Ingrown Toenail

An ingrown toenail occurs when the sharp edge of a toenail grows into the skin of the groove beside the nail (lateral nail groove), causing pain. Ingrown toenails most commonly occur on the first (big) toe. If left untreated, an ingrown toenail may become inflamed and infected. The infection can even spread throughout the toe.

SYMPTOMS

  • Pain, centered on the nail groove.

  • Tenderness and inflammation.

  • Pus drainage (occasionally).

  • Signs of infection: redness, swelling, pain, warm to the touch.

CAUSES

Ingrown toenails are caused when the toenail grows into the neighboring fleshy nail fold. This may be the result of poor nail trimming or pressure from shoes.

RISK INCREASES WITH:

  • Curved nail formations.

  • Clipping toenails too far on the sides, which allows tissue to grow over the nail.

  • Poorly fitted shoes, especially those that press down on the toenails.

  • Sports that require sudden stops, causing the toe to jam into the shoe.

PREVENTION

  • Trim toenails properly, making sure the sides are not clipped too short.

  • Wear properly fitted shoes.

  • Avoid excessive pressure on the toenails.

PROGNOSIS

Ingrown toenails are usually curable within 1 week, depending on the presence or absence of an infection.

RELATED COMPLICATIONS

  • Chronic infection, that cannot be cured without surgery.

  • Spread of infection throughout the toe, or even the bone.

TREATMENT

Treatment first involves resting from aggravating activities, wearing shoes that do not place pressure on the toenails, antibiotics (if infected), and soaking the foot in warm water (with or without Epsom salt). After the foot has been soaked, you may be able to gently lift the nail from the fleshy tissue, and place a bit of cotton ball under the nail, easing the pressure. If you have been prescribed antibiotics, expect relief to begin up to 48 hours after taking the medicine. Symptoms usually go away within 1 week. For people who suffer from persistent (chronic) ingrown toenails, surgery may be advised.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Antibiotics may be prescribed to fight infection. Take as directed by your caregiver. Finish the entire prescription, even if you start to feel better before you finish it.

SOAKS AND COLD THERAPY

  • Soak the toe (or whole foot) for 20 minutes, twice a day, in a gallon of warm water. You may add 2 tablespoons of Epsom salts or a mild detergent.

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 48 hours, despite treatment.

  • You develop fever, increased pain and swelling, or signs of infection (pain, redness, tenderness, swelling, warmth) in the toe, after surgery.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)