What are the main causes of ingrown toenails. How can you identify the symptoms of an ingrown toenail. What are the most effective treatment options for ingrown toenails. When should you seek medical attention for an ingrown toenail. How can you prevent ingrown toenails from occurring.

Understanding Ingrown Toenails: Definition and Prevalence

An ingrown toenail is a common and often painful condition that occurs when the edge of a toenail grows into the surrounding skin. This condition most frequently affects the big toe, but can potentially impact any toe. Ingrown toenails are particularly prevalent among teenagers and young adults, though they can affect individuals of all ages.

The anatomy of a toenail plays a crucial role in understanding how ingrown toenails develop. The nail plate, which is the visible part of the nail, grows from the matrix (the nail root) and sits on the nail bed. When the nail’s edges or corners grow into the soft tissue around the nail, it can lead to inflammation, pain, and potentially infection.

Common Causes and Risk Factors for Ingrown Toenails

Several factors can contribute to the development of ingrown toenails:

• Improper nail trimming techniques
• Wearing shoes that are too tight or short
• Trauma to the toe, such as stubbing or having it stepped on
• Genetic predisposition (some people naturally have nails that tend to curve)
• Repetitive pressure on the toes (common in athletes)
• Poor foot hygiene
• Certain nail conditions or fungal infections

Improper nail trimming is one of the most common causes of ingrown toenails. Many people tend to curve the nail edges when cutting, which can encourage the nail to grow into the surrounding skin. Additionally, cutting nails too short can allow the surrounding skin to fold over the nail as it grows, leading to an ingrown toenail.

Can tight shoes really cause ingrown toenails?

Yes, wearing shoes that are too tight or short can significantly increase the risk of developing ingrown toenails. Tight footwear puts pressure on the toes, potentially forcing the nail to grow abnormally. This is particularly problematic for the big toe, which bears much of the body’s weight when walking or running. Ensuring proper shoe fit is crucial for preventing this painful condition.

Recognizing the Symptoms of an Ingrown Toenail

Identifying an ingrown toenail early can help prevent complications and make treatment more effective. The symptoms typically develop gradually and may include:

1. Pain and tenderness along the side of the toenail
2. Redness and swelling around the affected area
3. Warmth in the toe
4. Difficulty wearing shoes comfortably
5. In advanced cases, pus drainage and signs of infection

Initially, an ingrown toenail may appear as a hardened, swollen area at the edge of the nail. As the condition progresses, the skin next to the nail may become red, warm, and increasingly painful. In some cases, you might notice a small amount of pus draining from the area, indicating a potential infection.

How quickly do ingrown toenail symptoms progress?

The progression of ingrown toenail symptoms can vary from person to person. Some individuals may experience mild discomfort for weeks before noticing significant pain or signs of infection. Others might develop severe symptoms within days of the nail beginning to grow inward. Factors such as foot hygiene, shoe choice, and individual susceptibility to infection can influence the rate of symptom progression.

Diagnosing Ingrown Toenails: When to See a Doctor

While mild cases of ingrown toenails can often be treated at home, certain situations warrant professional medical attention. You should consult a healthcare provider if:

• Pain is severe or getting worse
• You notice signs of infection (increased redness, warmth, swelling, or pus)
• You have diabetes, peripheral artery disease, or other conditions that affect blood flow to your feet
• Home remedies haven’t improved the condition after a few days
• You experience recurring ingrown toenails

A doctor can diagnose an ingrown toenail through a physical examination of the affected toe. In some cases, they may gently probe the nail fold (the skin alongside the nail) to determine the extent of the problem. If an infection is suspected, the doctor might take a sample of any drainage for laboratory testing to identify the specific bacteria involved.

Are X-rays necessary for diagnosing ingrown toenails?

In most cases, X-rays are not necessary for diagnosing ingrown toenails. The condition can typically be identified through a visual examination and assessment of symptoms. However, in rare instances where there’s suspicion of underlying bone involvement or other complications, a doctor might order X-rays to get a more comprehensive view of the toe’s structure.

Non-Surgical Treatment Options for Ingrown Toenails

For mild to moderate cases of ingrown toenails, several non-surgical treatment options can provide relief and promote healing:

1. Warm water soaks: Soak the affected foot in warm water for 15-20 minutes, 3-4 times daily. This helps reduce swelling and relieve pain.
2. Proper nail trimming: Cut toenails straight across, avoiding rounded edges. Use clean, sharp nail clippers.
3. Comfortable footwear: Wear shoes with adequate toe room to reduce pressure on the affected nail.
4. Over-the-counter pain relievers: Ibuprofen or acetaminophen can help manage pain and inflammation.
5. Topical antibiotics: If there’s mild infection, over-the-counter antibiotic ointments may be beneficial.
6. Dental floss technique: Gently lift the ingrown edge of the nail and place a small piece of dental floss or cotton under it to encourage proper growth.

