Ingrown toenail: Treatment, causes, and symptoms

An ingrown toenail happens when the edges or corners of the nail grow into the skin next to the nail and break the skin.

It is a common condition, and it can be painful, causing swelling, redness, and sometimes infection. It usually affects the big toe, either on one or both sides of the toe.

Ingrown toenails can usually be treated at home, but if the pain is severe or spreading, it may be necessary to see a health care provider, to prevent complications and relieve symptoms.

People with poor circulation, such as those with diabetes or peripheral vascular disease, are more likely to have complications.

Treatment

Ingrown toenails should be treated as soon as symptoms appear, especially if the person has diabetes, nerve damage in the foot or leg, or poor circulation in the foot. Otherwise, complications can occur.

The American College of Foot and Ankle Surgeons (ACFAS) advise seeing a doctor rather than using over-the-counter (OTC) medications, as these may mask the pain, but they will not solve the problem.

Seeing a doctor

The patient should see a doctor if:

they have diabetes or a circulatory problem

symptoms do not go away

an infection develops

A healthcare professional may remove some of the nail that is pushing into the skin.

They may need to remove a portion of the nail and the underlying nail bed to prevent the problem from coming back.

As the nail grows back, the healthcare provider may place a piece of cotton wool under the nail to stop it from digging into the skin again. It is important to change the cotton wool every day.

ACFAS do not recommend putting cotton under the nail as a home remedy because it increases the risk of infection.

If the area is infected, the doctor may prescribe antibiotics.

Surgery

If the problem remains, the doctor or podiatrist may recommend removing part of the nail through surgery. This is called a toenail avulsion.

The doctor will cut away the edges of the toenail, to make it narrower. They may also remove the folds of skin on either side of the toenail. If it is done under a local anesthetic, the patient will be awake but the area is numbed, so they will not feel anything. In some cases, a general anesthetic may be necessary.

If the nail has become very thick or distorted, the whole nail may be taken out, again under a local anesthetic.

This is not usually very painful, and most people can get back to normal activity the next day.

Removal

If the ingrown toenail keeps coming back, the cells in the nail bed may be removed so that the toenail cannot grow again.

These cells may be destroyed using a chemical called phenol, or another method, such as a laser.

Although the doctor will use a local anesthetic, the toe may feel tender when the anesthetic wears off. Ibuprofen or acetaminophen, for example, Tylenol, or paracetamol, may help.

For 1 to 2 weeks, the patient will have to wear either very soft and spacious footwear or open-toed sandals.

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Infections

When the nail pierces the skin, bacteria can enter the wound.

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