms at the site of an ingrown nail, see a doctor ASAP.

Risk Factors

If any of the following apply to you, you may have a higher risk of an ingrown toenail.

  • Heredity: In many people, the tendency for ingrown toenails is inherited.
  • Trauma: Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
  • Improper trimming: The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.
  • Improperly sized footwear: Ingrown toenails can result from wearing socks and shoes that are tight or short.
  • Nail conditions: Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

Treatment

Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.

Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your
symptoms have improved.

A partial nail avulsion will remove the nail, but will leave the nail root on the toe. This will allow the nail to regrow, hopefully along a more corrected path. A matrixectomy may be advised for repeating or severe ingrown nail cases. This procedure removes the nail, and the nail root, eliminating the problem by killing the cells that refuse to grow in a healthy direction. The nail will not grow back after this procedure.