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Overview

An ingrown toenail is a medical condition affecting your foot when the corner of the toenail (especially big toes) grows into the skin. This results in pain, swelling, and inflamed skin. These are common conditions that usually do not pose any health risk. You can easily manage an ingrown toenail at home through remedies discussed further in the article. However, if the toenail is infected with severe pain and discomfort, your healthcare provider can take the necessary steps to relieve your symptoms and help you avoid further complications. 

Read more about ingrown toenails, their causes, symptoms, treatment , and prevention. 

What is Meant by an Ingrown Toenail?

An ingrown toenail is a nail that has sharp corners and grows deep into your skin instead of over it, which can affect anyone. Still, there is a higher risk among adolescents, athletes, and those who suffer from diabetes (increased blood sugar levels), severe nerve damage in the leg or foot, poor blood circulation, and any infection around the nail. It is a common foot condition seen in every 2 out of 10 people.

What are the Causes of an Ingrown Toenail?

Ingrown toenails occur when the edge of the nail grows into the surrounding skin, causing pain, swelling, and redness. Several factors can contribute to the development of an ingrown toenail, including:

  • Genetics: Some people are more prone to ingrown toenails due to their inherited nail shape or thickness.
  • Improper toenail trimming: Cutting your toenails too short, rounding the edges, or tearing the nails instead of cutting them straight can cause the nail to grow into the skin.
  • Tight-fitting shoes: Shoes that are too tight or narrow can put pressure on your toes, causing the nails to grow into the skin.
  • Fungal infections: Fungal infections can cause the nails to thicken and become more difficult to trim properly, increasing the risk of ingrown toenails.
  • Toe injuries: Dropping something heavy on your toe, stubbing your toe, or any other trauma to the toe can cause the nail to grow into the skin.
  • Poor foot hygiene: Not keeping your feet clean and dry can increase the risk of bacterial and fungal infections, which can contribute to ingrown toenails.
  • Certain medical conditions: People with diabetes, poor circulation, or immune system disorders may be at increased risk for ingrown toenails.

What are the Symptoms of an Ingrown Toenail?

The symptoms of an ingrown toenail include:

  • The affected nail and toe are hard, swollen, and tender (painful when touched).
  • Increased soreness and redness around the affected toe. 
  • Mild to moderate pain, which may aggravate while standing, walking or wearing closed shoes.
  • The toe affected feels warm or hot due to inflammation. This can also cause fluid build-up and swelling.
  • The inflammation of the skin around the ingrown toenail can cause bleeding.
  • It may lead to infections due to bacteria entering the inflamed soft flesh.
  • White or yellow pus can be seen draining from the infected area.
  • Affects regular activities like standing and walking due to pain and discomfort.
  • You may experience difficulty wearing full-coverage footwear.

How is an Ingrown Toenail Diagnosed?

Most often, you can diagnose an ingrown toenail yourself, depending on the signs and symptoms and the clinical appearance of your toe. You may consult your podiatrist (foot specialist) for further physical evaluation and diagnosis. 

Physical examination

An ingrown toenail is diagnosed if your skin is:

  • Growing over the nail.
  • Swollen, red, or tender.
  • Infected with pus discharge.

Diagnostic tests 

  • Generally, you do not require additional tests or X-rays to diagnose an ingrown toenail.
  • However, in case of infections, you may require: 
    • A blood culture test: To identify the organism causing the infection, which helps to determine the type of medication needed to treat the condition (antibiotics or antifungal).
    • An X-ray: To check if the infection has spread to the underlying bone.

How is an Ingrown Toenail Treated?

The treatment for an ingrown toenail depends on the extent and severity of the condition and the presence of other pre-existing diseases like diabetes (increased blood sugar levels), hypertension (high blood pressure), etc, which may aggravate the symptoms. Treatment includes

Home remedies

The following home remedies help relieve pain and promote the healing of an ingrown toenail.

  • Soak in warm water with an antiseptic solution
    • This reduces swelling and pain.
    • Adding Epsom salts to water brings additional relief.
  • Soak in apple cider vinegar
    • Apple cider vinegar has antiseptic, anti-inflammatory, and pain-relieving properties.
    • Take water in a basin and add 1/4th cup of apple cider vinegar.
    • Soak the affected foot for up to 20 minutes daily.
    • Towel dry, and air dry the area properly.

Medical Treatment

If home remedies do not work, it is advisable to consult your podiatrist (a medical specialist who treats problems with feet and lower leg) for medical treatment.

  • Apply antiseptic ointment
    • This promotes healing and reduces the risk of infection.
    • Clean the affected area with a gauze or cotton soaked in an antiseptic solution, and let it dry.
    • Apply the prescribed antibiotic or antifungal cream at least 3 times daily.
    • Bandage the toenail after application.
  • Wear comfortable shoes and socks 
    • Tight shoes and socks can cause crowding of your toes.
    • Wear footwear that fits and leaves space as well.
    • Use sandals instead of shoes until the toenail heals.
  • Take pain relievers s prescribed by your podiatrist
    • Acetaminophen may relieve the pain taken in intervals of 4 to 6 hours for the prescribed duration.
  • Use a toe protector
    • It provides cushioning support to the ingrown toenail.
    • These are available as rings that fit well around the affected area.
  • Try a toe brace
    • These composite devices hold the toe in place and protect the skin around it.
    • It treats as well as prevents ingrown toenails.
  • Use oral antibiotics as prescribed by your podiatrist
    • This help relieves pain and swelling and fights against infection.

Surgical Treatment

If the ingrown toenails are not treatable by home remedies, or if the condition aggravates, you may consult your podiatrist for a surgical treatment. The most common surgeries for ingrown toenails include:

  • Wedge resection/excision
    • This is also known as partial nail avulsion, where a portion of your toenail is removed. 
  • Complete toenail avulsion (removal)
    • Your doctor may remove your entire toenail.
    • It takes almost 18 months for the removed nail to grow back.
    • However, this procedure has a higher risk of ingrown toenails in the future, because the nail grows back deformed.
  • Surgery on the tip of the toe
    • Your doctor may remove and reshape the soft tissue at the tip of your toe.
    • This is recommended when other procedures fail.
  • Matrixectomy
    • This procedure involves the removal of the nail bed along with the nail.
    • This is recommended if nail avulsion or wedge resection methods fail.
    • The types of matrixectomy include:
      • Phenol matrixectomy
      • Sodium hydroxide matrixectomy
      • Laser matrixectomy
      • Electrosurgical matrixectomy
  • Zadek’s procedure 
    • It is a procedure that involves the removal of your whole toenail and cutting away the tissue area from where your ingrown nail grows.

What are the Complications of an Ingrown Toenail?

If you ignore an ingrown toenail in its early stages and if not treated on time, it could end up in necrosis (tissue death):

  • Infection of the bone
  • Open sores 
  • Foot ulcers
  • Oozing pus
  • Compromised circulation to the affected area

How to Prevent an Ingrown Toenail?

As the saying goes, prevention is better than cure, the same is true with ingrown toenails. To help prevent an ingrown toenail:

  • Wear shoes that fit properly: Tight-fitting shoes tend to put a lot of pressure on your toenails which causes them to grow into soft flesh.
  • Keep your toenails at a moderate length: Trim your toenails to the level of your toe so that the underlying soft skin is not exposed.
  • Trim your toenails straight across your toe: Do not round or curve your toenails.
  • Try to wear protective footwear: Especially during activities that put you at high risk of injuring your toes.

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