- An ingrown toenail is a common condition often seen in the big toenail.
- Athletes commonly suffer from ingrown toenails.
- Improper shoe gear and toe injuries are commonly associated with ingrown toenails.
- It is not uncommon for an ingrown toenail to recur.
- Conservative treatments include soaks, elevation, and good foot hygiene. Medical treatment is not always required. Oral antibiotics are sometimes required as a treatment. Sometimes minor toenail surgery is required.
What are ingrown toenails?
An ingrown toenail is caused by the pressure from the in growth of the nail edge into the skin of the toe. Once the edge of the nail breaks through the skin, it produces inflammation. Initially presenting as a minor discomfort, it may progress into an infection in the adjacent skin (cellulitis) and/or become a reoccurring problem. Ingrown toenails most commonly affect the large (great) toes. An ingrown toenail is medically referred to as onychocryptosis.
What are the symptoms and signs of an ingrown toenail?
Ingrown toenail symptoms and signs include redness, pain, and swelling. Sometimes there may be a clear yellowish drainage, or if it becomes infected, pus drainage. Occasionally, ingrown toenails resolve without treatment. Painful, persistent, and recurring ingrown toenails should be treated by a podiatrist.
What causes ingrown toenails?
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The main causes of an ingrown toenail are improper trimming of the toenail, an inherited or hereditary condition, and improper shoe fitting. Injury and nail picking are also common causes.
Are some people more prone to ingrown toenails?
There are a number of risk factors that may predispose a person to having an ingrown toenail. The following are some of the more common:
- Athletics, particularly stop and start sports such as tennis, soccer, and basketball
- Improper shoe gear that is either too small or too large
- Repetitive pressure or trauma to the feet
- Poor foot hygiene
- Abnormal gait
- Foot or toe deformities, such asbunions and hammertoes
- Congenital toenail deformity
- Abnormally long toes
- Obesity
- Diabetes
- Fungus infection of the nails (onychomycosis)
- Arthritis
- Soft tissue or bony tumors of the toes
- Hyperhidrosis (excessive sweating of the feet)
- Edema of the lower extremities
Which nails are most commonly affected by ingrown toenails?
Ingrown toenails most commonly occur in the large or “great toes.” However, any of the toenails can be affected on either border or side.
What causes infections in ingrown toenails?
The warm, moist environment of the feet can be a breeding ground for bacteria and fungi. These commonly include Staphylococcus,Pseudomonas, dermatophytes, Candida, and Trichophyton. When there is a break in the skin from the offending nail border, these organisms can invade the area and cause an infection. Treatment for these infections is essential to maintain healthy toenails and feet.
How do physicians diagnose an ingrown toenail?
The diagnosis of an ingrown toenail is typically straightforward. However, the signs and symptoms of ingrown toenails can vary quite dramatically, particularly if an infection develops. There may simply be some tenderness at the nail border when pressure is applied. There is typically an incurvation of the nail or a spike of nail (spicule) pressing into the skin of the nail border. Associated redness and swelling localized to the nail also suggest the diagnosis of an ingrown toenail. When an infection is involved, there may be severe redness and swelling, drainage, pus, and malodor.
Making the proper diagnosis requires taking into account the medical history and all possible causative factors. If you are unsure, seek professional help. Some conditions such as tumors, foreign bodies, trauma, and fungal infection may appear to be an ingrown toenail to the untrained eye.
What are possible complications of ingrown toenails?
An unresolving ingrown toenail can have serious consequences. A localized infection of the nail border (paronychia) can progress to a deeper soft-tissue infection (cellulitis) which can in turn progress to a bone infection (osteomyelitis). Complications can include scarring of the surrounding skin and nail borders as well as thickened, deformed (onychodystrophy) fungal toenails (onychomycosis).
How do people treat an ingrown toenail at home?
The following home-care treatments may provide temporary relief.
- Lukewarm water foot soaks for 15 to 20 minutes with any one of the following options can be helpful: one part white vinegar to four parts water; 2 tablespoons Epsom salts per quart of water; or a dilute Clorox type bleach with 1/3 teaspoon of Clorox in 1 gallon of water.
- Elevate the foot and leg.
- Take oral anti-inflammatory drugs.
- Trim the toenail straight across the top without digging into the corners or leaving them too short.
- Carefully rolling back be overgrown skin at the affected nail border may allow one to slip a small piece of cotton or dental floss to lift the offending edge of the nail up from the skin.
If symptoms persist, medical treatment from a podiatrist is recommended.
When should someone seek medical treatment for an ingrown toenail?
Persons with diabetes or those who have a compromised immune system should promptly seek the care of a podiatrist/physician for ingrown toenail treatment. If home treatments are not successful within a week or there is persistent pain and/or signs of infection, podiatric medical treatment is recommended. Signs of infection can include swelling, redness, streaking, pain, and drainage that may be yellow, green, or white and purulent (containing pus).
What is the treatment for ingrown toenails?
There are various types of treatments, including self-care, soaking, avoidance of shoe pressure on the toenails, proper methods to trim the nails, and various surgical treatments. Sometimes antibiotics may be required.
What types of nail surgery are used for ingrown toenails?
Surgical treatments include the following: temporary section of the offending nail border or corner, avulsion (detachment) of the nail or offending nail border, or permanent elimination of the nail (matrixectomy) or offending nail border (partial matrixectomy). A matrixectomy is the destruction or removal the cells where the nail grows from called the nail matrix. The nail matrix is at the base of the toenail under the skin. This procedure can be done surgically by dissection, chemically, or electrically by destroying part or all of the matrix cells. These procedures are commonly reserved for chronic or recurrent situations.
Is surgery really necessary?
If conservative treatments fail, surgery to remove the offending nail border is recommended. If the condition is recurrent and/or chronic, a matrixectomy may be recommended.
How can people prevent ingrown toenails from recurring?
Avoid shoes that are too small (putting pressure on the toenail) or too large (where the foot is moving back-and-forth inside the shoe. Improperly fitting footwear can cause trauma to the toenail. Use proper methods of trimming the toenail with clean instruments and do not trim them too short.
Ingrown toenail do’s
- Do wear properly fitting shoes that allow you to wiggle your toes without having your foot slide around within.
- Do avoid repeated pressure and trauma to the toenails.
- Do wear sport-specific shoes.
- Do practice good foot hygiene.
- Do trim toenails straight across.
Ingrown toenail dont’s
- Don’t cut down the corners of the toenails.
- Don’t trim toenails too short.
- Don’t wear improperly fitting shoes.
- Don’t avoid treatment by a professional if symptoms persist.
- Don’t try and do surgery on the toenail yourself.
What is the prognosis for an ingrown toenail?
The prognosis for an ingrown toenail is generally very good, particularly if professional treatment is engaged when the problem does not resolve itself after a week or so and risk factors are addressed.