Ingrown toenail Information | Mount Sinai

Onychocryptosis; Unguis incarnates; Surgical nail avulsion; Matrix excision; Ingrown toenail removal

An ingrown toenail occurs when the edge of the nail grows into the skin of the toe.

An ingrown toenail is a condition in which the edge of the toenail grows into the skin of the toe. The big toe is most commonly affected. Symptoms include pain, redness, and swelling around the toenail.

Causes

An ingrown toenail can result from a number of things. Poorly fitting shoes and toenails that are not properly trimmed are the most common causes. The skin along the edge of a toenail may become red and infected. The great toe is affected most often, but any toenail can become ingrown.

An ingrown toenail may occur when extra pressure is placed on your toe. This pressure is caused by shoes that are too tight or fit poorly. If you walk often or play sports, a shoe that is even a little tight can cause this problem. Deformities of the foot or toes can also place extra pressure on the toe.

Nails that are not trimmed properly can also cause ingrown toenails:

• Toenails that are trimmed too short, or if the edges are rounded rather than cut straight across may cause the nail to curl and grow into the skin.
• Poor eyesight, inability to reach the toes easily, or having thick nails can make it hard to properly trim nails.
• Picking or tearing at the corners of the nails can also cause an ingrown toenail.

Some people are born with nails that are curved and grow into the skin. Others have toenails that are too large for their toes. Stubbing your toe or other injuries can also lead to an ingrown toenail.

Symptoms

There may be pain, redness, and swelling around the nail.

Exams and Tests

Your health care provider will examine your toenail and ask about your symptoms.

Tests or x-rays aren’t usually needed.

Treatment

If you have diabetes, nerve problem in the leg or foot, poor blood circulation to your foot, or an infection around the nail, see a provider right away. Don’t try to treat an ingrown nail at home.

Otherwise, to treat an ingrown nail at home:

• Soak the foot in warm water 3 to 4 times a day if possible. After soaking, keep the toe dry.
• Gently massage over the inflamed skin.
• Place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic.

When trimming your toenails:

• Briefly soak your foot in warm water to soften the nails.
• Use a clean, sharp trimmer.
• Trim toenails straight across the top. Do not taper or round the corners or trim too short. 
• Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse.

Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem.

If this doesn’t work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist), or a skin specialist (dermatologist).

If the ingrown nail doesn’t heal or keeps coming back, your provider may remove part of the nail:

• Numbing medicine is first injected into the toe.
• The ingrown part of the nail is removed. This procedure is called a partial nail avulsion.
• It takes 2 to 4 months for the nail to regrow.

If the toe is infected, your doctor may prescribe antibiotics.

After the procedure, follow any instructions for helping your nail heal.

Outlook (Prognosis)

Treatment usually controls the infection and relieves pain. The condition is likely to return if you don’t practice good foot care.

This condition may become serious in people with diabetes, poor blood circulation, and nerve problems.

Possible Complications

In severe cases, the infection can spread through the toe and into the bone.

When to Contact a Medical Professional

Call your provider if you:

• Are not able to treat an ingrown toenail at home
• Have severe pain, redness, swelling, or fever
• Have diabetes, nerve damage in the leg or foot, poor circulation to your foot, or an infection around the nail

Prevention

Wear shoes that fit properly. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for playing sports should also have plenty of room, but not be too loose.

When trimming your toenails:

• Briefly soak your foot in warm water to soften the nail.
• Use a clean, sharp nail trimmer.
• Trim toenails straight across the top. Do not taper or round the corners or trim too short.
• Do not pick or tear at the nails.

Keep your feet clean and dry. People with diabetes should have routine foot exams and nail care.

Dinulos JGH. Nail diseases. In: Dinulos JGH, ed. Habif’s Clinical Dermatology: A Color Guide in Diagnosis and Therapy. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 25.

Grear BJ. Disorders of nails. In: Azar FM, Beaty JH, eds. Campbell’s Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 88.

Marks JG, Miller JJ. Nail disorders. In: Marks JG, Miller JJ, eds. Lookingbill and Marks’ Principles of Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 21.