It’s important to maintain good foot hygiene during treatment, keeping the affected area clean and dry. If symptoms don’t improve within 2-3 days of home treatment, or if they worsen, it’s advisable to seek medical attention.

Is the dental floss technique safe for everyone to try?

While the dental floss technique can be effective, it’s not recommended for everyone. People with diabetes, circulation problems, or weakened immune systems should avoid this method due to the increased risk of infection. Additionally, if the ingrown toenail is severely painful or shows signs of infection, it’s best to consult a healthcare professional rather than attempting this technique at home.

Surgical Interventions for Severe or Recurring Ingrown Toenails

When non-surgical treatments are ineffective or for severe cases, surgical intervention may be necessary. Common surgical procedures for ingrown toenails include:

• Partial nail avulsion: Removal of the ingrown portion of the nail
• Complete nail plate avulsion: Removal of the entire nail
• Matrixectomy: Removal of part of the nail bed to prevent regrowth of the problematic nail section

These procedures are typically performed under local anesthesia in a doctor’s office or outpatient setting. The choice of procedure depends on the severity of the condition, the frequency of recurrence, and individual patient factors.

After surgical treatment, proper wound care is crucial for preventing infection and ensuring optimal healing. This may include regular cleaning, application of antibiotic ointment, and wearing appropriate bandages. Most patients can return to normal activities within a few days, although complete healing may take several weeks.

What is the success rate of surgical treatments for ingrown toenails?

Surgical treatments for ingrown toenails generally have high success rates. Partial nail avulsion combined with matrixectomy, which prevents regrowth of the problematic nail portion, has a success rate of approximately 95% in preventing recurrence. However, the exact success rate can vary depending on the specific procedure, the skill of the surgeon, and how well the patient follows post-operative care instructions.

Prevention Strategies: Keeping Ingrown Toenails at Bay

Preventing ingrown toenails is often easier than treating them. Here are some effective prevention strategies:

1. Proper nail trimming: Cut nails straight across, not too short, and avoid rounding the edges.
2. Appropriate footwear: Choose shoes that provide adequate room for your toes.
3. Good foot hygiene: Keep feet clean and dry to prevent bacterial growth.
4. Protective measures: Use steel-toed shoes if your work puts your toes at risk of injury.
5. Regular foot checks: Inspect your feet regularly, especially if you have diabetes or circulation problems.
6. Professional care: Consider regular visits to a podiatrist if you’re prone to ingrown toenails.

For individuals with chronic or recurrent ingrown toenails, a podiatrist might recommend permanent removal of the nail or destruction of the nail matrix to prevent regrowth. This is particularly beneficial for those with congenital nail deformities or persistent issues despite proper care.

Can wearing socks prevent ingrown toenails?

Wearing properly fitting socks can indeed help prevent ingrown toenails. Socks provide a barrier between your toes and shoes, reducing friction and pressure. They also help absorb moisture, keeping your feet dry and less prone to bacterial growth. However, it’s important to choose socks that fit well and aren’t too tight, as overly constricting socks can contribute to nail problems.

Special Considerations for High-Risk Groups

Certain groups of people are at higher risk for complications from ingrown toenails and require special care:

• Diabetics: Due to potential nerve damage and poor circulation, even minor foot injuries can lead to serious complications.
• Athletes: Repetitive pressure on the toes from sports activities can increase the risk of ingrown toenails.
• Elderly individuals: Age-related changes in nail thickness and shape can make proper trimming more challenging.
• People with peripheral artery disease: Reduced blood flow to the feet can impair healing and increase infection risk.

For these high-risk groups, regular foot examinations, proper nail care, and prompt treatment of any foot issues are crucial. In many cases, it’s advisable for these individuals to have their toenails trimmed by a professional podiatrist to minimize the risk of complications.

How often should diabetics have their feet professionally examined?

Diabetics should have their feet professionally examined at least once a year, and more frequently if they have additional risk factors or a history of foot problems. During these examinations, a healthcare provider will check for signs of neuropathy, circulation issues, and potential foot injuries or infections. Regular self-examinations at home are also crucial, ideally performed daily, to catch any potential problems early.

