Ingrown toenails

Overview

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. The result is pain, inflamed skin, swelling and, sometimes, an infection. Ingrown toenails usually affect the big toe.

Often you can take care of ingrown toenails on your own. If the pain is severe or spreading, your health care provider can take steps to relieve your discomfort and help you avoid complications of ingrown toenails.

If you have diabetes or another condition that causes poor blood flow to your feet, you're at greater risk of complications of ingrown toenails.

Symptoms

Ingrown toenail symptoms include:

• Pain and tenderness
• Inflamed skin
• Swelling
• Infection

When to see a doctor

See your health care provider if you:

• Experience severe discomfort in a toe, pus or inflamed skin that seems to be spreading
• Have diabetes or another condition that causes poor blood flow to the feet and you have a foot sore or infection

Causes

Causes of ingrown toenails include:

• Wearing shoes that crowd the toenails
• Cutting toenails too short or not straight across
• Injuring a toenail
• Having very curved toenails
• Nail infections
• Certain medical conditions

Risk factors

Factors that increase your risk of ingrown toenails include:

• Being an adolescent, when feet tend to perspire more, which softens the nail and skin
• Having nail care habits that encourage the nail to grow into the skin, such as cutting the nails too short or rounding the corners
• Having a reduced ability to care for your nails
• Wearing shoes that constrict the toes
• Participating in activities, such as running and kicking, that put your toes at risk of injury
• Having a condition, such as diabetes, that causes poor blood flow

Complications

Complications can be especially severe if you have diabetes, which can cause poor blood flow and damaged nerves in the feet. So a minor foot injury — a cut, scrape, corn, callus or ingrown toenail — may not heal properly and become infected.

Prevention

To help prevent an ingrown toenail:

• Trim your toenails straight across. Don't curve your nails to match the shape of the front of your toe. If you get a pedicure, ask the person doing it to trim your nails straight across. If you have a condition that causes poor blood flow to the feet and you can't trim your nails, see a podiatrist regularly to have your nails trimmed.
• Keep toenails at a moderate length. Trim toenails so they're even with the tips of your toes. If you trim your toenails too short, the pressure from your shoes on your toes may direct a nail to grow into the tissue.
• Wear shoes that fit properly. Shoes that place too much pressure on your toes or pinch them may cause a nail to grow into surrounding tissue. If you have nerve damage to the feet, you may not be able to sense if your shoes fit too tightly.
• Wear protective footwear. If your activities put you at risk of injuring your toes, wear protective footwear, such as steel-toed shoes.
• Check your feet. If you have diabetes, check your feet daily for signs of ingrown toenails or other foot problems.

Diagnosis

Your health care provider can diagnose an ingrown toenail based on your symptoms and a physical examination of the nail and the surrounding skin.

Treatment

If home remedies haven't helped your ingrown toenail, your health care provider may recommend:

• Lifting the nail. For a slightly ingrown nail, your health care provider may carefully lift the ingrowing nail edge and place cotton, dental floss or a splint under it. This separates the nail from the overlying skin and helps the nail grow above the skin edge, usually in 2 to 12 weeks. At home, you'll need to soak the toe and replace the material daily. Your health care provider might also prescribe a corticosteroid cream to apply after soaking.

  Another approach, which minimizes the need for daily replacement, uses cotton coated with a solution that fixes it in place and makes it waterproof (collodion).

• Taping the nail. With this method, your health care provider pulls the skin away from the ingrown nail with tape.
• Placing a gutter splint under the nail. With this method, your health care provider numbs the toe and slips a tiny slit tube underneath the embedded nail. This splint stays in place until the nail has grown above the skin edge. This method helps ease the pain of an ingrown nail as well.
• Partially removing the nail. For a more severe ingrown toenail (inflamed skin, pain and pus), your health care provider may numb the toe and trim or remove the ingrown portion of the nail. It could take 2 to 4 months for your toenail to grow back.
• Removing the nail and tissue. If you have the problem repeatedly on the same toe, your health care provider may suggest removing a portion of the nail along with the underlying tissue (nail bed). This procedure may prevent that part of the nail from growing back. Your health care provider will numb the toe and use a chemical, a laser or other methods.

After a nail-removal procedure, you can take a pain reliever as needed. It might help to apply a wet compress for a few minutes for a few days, until the swelling has gone down. And rest and elevate the toe for 12 to 24 hours. When you resume moving about, avoid activities that hurt your toe, and don't swim or use a hot tub until your health care provider tells you it's okay to do so. It's okay to shower the day after surgery. Call your health care provider if the toe isn't healing.

Sometimes, even with successful surgery, the problem occurs again. Surgical approaches are better at preventing recurrence than are nonsurgical methods.

Self care

You can treat most ingrown toenails at home. Here's how:

• Soak your feet in warm, soapy water. Do this for 10 to 20 minutes 3 to 4 times a day until the toe improves.
• Place cotton or dental floss under your toenail. After each soaking, put fresh bits of cotton or waxed dental floss under the ingrown edge. This will help the nail grow above the skin edge.
• Apply petroleum jelly. Put petroleum jelly (Vaseline) on the tender area and bandage the toe.
• Choose sensible footwear. Consider wearing open-toed shoes or sandals until your toe feels better.
• Take pain relievers. A nonprescription pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) may help ease the toe pain.

Preparing for your appointment

Your primary health care provider or a foot doctor (podiatrist) can diagnose an ingrown toenail. Prepare a list of questions to ask during your appointment. Some basic questions include:

• Is my condition temporary or long term (chronic)?
• What are my treatment options and the pros and cons of each?
• What results can I expect?
• Can I wait to see if the condition goes away on its own?
• What nail care routine do you recommend while my toe heals?

Your health care provider is likely to ask you questions such as:

• When did you begin experiencing symptoms?
• Do you have the symptoms all the time?
• What at-home treatments have you used?
• Do you have diabetes or another condition that causes poor blood flow to your legs or feet?