Last reviewed on: 5/3/2021

Reviewed by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Remedies, removal, causes, and symptoms

An ingrown toenail occurs when the edges or corners of the nail grow into the skin next to the nail and break the skin. It can be painful and can lead to an infection. Treatments vary from home remedies — such as soaking the feet and wearing wider shoes — to surgery.

An ingrown toenail is a common condition, but it can be painful, causing swelling, redness, and sometimes infection. It usually affects the big toe, either on one or both sides.

People can usually treat ingrown toenails at home. However, if the pain is severe or spreading, it may be necessary to see a healthcare professional, to relieve symptoms, and prevent further complications. If a person has a badly ingrown toenail, they may need to see a foot specialist (podiatrist) for treatment.

This article explores the treatments and home remedies for ingrown toenails, plus causes, symptoms, and prevention of infections.

A person should treat ingrown toenails as soon as symptoms appear, especially if they have diabetes, nerve damage in the foot or leg, or poor circulation in the foot. Otherwise, complications can occur, such as infections.

The American College of Foot and Ankle Surgeons advises consulting a healthcare professional rather than using over-the-counter (OTC) medications. OTCs may mask the pain, but they do not resolve the underlying problem.

Consult a doctor

A person should consult a doctor if:

• they have diabetes
• they have peripheral vascular disease
• they have a circulatory problem
• symptoms do not go away
• an infection develops

Removal

If the problem remains, the doctor or podiatrist may recommend removing part or all of the nail through surgery.

Partial toenail avulsion

During this type of surgery, a person can expect to:

• receive a local anesthetic
• have one or both edges of the nail removed
• have the root of the nail destroyed using a chemical called phenol

Once part of the nail begins to grow back, the podiatrist may place a piece of cotton wool under the nail. This will stop it from digging into the skin. It is important to change the cotton wool every day. Keeping the same cotton wool increases the risk of infection as the nail provides a place for harmful bacteria to grow.

If the area is infected, the doctor may prescribe antibiotics.

The healing time for this procedure is 4–6 weeks.

Total nail avulsion

If the ingrown toenail keeps returning, a podiatrist may remove the cells in the nail bed so that the toenail cannot grow again.

During this type of procedure, a person can expect to:

• receive a local anesthetic
• have the entire nail or a large part of the nail removed
• have the root of the nail destroyed using a chemical called phenol

As the toe may feel tender when the anesthetic wears off, doctors may recommend Ibuprofen or acetaminophen, Tylenol, or paracetamol.

The healing time for this procedure is 6–8 weeks. During this time, a person will have to wear either very soft and spacious footwear or open-toed sandals.

Often, a healthcare professional will advise someone to treat the nail themselves. If a person suspects they may have an ingrown toenail, it is important to keep the area clean and dry to prevent infection.

Here are some tips:

• Soak the foot in warm water 3–4 times a day, while using a cotton bud to gently push the skin away from the toenail. A doctor may advise you to add Epsom salt to the warm water.
• Avoid repeatedly cutting the toenail, as this can make the problem worse.
• Wear footwear that leaves the toes plenty of room for movement.

When the nail pierces the skin, bacteria can enter the wound.

This can result in infection and cause the following symptoms to occur in the affected areas:

• redness
• swelling
• warmth
• bleeding and pus

Anyone with symptoms of infection should seek medical help, either with a primary care physician, orthopedic surgeon, or podiatrist.

Here are some of the causes of ingrown toenails:

• Footwear: Shoes and socks that crowd the toes and are too tight increase the chance of an ingrown toenail.
• Cutting the toenails too short: Not cutting straight across or cutting the edges of the toenail can encourage the surrounding skin to fold over the nail. The nail can then push into that skin and pierce it.
• Toenail injury: Dropping something on the toe, kicking something hard, and other accidents can lead to ingrown toenails.
• An unusual curvature: This increases the risk that the toenail will grow into the soft tissue, causing inflammation and possible infection.
• Posture: How a person walks or stands can affect the likelihood of developing ingrown toenails.
• Poor foot hygiene or excessive sweating: If the skin on the toes and feet is moist and warm, there is a higher chance of developing an ingrown toenail. A fungal infection can increase the risk.
• Heredity: Ingrown toenails can run in families.
• Genetic factors: Some people are born with larger toenails.

