An ingrown toenail (onychocryptosis) is a common condition where the edge of the nail plate grows into the surrounding skin of the toe, causing inflammation and pain. This irritates the soft tissue, leading to redness, swelling, and often an infection. The appropriate level of care depends on its severity, ranging from mild discomfort to a serious infection.
Initial Steps and At-Home Management
For minor cases where the toe is only mildly red and tender without pus or significant swelling, management can begin at home. Soaking the foot in warm, soapy water or water mixed with Epsom salt for 10 to 20 minutes, three to four times a day, helps soften the skin and relieve discomfort. After soaking, gently lift the nail edge and place a small wisp of cotton or waxed dental floss underneath it to encourage the nail to grow over the skin.
Choosing the right footwear is also important; wear shoes with a wide toe box or switch to open-toed sandals until the toe heals to avoid pressure on the nail. An over-the-counter antiseptic or antibiotic ointment can be applied, followed by a light bandage, to prevent a localized infection. Avoid aggressively cutting the nail or attempting “bathroom surgery,” as using sharp instruments often introduces bacteria and creates a gateway for a more serious infection.
Seeking Care from a General Practitioner
When home care measures fail or signs of a minor infection appear, a general practitioner (GP) or family doctor is the next step. The GP confirms the diagnosis and assesses the severity of the inflammation, looking for signs like increased redness, throbbing pain, or pus. They determine if the infection is localized or if it has begun to spread beyond the immediate area of the nail fold.
If a localized infection is present, the GP may prescribe oral antibiotics to control bacterial growth and reduce inflammation. For milder, non-infected cases, the doctor might perform an in-office procedure like lifting the nail edge and placing a specialized splint or cotton wick to separate the nail from the skin. The GP focuses on infection control and initial intervention, often referring the patient to a specialist if the condition is recurring or requires surgical removal.
Specialized Treatment by a Podiatrist
A podiatrist, or foot and ankle specialist, treats severe, recurrent, or complicated ingrown toenails. These specialists are trained to perform minor surgical procedures that offer a permanent solution when conservative care has failed. The most common procedure is a Partial Nail Avulsion (PNA), typically performed under local anesthesia injected at the base of the toe.
During a PNA, the podiatrist removes the small wedge of the nail plate embedded in the skin. To prevent recurrence, a chemical agent, most often phenol, is applied to the exposed nail matrix (the root area). Phenol destroys the cells responsible for growing that section of the nail, resulting in a permanently narrower nail. This technique, known as phenolization, has a high success rate in preventing the nail from growing back into the skin.
Conditions Requiring Immediate Specialized Care
Patients with systemic conditions like diabetes mellitus or peripheral artery disease (PAD) should seek immediate specialized care from a podiatrist or specialized wound clinic at the first sign of an ingrown toenail. These patients have compromised circulation and nerve function (neuropathy) in their feet. This means they may not feel the pain of a small wound, and their body struggles to fight off infection and heal.
For these individuals, even a minor ingrown toenail can rapidly escalate into a severe infection, such as cellulitis or osteomyelitis (bone infection). Signs of a widespread infection, such as fever, chills, or red streaks extending up the leg from the toe, require immediate medical attention. Immediate specialist intervention is necessary to prevent serious complications, which can include tissue death and, in rare cases, amputation.