Ingrown Toenail – OrthoInfo – AAOS

If you trim your toenails too short, particularly on the sides of your big toes, you may set the stage for an ingrown toenail. Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin. An ingrown toenail may also happen if you wear shoes that are too tight or too short.

An ingrown toenail.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may get red and infected, and feel very sore. Ingrown toenails are a common, painful condition—particularly among teenagers. Any of your toenails can become ingrown, but the problem more often affects the big toe. An ingrown nail occurs when the skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. Redness, pain and swelling at the corner of the nail may result and infection may soon follow. Sometimes a small amount of pus can be seen draining from the area.

Ingrown nails may develop for many reasons. Some cases are congenital—the nail is just too large for the toe. Trauma, such as stubbing the toe or having the toe stepped on, may also cause an ingrown nail. However, the most common cause is tight shoe wear or improper grooming and trimming of the nail.

The anatomy of a toenail.

Nonsurgical Treatment

Ingrown toenails should be treated as soon as they are recognized. If they are recognized early (before infection sets in), home care may prevent the need for further treatment:

• Soak the foot in warm water 3-4 times daily.
• Keep the foot dry during the rest of the day.
• Wear comfortable shoes with adequate room for the toes. Consider wearing sandals until the condition clears up.
• You may take ibuprofen or acetaminophen for pain relief.
• If there is no improvement in 2-3 days, or if the condition worsens, call your doctor.

You may need to gently lift the edge of the ingrown toenail from its embedded position and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day.

Surgical Treatment

If excessive inflammation, swelling, pain and discharge are present, the toenail is probably infected and should be treated by a physician (see left image below). You may need to take oral antibiotics and the nail may need to be partially or completely removed (see middle image below). The doctor can surgically remove a portion of the nail, a portion of the underlying nail bed, some of the adjacent soft tissues and even a part of the growth center (see right image below).

Possible treatment options for an ingrown toenail.

Surgery is effective in eliminating the nail edge from growing inward and cutting into the fleshy folds as the toenail grows forward. Permanent removal of the nail may be advised for children with chronic, recurrent infected ingrown toenails.

If you are in a lot of pain and/or the infection keeps coming back, your doctor may remove part of your ingrown toenail (partial nail avulsion). Your toe is injected with an anesthetic and your doctor uses scissors to cut away the ingrown part of the toenail, taking care not to disturb the nail bed. An exposed nail bed may be very painful. Removing your whole ingrown toenail (complete nail plate avulsion) increases the likelihood your toenail will come back deformed. It may take 3-4 months for your nail to regrow.

Unless the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and to wear shoes and hosiery (socks) with adequate room for the toes. Nails should be cut straight across with a clean, sharp nail trimmer without tapering or rounding the corners. Trim the nails no shorter than the edge of the toe. Keep the feet clean and dry at all times.

Proper and improper toenail trimming.

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Ingrown Toenails: Causes, Symptoms, and Diagnosis

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Ingrown toenails occur when the edges or corners of your nails grow into the skin next to the nail. Your big toe is most likely to get an ingrown toenail.

If a toenail grows back into the skin around the nail bed, it’s known as an ingrown toenail. These can be painful and can become infected.

You can treat ingrown toenails at home. However, they can cause complications that might require medical treatment. Your risk of complications is higher if you have diabetes or other conditions that cause poor circulation.

Ingrown toenails occur in both men and women. According to the National Health Services (NHS), ingrown toenails may be more common in people with sweaty feet, such as teenagers. Older people may also be at higher risk because toenails thicken with age.

Many things can cause an ingrown toenail, including:

• cutting toenails incorrectly (Cut straight across, since angling the sides of the nail can encourage the nail to grow into the skin.)
• irregular, curved toenails
• footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for your feet
• toenail injury, including stubbing your toe, dropping something heavy on your foot, or kicking a ball repeatedly
• poor posture
• improper foot hygiene, such as not keeping your feet clean or dry
• genetic predisposition

Using your feet extensively during athletic activities can make you especially prone to getting ingrown toenails. Activities in which you repeatedly kick an object or put pressure on your feet for long periods of time can cause toenail damage and increase your risk of ingrown toenails. These activities include:

• ballet
• football
• kickboxing
• soccer

Ingrown toenails can be painful, and they usually worsen in stages.

Early-stage symptoms include:

• skin next to the nail becoming tender, swollen, or hard
• pain when pressure is placed on the toe
• fluid building up around the toe

If your toe becomes infected, symptoms may include:

• red, swollen skin
• pain
• bleeding
• oozing pus
• overgrowth of skin around the toe

Treat your ingrown toenail as soon as possible to avoid worsening symptoms.