The symptoms of an ingrown toenail include:

• pain in response to pressure
• tender, swollen, or hard skin next to the nail
• inflamed skin at the top of the toe
• bleeding from the ingrown toenail
• white or yellow pus in the affected area
• fluid buildup in the affected area

To prevent ingrown toenails from developing:

• Cut the nails correctly: People should cut straight across the nail, not rounded at the corners, and not too short. It is easier to cut the nails after a bath or shower.
• See a podiatrist regularly: A person can visit a podiatrist for professional trimming, especially if they have circulatory problems in the feet or cannot cut their own nails. People with diabetes or peripheral vascular disease need to be particularly careful.
• Maintain hygiene and dryness: An ingrown toenail is less likely if the feet are clean and dry.
• Choose footwear that fits properly: Shoes must be the right length and width. Tight shoes cause pressure, but if shoes are too loose, the toes may hit against the tip of the shoe. This also adds pressure and could cause an ingrown toenail.

An ingrown toenail is a common condition that can cause pain and swelling. People can usually prevent them by maintaining hygiene and dryness on the feet. Healthcare professionals recommend following certain self-care practices, such as cutting nails correctly and wearing shoes that fit well.

However, if the pain is severe or a person has a badly ingrown toenail, they may need surgery to remove part or all of the nail to prevent further complications.

Ingrown toenail: what to do about it

Contents

• 1 Causes of the disease
• 2 Symptoms of pathology
• 3 Diagnosis of the disease
  • 3. 1 Methods of treatment
  • 3.2 Disease prevention

Ingrown toenail is a disease from which many people who violate the rules of nail care suffer. The reason that the nail has grown into the finger is in most cases considered to be improper pedicure. The mistake of a person is that he deeply cuts off the corners of the nail and forms round edges. Often, the nail grows in due to wearing tight and uncomfortable shoes, poor hygiene or fungal diseases.

In medicine, the disease is called onychocryptosis. An ingrown toenail is much more common than the same problem on the hand or other toes.

In the medical center in Minsk “Clinic in Uruchcha” experienced doctors carry out a complete diagnosis of the disease, and also remove the ingrown toenail.

Causes of disease

Why does a large toenail grow in? There are several groups of causes of this condition.

On the one hand, there are external causes of ingrown nails, which relate to improper care of the nail plate, wearing uncomfortable shoes. On the other hand, there are diseases that provoke onychocryptosis.

External causes include:

• Improper hygiene procedures and pedicure. The factor due to which ingrown nails are formed is carelessness when cutting nails. For example, a person accidentally or intentionally cuts off the corner of the nail, does not notice the formed burr or the presence of a sharp edge. A severely ingrown nail is also formed due to the fact that a person cuts his nails too short. Ignorance of the rules for performing a pedicure leads to inflammation and ingrown nails.
• High load on the legs. An ingrown toenail may appear due to too much stress on the legs due to a person’s professional activity or other circumstances. The point here is the pressure that the body exerts on the feet and the nail plate, which will certainly affect the growth of the nail.
• Uncomfortable or tight footwear. When wearing shoes of a smaller size, the gap for the location of the fingers decreases, which becomes a threat to the abnormal growth of the nail plate. And the narrow nose of the shoe exacerbates the situation: the fingers take a forced position, and the nail does not grow in accordance with the norm.

Ingrown toenail can be formed due to some pathological conditions:

• Flat feet and valgus feet. Due to the deformity of the foot, the pressure of the second toe increases, and the big toe is bent.
• Pregnancy and postpartum period. Often, in women, a toenail grows into the skin during childbearing or a month after childbirth.
• Pathologies associated with impaired metabolism and oxygen delivery to the nail plate. Diabetes mellitus, diseases of the cardiovascular system, endocrine disorders lead to the fact that the nail receives an insufficient amount of mineral components for proper growth and development. Obesity also often causes fragility, brittleness, or complaints that the nail has grown into the skin.
• Treatment of oncological diseases. Radiation therapy or chemotherapy causes a significant blow to the systems and organs of the whole organism. This also applies to the nail plates – they can grow in due to the pathological direction of growth.
• Fungal diseases. Due to fungal growth, the nail thickens, the plate loses its anatomical shape. Then there is an ingrown nail, which gives a person a lot of discomfort.
• Overgrowth of soft tissue in the subungual pad. This disorder is considered a congenital feature. An alarm should be sounded if an ingrown nail becomes inflamed and unpleasant symptoms appear.
• Dermatological pathology. Some diseases from the field of dermatology, for example, psoriasis, lichen of various types, and the appearance of warts, can affect the growth of the nail plate.
• Mechanical traumatization of limbs. Finger injury or frostbite can lead to an ingrown toenail. In this case, you can not do without qualified medical care.

