An ingrown toenail (onychocryptosis) is a common and painful condition where the edge of the nail grows into the surrounding soft flesh of the toe. This penetration causes inflammation, tenderness, and swelling, often affecting the big toe. Relief may involve self-care for mild cases or professional intervention for more severe ones. Seeking prompt care is advised, as an untreated ingrown toenail can quickly worsen and lead to a significant infection.
When Home Care Is Appropriate
For a mild ingrown toenail that is only slightly red and painful without discharge, home treatment is often the appropriate first step. The goal of self-care is to soften the skin and nail while reducing inflammation to encourage proper nail growth. Soaking the affected foot in a warm water solution with Epsom salt for 15 to 20 minutes, two to three times a day, can help reduce swelling and tenderness.
After soaking, the skin around the nail should be gently pushed away, and a small, clean piece of cotton or unwaxed dental floss can be carefully placed under the offending nail corner to lift it from the skin. Over-the-counter pain relievers, such as ibuprofen, may be used to manage discomfort. It is important to wear wide, open-toed shoes during this time to prevent pressure on the toe and to trim the toenails straight across without rounding the corners.
Home care must stop immediately if “red flags” appear, indicating a likely infection or worsening condition. These signs include increased or spreading redness, warmth, throbbing pain, or the presence of pus or watery discharge. An infection that progresses beyond the toe can lead to serious conditions like cellulitis, particularly for individuals with diabetes or poor circulation. If home remedies do not provide significant relief within two to three days, seek medical help.
Choosing the Right Specialist for Professional Removal
When professional treatment is needed, the choice of specialist depends on the severity and recurrence of the problem. Podiatrists, who are foot and ankle specialists, are the primary recommendation for the long-term management of ingrown toenails. They possess specialized instruments and expertise in foot biomechanics, allowing them to remove the nail and address the underlying causes of recurrence. Podiatrists are skilled in performing minimally invasive procedures designed to prevent the problem from returning, often without a referral.
Primary Care Physicians (GPs or Family Doctors) and Urgent Care clinics can also treat ingrown toenails, especially for simple, non-recurring cases or when an infection requires immediate attention. A GP can prescribe oral antibiotics to manage an active infection, though they typically do not remove the portion of the nail causing the issue. Urgent care facilities are suitable for immediate assessment and temporary relief if a podiatrist appointment is unavailable quickly. However, for a permanent solution or chronic inflammation, the specialized surgical techniques offered by a podiatrist are superior.
For recurring or severe ingrown toenails, a podiatrist is the most effective choice. They are best equipped to perform procedures that address the nail root, which is the source of the recurring issue, offering a permanent solution. Choosing a foot specialist ensures the treatment includes preventative education and advanced care beyond simple symptom relief.
What to Expect During the Removal Procedure
Once professional intervention is chosen, the procedure is typically a minor surgical one performed in the office setting. Before removal, the toe is completely numbed using a local anesthetic administered via a digital nerve block at the base of the toe. This ensures the patient feels no pain during the procedure.
The most common procedure is a Partial Nail Avulsion (PNA), where the specialist removes only the offending edge of the nail digging into the skin. For chronic or recurring cases, PNA is often combined with a chemical Matrixectomy. This involves applying a chemical, typically phenol, to the exposed nail matrix underneath the removed nail edge. The phenol destroys the cells that produce the nail in that specific area, permanently preventing that edge from growing back and eliminating recurrence.
After the nail segment and chemical are applied, the toe is dressed with a sterile bandage. Patients are usually able to walk immediately afterward, but they are advised to keep the foot elevated and dry for the first 24 hours. Post-procedure care often includes soaking the toe in saltwater or a similar solution for several days to aid healing and applying an antibiotic ointment. Recovery is relatively quick, with most patients returning to normal activities within a few days.