Your doctor will most likely be able to diagnose your toe with a physical exam. If your toe seems infected, you might need an X-ray to show how deep the nail has grown into the skin. An X-ray can also reveal if your ingrown nail was caused by injury.

If you need help finding a primary care doctor or gastroenterologist, you can browse doctors in your area through the Healthline FindCare tool.

Ingrown toenails that aren’t infected can normally be treated at home. However, if your toenail has pierced the skin, or there is any sign of infection, seek medical treatment. Signs of infection include:

• warmth
• pus
• redness and swelling

Home treatment

To treat your ingrown toenail at home, try:

• soaking your feet in warm water for about 15 to 20 minutes three to four times per day (At other times, your shoes and feet should be kept dry.)
• pushing skin away from the toenail edge with a cotton ball soaked in olive oil
• using over-the-counter medicines, like acetaminophen (Tylenol), for the pain
• applying a topical antibiotic, such as polymyxin and neomycin (both present in Neosporin) or a steroid cream, to prevent infection

Try home treatments for a few days to a few weeks. If the pain worsens or you find it difficult to walk or perform other activities because of the nail, see your doctor.

If the toenail does not respond to home treatments or an infection occurs, you may need surgery. In cases of infection, stop all home treatments and see your doctor.

Surgical treatment

There are different types of surgical treatments for ingrown toenails. Partial nail removal only involves removing the piece of nail that is digging into your skin. Your doctor numbs your toe and then narrows the toenail. According to the NHS, partial nail removal is 98 percent effective for preventing future ingrown toenails.

During a partial nail removal, the sides of the nail are cut away so that the edges are completely straight. A piece of cotton is placed under the remaining portion of the nail to keep the ingrown toenail from recurring. Your doctor may also treat your toe with a compound called phenol, which keeps the nail from growing back.

Total nail removal may be used if your ingrown nail is caused by thickening. Your doctor will give you a local pain injection and then remove the entire nail in a procedure called a matrixectomy.

After surgery

After surgery, your doctor will send you home with your toe bandaged. You will probably need to keep your foot raised for the next one to two days and wear special footwear to allow your toe to heal properly.

Avoid movement as much as possible. Your bandage is usually removed two days after surgery. Your doctor will advise you to wear open-toe shoes and to do daily salt water soaks until your toe heals. You will also be prescribed pain relief medication and antibiotics to prevent infection.

Your toenail will likely grow back a few months after a partial nail removal surgery. If the entire nail is removed down to the base (the nail matrix under your skin), a toenail can take over a year to grow back.

If left untreated, an ingrown toenail infection can cause an infection in the bone in your toe. A toenail infection can also lead to foot ulcers, or open sores, and a loss of blood flow to the infected area. Tissue decay and tissue death at the site of infection are possible.

A foot infection can be more serious if you have diabetes. Even a small cut, scrape, or ingrown toenail may quickly become infected due to the lack of blood flow and nerve sensitivity. See your doctor right away if you have diabetes and are concerned about an ingrown toenail infection.

If you have a genetic predisposition to ingrown toenails, they may keep coming back or appear on multiple toes at once. Your quality of life may be affected by pain, infections, and other painful foot issues that require multiple treatments or surgeries. In this case, your doctor may recommend a partial or full matrixectomy to remove the toenails causing chronic pain. Read more about foot care and diabetes.

Ingrown toenails can be prevented by making several lifestyle changes:

• Trim your toenails straight across and make sure that the edges do not curve in.
• Avoid cutting toenails too short.
• Wear proper fitting shoes, socks, and tights.
• Wear steel-toe boots if you work in hazardous conditions.
• If your toenails are abnormally curved or thick, surgery may be necessary to prevent ingrown nails.

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Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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Ingrown nail – stages of the disease, methods of treatment

16.02.2021

There will be no doubt that this is a serious and not at all trifling problem only for those who know firsthand what excruciating pain occurs if the case is neglected.

Approximately 10% of the country’s population suffers from an ailment – an ingrown nail, in other words, onychocryptosis. Typically, the toenail grows into the soft surrounding tissue.

How does a nail work?

A horn formation (plate) is called a nail. The nail is located in the nail bed. At the root of the nail is a matrix – due to it, the nail grows. If the matrix is ​​damaged, then the nail will grow incorrectly or stop growing altogether. On the sides of the nail are skin folds, they are called the nail roller.