What does an ingrown toenail look like? Part of the nail plate goes deep into the soft tissues – it is this “immersion” of the nail into the tissue that causes discomfort to a person.

Why do toenails grow in? This is usually due to a combination of several factors. For example, a person regularly gets pedicures wrong, wears tight shoes, and suffers from a fungal infection of the feet.

Correction of an ingrown nail at a reasonable price is available at the medical center in Minsk “Clinic in Uruchcha”. Our experienced doctors know how to treat an ingrown toenail!

Symptoms of pathology

How to understand that the nail has grown ? The patient has typical symptoms of the disease:

• Intense pain syndrome. The patient feels severe pain in the area of ​​the nail, which is aggravated by walking or putting on street shoes. The pain is associated with the course of the inflammatory process, and tight shoes aggravate the situation: the space between the fingers decreases, and there is pressure on the ingrown nail plate.
• Redness, swelling, bright pulsation in the area of ​​the nail indicates that urgent medical intervention is needed: the pathology may be complicated by an infectious process.
• Purulent discharge from under the nail plate is a sign of infection in the focus of inflammation. An urgent treatment of an ingrown nail and a doctor’s consultation is required.
• Formation of small ulcers. Ulcers form if the ingrown nail has been injured or subjected to mechanical influence (intense blow or severe bruising).
• Growth of abnormal tissue around the nail – this symptom should alert the patient, because such tissue resembles raw meat in appearance.
• Violation of the normal shape of the plate. The nail may decrease in length, its thickness increases, and the soft tissues become coarser – these signs indicate that the disease has become chronic.

Treatment can be carried out therapeutically, without surgery, if you consult a doctor in time. Doctors of the medical center in Minsk “Clinic in Uruchcha” will help you cope with onychocryptosis quickly and painlessly!

Diagnosis of the disease

How to deal with an ingrown toenail ? As soon as you see that the toenail grows into the skin, you should definitely consult a doctor.

Diagnosis of the disease will be based on an external examination, anamnesis of the patient, questioning and collecting his complaints. In addition, diagnosis is impossible without laboratory tests:

• Complete blood count. Allows you to assess the state of the body, detect the inflammatory process and draw a conclusion about the need for surgical treatment.
• Blood glucose test. This study will show diabetes mellitus or metabolic disorders, which may be an indirect factor activating inflammation.
• X-ray of the foot. Thanks to this instrumental method, the doctor will be able to detect an inflammatory process on the bone, or the formation of osteophytes (bone outgrowths).

If the doctor suspects a fungal infection, he will refer you to a specialized specialist – a dermatologist, who will begin the treatment of an ingrown toenail from a dermatological point of view so that the process does not resume even after resection.

If an ingrown toenail is not diagnosed in time, the problem becomes chronic. As a rule, half of the patients who did not seek medical help on time suffer from onychocryptosis.

In the medical center in Minsk “Clinic in Uruchcha” experienced doctors treat ingrown toenails painlessly and at the best price!

Methods of treatment

There are therapeutic and surgical (through surgery) methods for the treatment of ingrown toenails. Therapy should be carried out under the strict supervision of the attending physician, and self-medication should be abandoned!

Therapeutic treatments for disease include the following:

• Use of non-steroidal anti-inflammatory drugs. Means will help reduce the intensity of inflammation, reduce pain. As a rule, patients take Paracetamol or Ibuprofen, the dosage is determined by the attending physician. The patient takes painkillers for an ingrown toenail if he is worried about too much pain.
• Special baths for disinfection. How to soften an ingrown toenail ? Baths are performed 2-4 times a day: ordinary baking soda, potassium permanganate or sea salt must be dissolved in water. Thanks to the baths, the tissues soften, and the problem of how to cut out the ingrown nail no longer worries the patient. After removing the nail, the area must be treated with iodine or brilliant green.
• Use of Vishnevsky’s ointment. Vishnevsky’s ointment is indispensable for infectious processes. The bandage on the site of inflammation should be applied at night, and removed in the morning. Even a heavily ingrown nail can be removed in the morning when it comes out from under the roller.

