Introduction

An ingrown toenail is a common condition in which the corner or side of one of your toenails grows into the soft flesh of your toe. The result is pain, redness, swelling and, sometimes, an infection. The condition usually affects your big toe.

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

If you have diabetes or another condition that causes poor circulation to your feet, you"re at greater risk of complications from an ingrown toenail.

Signs and symptoms

Signs and symptoms of an ingrown toenail include:

Pain and tenderness in your toe along one or both sides of the nail
Redness around your toenail
Swelling of your toe around the nail
Infection of the tissue around your toenail

Causes

Ingrown toenails result when the nail grows into the flesh of your toe, often the big toe. Common causes include:

Wearing shoes that crowd your toenails
Cutting your toenails too short or not straight across
Injury to your toenail
Unusually curved toenails
Thickening of your toenails

Risk factors

Anyone can develop an ingrown toenail. But you may be more prone to ingrown toenails if you have toenails that curve down.

Ingrown toenails are also more common in older adults, because nails tend to thicken with age. This thickening or change to the curvature of your nails can cause ingrown toenails.

When to seek medical advice

If you experience severe discomfort in your toe or pus or redness that seems to be spreading, see your doctor. If you have diabetes or any circulation impairment to your lower extremities, seek the advice of a foot doctor (podiatrist) on how to properly care for ingrown toenails. Also seek prompt treatment for any foot sore or infection.

Complications

Left untreated or undetected, an ingrown toenail can infect the underlying bone and lead to a serious bone infection.

Complications can be especially severe if you have diabetes because the circulation and nerve supply to your feet can be impaired. Therefore, any relatively minor injury to your foot — cut, scrape, corn, callus or ingrown toenail — can lead to a more serious complication. In rare cases, an ingrown toenail can result in a difficult-to-heal open sore (foot ulcer), which could eventually require surgery. Foot ulcers left untreated may become infected and eventually even gangrenous. Sometimes amputation is the only treatment option.

Treatment

If home remedies don"t help, your doctor can treat an ingrown toenail by trimming or removing the ingrown portion of your nail to help relieve pain. Before this procedure, your doctor numbs your toe by injecting it with an anesthetic. After the procedure, you may need to rest your foot and soak it in warm water. Your doctor may also recommend using topical or oral antibiotics, especially if the toe is infected or at risk of becoming infected.

For a recurrent ingrown toenail, your primary doctor or foot doctor may suggest removing a portion of your toenail along with the underlying tissue (nail bed) to prevent that part of your nail from growing back. This procedure can be done with a chemical, a laser, or other methods.

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 have your toenails done at a nail salon, be sure to tell your pedicurist to trim your nails straight across. If you have circulation problems in your feet from disorders such as diabetes or peripheral vascular disease, see a podiatrist regularly to have your nails professionally trimmed.
Keep toenails at a moderate length. Trim toenails so that they"re even with the tips of your toes. If you trim your toenails too short, the pressure from your shoes on your toes" tissue may direct your nails to grow into the tissue.
Wear shoes that fit properly. Shoes that place excessive pressure on your toes or pinch your toes may cause your nails to grow into surrounding tissue. If you have nerve impairment to your feet, you may not be able to sense if your shoes fit too tightly. Take care to buy and wear properly fitted shoes, preferably from a shoe store specializing in fitting shoes for people with foot problems.
Wear protective footwear. If your work puts you at risk of injuring your toes, buy footwear such as steel-toed shoes, which protect your toes.

Self-care

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

Soak your feet. Do this for 15 to 20 minutes twice a day, using warm salt water (1 teaspoon of table salt per pint of water) or warm, soapy water. Soaking reduces swelling and relieves tenderness.
Give your nail some help. Put fresh bits of cotton under the ingrown edge after each soaking. This will help the nail eventually grow above the skin edge.
Use a topical antibiotic. Apply an antibiotic ointment and bandage the tender area.
Choose sensible footwear. Consider wearing open-toed shoes or sandals until your toe feels better.
Take pain relievers. If there"s severe pain, take over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve the pain until you can make an appointment with a podiatrist or dermatologist.
Check your feet. If you have diabetes, check your feet daily for signs of ingrown toenails or other foot problems.

March 17, 2005