An ingrown toenail, medically known as onychocryptosis, occurs when the corner or side edge of a toenail grows into the surrounding soft flesh of the toe. This penetration causes irritation, pain, and inflammation in the nail fold. While common, especially on the big toe, it does not always require immediate professional medical intervention. For healthy individuals, the initial discomfort can often be managed with simple care techniques performed at home. The decision to seek medical attention depends on the severity of symptoms and the presence of infection.
Initial Steps for Self-Care
If the ingrown toenail is mildly painful and shows no evidence of infection, a conservative approach at home is the appropriate first step. The primary goal of self-care is to soften the nail and surrounding skin while gently guiding the nail edge away from the flesh. Soaking the affected foot in warm, soapy water or warm water with Epsom salts for 15 to 20 minutes can be done three to four times daily.
After soaking, the skin and nail plate will be softer, allowing for the gentle lifting of the nail corner. A small piece of cotton or waxed dental floss can be carefully placed under the lifted edge to create a temporary cushion and separate the nail from the skin. This material should be replaced daily after each soak to maintain cleanliness.
Avoid tight-fitting footwear, especially shoes with a narrow toe box, as constant pressure can worsen the condition. Wear open-toed shoes or sandals until the toe begins to heal, and ensure all regular shoes are roomy enough to accommodate the foot without pinching. If pain or swelling persists or increases after two or three days of diligent home care, a medical consultation is necessary.
Clear Signs You Need Professional Medical Care
The presence of infection is the most immediate sign that professional medical care is required. Localized signs of infection include constant increased pain and throbbing, swelling that spreads beyond the nail, and noticeable warmth to the touch. The appearance of pus or any yellow, white, or green discharge draining from the nail fold indicates an active bacterial infection that needs treatment.
Systemic signs of infection, such as fever or chills, suggest the infection may be spreading beyond the toe and require immediate medical attention. Individuals with underlying health conditions, particularly diabetes, peripheral artery disease (PAD), or nerve damage, should seek professional care even for a minor ingrown toenail. These conditions compromise circulation and sensation, increasing the risk of the infection progressing rapidly to severe complications like cellulitis or bone infection (osteomyelitis).
If the ingrown toenail is recurrent, meaning it has happened multiple times on the same toe, self-care is unlikely to resolve the issue. Similarly, if a significant amount of extra flesh, known as hypergranulation tissue, has formed around the nail edge, professional treatment is needed. A podiatrist or other healthcare provider can offer definitive treatments that prevent future recurrence.
What to Expect During Medical Treatment
A healthcare provider, often a podiatrist, will assess the severity of the ingrown toenail to determine the appropriate treatment path. For cases with moderate inflammation or established infection, the most common procedure is a minor surgery called a partial nail avulsion, also known as a wedge resection. This procedure is performed in the office after the toe is completely numbed using a local anesthetic, typically a digital block.
During the partial nail avulsion, the surgeon removes only the small, problematic wedge of the nail plate embedded in the skin. If the problem is recurrent or severe, the surgeon may also perform a chemical matrixectomy. This aims to permanently stop the removed section of the nail from regrowing.
A chemical agent, most commonly phenol, is applied to the exposed nail matrix (the nail root) to destroy the cells responsible for producing that specific edge of the nail. This permanent alteration results in a slightly narrower nail plate, which eliminates the source of the ingrowth. Following the procedure, the area is dressed with a sterile bandage, and the patient receives instructions for post-procedure care, including soaking and dressing changes.
Recovery time for the procedure itself is short, often allowing a return to normal activities within a few days, though the toe may take a few weeks to fully heal. Antibiotics, either oral or topical, may be prescribed if an active infection is confirmed.