Causes of onychocryptosis

• genetic predisposition,
• overweight,
• wearing tight shoes,
• shoes with heels,
• incorrect pedicure,
• diabetes,
• vascular disease of the lower extremities,
• fungal diseases,
• non-observance of personal hygiene,
• injury

Most often, an ingrown toenail occurs in young people. They try, during a pedicure, to round off the corners of the nail plate as much as possible, thereby disrupting the natural growth of the plate, it begins to grow into the soft tissue.

Stages of the disease

• The first stage is redness around the nail, swelling and slight discomfort when walking.
• The second stage – part of the nail cuts into the skin, swelling occurs. A person experiences obvious pain and not only when walking.
• The third stage – in addition to pain in the focus of inflammation, purulent discharge appears. The nail thickens. The so-called “wild meat” appears – tissue grows.
• Fourth stage – soft tissue granulation occurs. The disease becomes chronic. Difficult to treat.

Consequences

If an ingrown toenail is not treated promptly, complications can occur. Inflammation can go to the bone (ostiomyelitis), up to gangrene and amputation of the toes.

At risk are people with diabetes, the elderly.

Prophylaxis

First of all, it is necessary to cut the nails correctly, the cut should be even (parallel to the nail roller), when carrying out a pedicure, it is necessary to hold the legs in a warm bath, and follow the rules of hygiene daily. Wear loose, comfortable shoes.

Conservative treatment

If the stage of the disease is first or second, then nail softeners are recommended. Orthopedic inserts, staples, springs, plates are also recommended. Devices are fixed on the nail in order to correct the deformation of the nail. The procedure is painless. Delivers a minimum of inconvenience. The use of cosmetic varnish is allowed. It is recommended to wear the devices for 3-4 months.

With fungal diseases, appropriate medications will help.

Laser treatment

Gentle, painless method. As a rule, the nail plate is not completely removed. Remove only the ingrown part of the nail. Also, the infected tissue is cleared by the laser, preventing the process of further inflammation.

Radio wave treatment

No less popular method than all the others. When using it, the immune properties of the skin and tissues increase. No bleeding, no scarring.

Surgical treatment

The most radical. The ingrown edge of the nail, the nail bed and part of the nail root dry out. Either a wedge-shaped resection of the nail plate or a selective resection of the nail matrix is ​​performed. In advanced cases, the nail is completely removed. The disadvantage of this procedure is that the nail plate is restored within six months.

ingrown nail

Ingrown nail. Treatment of an ingrown nail with the method of aesthetic laser restoration of the nail bed at the AMC in Vladimir

Ingrown toenail is an ingrowth of the inner or outer edge of the nail plate of the toe into the nail fold. In the vast majority, the first toe is affected, but it also occurs on other fingers. An ingrown toenail is a common disease that occurs at any age. It affects mainly the outer edge of the nail bed. As a rule, an ingrown nail is accompanied by significant discomfort during movement and pain.

At the first signs of an ingrown, it is recommended to consult a specialist for the competent appointment of conservative treatment in order to avoid the development of pathology.

In the event that conservative therapy no longer copes with the problem, a surgical procedure is performed to treat the ingrown toenail. The standard, generally accepted surgical procedure was adapted and improved by AMK specialists in Vladimir in the early 2000s, after which this procedure was called: “Aesthetic laser restoration of the nail bed with an ingrown toenail”.

How is the aesthetic laser restoration of the nail bed for an ingrown toenail performed at the AMK in Vladimir?

As mentioned above, this variant of ingrown toenail treatment is performed on an outpatient basis, that is, without hospitalization and under local anesthesia.
During the procedure, only the marginal removal of the nail plate is performed (only the ingrown part, not the entire nail plate). After that, the nail bed is treated with a laser with a wavelength of 970 to 1050 nm. The next step is the formation of a new periungual roller. During this stage, the inflamed tissues of the periungual roller are excised to healthy ones with the simultaneous formation of a new one. At the end of the procedure, an aseptic fixing pressure bandage is applied in a certain way.
A very important step in the restoration of the nail bed with an ingrown nail is postoperative dressings.

The cost of aesthetic laser nail bed restoration, indicated in the price section, already includes the cost of the procedure itself, as well as all necessary dressings and follow-up examinations until complete recovery.

It usually takes 3 weeks from the moment of the procedure to the final healing. The effectiveness of the procedure is 98% – that is, in 9In 8 cases out of 100, it is possible not only to correct the current condition, but also to eliminate the chance of a recurrence of this disease.

Despite the high success rate of this treatment option, it is important to remember and follow all nail care recommendations that will be given by the specialist at the end of treatment.

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