Ingrown toenails

Written By Ellie Woodcock, Verified By Magdalena Czerwiec-Pichlinska

When a toenail gradually curls and grows into the skin of the toe, this is called an Ingrown Toenail. They mostly affect the big toes, but can also occur on any other toe and can grow on either one, or both sides of the toe. People suffering from ingrown toenails will present with redness, swelling, tenderness or bleeding in the surrounding area.

Ingrown toenails can affect everyone, however, some people are at higher risk, such as those with nerve-related disabilities, poor blood circulation, injuries, an ongoing toe infection, or are diabetic.

The symptoms of an ingrown toenail include:

• Inflammation around the area
• Redness
• Fluid build-up which can cause tissue swelling
• Pain on palpation, or direct pressure on the toe
• In cases where there is an infection, the toe may be hot to the touch and have yellow pus

There are a number of circumstances which may lead to an ingrown toenail, including:

• Poorly maintained toenails: cutting off the edges will prompt the skin to grow over the nail and dig into the skin
• Poor foot hygiene: sweaty feet can soften the skin, creating an environment where the toenail can easily grow into it
• Poor walking pattern
• The shape of the toenail: a curved and irregular shape may increase the risk
• Toe injuries, such as dropping heavy objects directly on the toes, repetitive stress on the toe, or stubbing the toe
• Fungal-related toe infection
• Wearing tight and pointy shoes, or socks, for a prolonged period of time. Pressure will develop around the toenails, particularly the big toe, causing the nail to pierce the skin

Ingrown toenails are diagnosed through a physical examination by a professional, podiatrist or doctor. The main purpose of the examination is to rule out any signs of infection. If there are any signs of infection, an X-ray will be suggested to see how deep into the skin the nail has progressed.

There are many different treatment options available for an ingrown toenail, including home treatment; conservative treatment; and surgical intervention.

You can use the following preventative techniques at home:

1. Put the affected foot in warm water for 15 to 20 minutes per day, to soften the nail. Otherwise, keep the foot dry at all other times.
2. Gently push the skin away from the toenail until it fully detaches, then apply antibiotic cream on top to prevent inflammation. Make sure the toe is protected, or covered with a bandage, after the antibiotic cream is applied and keep the area dry.
3. Carefully pick shoes, especially when planning a long walk. Loose and breathable shoes are recommended during the healing process.
4. Take painkillers or anti-inflammatory medication for pain management. If you prefer to not take medication, apply the antibiotic gel.

In severe cases, surgical intervention may be required. This could be partial, or complete nail avulsion (removing part of, or the whole of the toenail that is digging into the skin). For children who are subject to repeated infections, doctors may suggest permanently removing the affected toenail.

During complete nail avulsion, your doctor will inject anaesthetic to numb the toe first, then remove part of, or the entire toenail. During partial nail avulsion, the edges of the toenail will be trimmed until it is completely straight. An external padding is placed under the remaining nail, preventing this from growing into the affected side of the toe in the future.

After surgery, the foot will be protected by a bandage. During the first few days, keep it elevated and put an ice pad on top to decrease the swelling from the surrounding area. Special-made footwear will be used to prevent weight bearing for a few days. Avoid movement as much as possible in the immediate days following the surgery, as your toe will take time to heal. The doctor may remove the bandage after 3 days and prescribe painkillers and antibiotics to prevent infection. During the healing process, you can keep your toes clean and dry by wearing open-toe shoes or sandals.

If you remove part of the toenail, it can take a few months to grow it back. If you decide to completely remove the affected toenail, it can take up to a year to grow back.

If an ingrown toenail is left untreated, the chances of infection are high, particularly if there is an open wound. The nail may also grow deep into the bone of your toe. An open wound can lead to foot ulcers, pressure sores, a decrease in or loss of blood flow to the toe, tissue damage and limb loss.

A serious infection or complication can happen to people who have certain medical conditions such as diabetes, vascular problems, or nerve-related pain in the toe. Patients with diabetes will experience more serious infections due to a lack of sensation and blood flow over the affected area. In addition, the healing process for people with these medical conditions will be slower.

To help prevent ingrown toenails, you can change your daily routine accordingly:

• Keep your feet clean and dry
• Do not cut your toenails too short
• Trim your toenails straight and prevent the edge from cutting into the skin
• Wear fitted, but not tight shoes and socks
• Pay attention to the condition of your toenail. If it appears thicker and starts to grow into the skin, seek professional advice before it progresses

You should seek help from your GP or doctor if:

• There is a health risk which could cause complications, such as diabetes, or other immune system diseases
• There are any signs of infection, such as swelling, redness and being hot to the touch
• Your toe condition is getting worse with at-home management
• You begin having allergic reactions
• You are not sure how to manage your ingrown toenail