An ingrown toenail occurs when the edge of a toenail grows into the surrounding skin. This common foot condition can cause discomfort and pain as the nail irritates the soft tissue. While some mild cases might seem to improve temporarily, an ingrown toenail often does not resolve completely without some form of intervention, and can worsen if left unaddressed.
Understanding Ingrown Toenails
An ingrown toenail develops when the side or corner of a toenail curves downwards and presses into the skin of the toe, typically affecting the big toe but possible on any digit. This penetration of the nail plate into the surrounding flesh can lead to inflammation, pain, and tenderness. The area around the affected nail may become visibly red and swollen.
Several factors contribute to the development of an ingrown toenail. Improper nail trimming is a frequent cause, especially when nails are cut too short or rounded at the corners. Wearing ill-fitting shoes that compress the toes, such as those that are too tight or narrow, also puts pressure on the nails. Additionally, trauma to the toe, like stubbing it or having it stepped on, can lead to an ingrown nail. Some individuals may have a genetic predisposition due to naturally curved toenails or a nail shape that is too large for the toe. Other contributing factors can include excessive foot perspiration, which softens the skin.
Self-Care and When Professional Help is Needed
For mild ingrown toenails without signs of infection, initial self-care measures can provide relief. Soaking the affected foot in warm, soapy water or water with Epsom salt for 10 to 20 minutes several times a day can soften the skin and reduce inflammation. After soaking, gently lifting the ingrowing nail edge and placing a small piece of cotton or dental floss underneath it can help separate the nail from the skin. Applying an antibiotic ointment to the area and wearing roomy shoes or sandals can also alleviate symptoms.
The nail continues to grow into the skin if the underlying cause is not addressed. Without proper care, the condition can progress, leading to increased pain and a higher risk of infection. An infection can develop when bacteria enter the broken skin, leading to further symptoms. These signs include worsening pain, increased redness or darkening of the area, significant swelling, warmth, pus or liquid drainage, and a foul odor.
Professional medical attention is necessary if self-care measures do not improve symptoms within a few days, or if the condition worsens. Individuals with certain health conditions, such as diabetes or poor circulation, should consult a healthcare provider immediately if they develop an ingrown toenail, as these conditions increase the risk of severe complications. A doctor or podiatrist should also be seen if there is intense pain that disrupts daily activities, visible signs of infection like pus, bleeding, or if the problem recurs frequently.
Medical Interventions
When self-care is insufficient or an ingrown toenail becomes severe or infected, medical professionals can offer treatments. For mildly ingrown nails, a healthcare provider might carefully lift the ingrowing edge and place cotton, dental floss, or a small splint underneath it. This method helps to separate the nail from the skin, encouraging the nail to grow correctly over a period of several weeks.
For more persistent or severe cases, a minor surgical procedure may be recommended. One common intervention is a partial nail avulsion (PNA), where a doctor numbs the toe with a local anesthetic and then trims or removes only the ingrown portion of the nail. This procedure provides immediate relief by removing the source of irritation.
To prevent recurrence, especially in chronic situations, the healthcare provider may apply a chemical, such as phenol, to the nail matrix (the tissue from which the nail grows) after removing the nail section. This chemical application helps to permanently prevent that specific part of the nail from growing back.
In rare instances, if the problem is extensive or recurring despite other treatments, the entire toenail might need to be removed, known as a total nail avulsion. Following these procedures, patients typically experience soreness that can be managed with over-the-counter pain relievers, and they receive specific instructions for wound care to promote healing.
Preventing Future Ingrown Toenails
Preventing ingrown toenails involves adopting foot care practices that can reduce the likelihood of recurrence. Proper nail trimming is a primary preventive measure; toenails should always be cut straight across, rather than rounding the corners or cutting them too short. Keeping the nail length moderate, even with the tips of the toes, helps prevent pressure from footwear.
Wearing appropriate footwear is also important for prevention. Shoes should have a wide toe box, allowing toes to move freely without being compressed. Avoiding shoes that are too tight, narrow, or high-heeled can prevent undue pressure on the toenails.
Additionally, protecting feet from trauma, especially during activities that involve repetitive impact or pressure on the toes, can prevent ingrown nails. Maintaining good foot hygiene, including washing feet daily and thoroughly drying them, especially between the toes, helps prevent infections and keeps the skin healthy. Avoiding picking or tearing at toenails also promotes healthier nail growth and reduces the risk of irregular edges.