In addition, doctors advise using ichthyol ointment, which relieves inflammation and reduces irritation. The bandage also needs to be applied at night, and cut the nail in the morning. An ingrown toenail can also be removed using these methods.

The following methods are used as surgical methods for the treatment of ingrown toenails:

• Cauterization with a laser. The method is effective if the ingrown nail occurs at the level of the cuticle. Thanks to the laser, it is possible to prevent relapses, because the laser removes germ cells, the site of inflammation and young granulation tissue.
• Ingrown nail resection. The doctor performs the operation under local anesthesia, and in this case it is necessary to remove the entire nail plate, because one of the indications for resection is a suppurative process. After 3 months, a new nail grows in a person.
• Removal using radio wave technology. A gentle treatment method, thanks to which the patient does not leave any scars or stitches on the finger. During the operation, the doctor removes the ingrown part and processes the growth zone to prevent the recurrence of the disease.

Sometimes a doctor will pack an ingrown toenail to stop bleeding or draining pus.

After the operation, the intervention area should be treated with antiseptic solution and antibacterial ointment for 3-5 days. With severe pain, the doctor prescribes painkillers. It is necessary to wear only wide shoes so as not to squeeze the operated area.

Disease prevention

Ingrown toenail or handnail formation is easier to prevent than to treat!

First, you must buy and wear only loose shoes. Squeezing of fingers and nails is one of the direct causes of nail ingrowth into soft tissues. Do not forget to change socks twice a day to prevent the development of fungal diseases, which are considered a risk factor for onychocryptosis.

Finally, it is necessary to do a pedicure correctly. Before the procedure, it is recommended to moisten the feet in a special warm foot bath. Nails should be cut straight, without rounding. Using a soft nail file, it is recommended to process the tips and edges of the nail, remove sharp ends.

Do your pedicure as carefully as possible: leave a free edge of the nail, do not cut it too much. The free edge should be 2-3 millimeters. If you notice the presence of dirt or excess skin, remove it with an alcohol-treated cotton wool or bandage.

As a regular care product, you can use special liquids that soften the skin, moisturize it, and reduce the intensity of the hardening process.

Onychocryptosis is an unpleasant and painful condition. By following simple rules, you can prevent this disease. And if you notice the first signs of the formation of an ingrown nail, be sure to contact your doctor! He will conduct a thorough diagnosis and determine ways to eliminate the disease.

Ingrown toenail | News and promotions of the European Medical Center “UMMC-Health”

Dictionary

Onychocryptosis – ingrowth of the nail plate into the lateral part of the nail fold. Most often, the nail grows on the big toe. The disease is very common.

How does it manifest itself?

At the first stage, the nail fold becomes inflamed and reddened at the site of damage, the skin temperature in this area rises. There is pain when pressed; pain in the process of walking, and even in closed narrow shoes, brings a lot of unpleasant moments. In the absence of proper treatment, the disease progresses to purulent complications.

Who is to blame?

Cause: Incorrect cutting of nails. It is important that during growth, the corners of the nails do not cut into the side roller and do not “grow” into it.

Solution: Toenails should not be cut deep and at a right angle, 1.5 millimeters the nail should protrude beyond the edge of the nail bed. Do not sharply deepen the corners of the nails, just file them gently.

Reason: Tight shoes, high heels, tight tights. Beautiful pumps, fashionable autumn boots with a narrowed toe – all this can squeeze the finger, especially the big one, causing a mechanical obstacle to the proper growth of the nail plate. In this position, the growing nail often injures the soft tissues of the lateral nail folds, causing inflammation.

Solution: You can always find a trendy but comfortable pair in stores. By the way, properly selected shoes will reduce the number of repetitions of this problem.

Cause: Flat feet, fungal infection. If there is a fungus, the nail changes not only its shape, but also its structure: the nail plate becomes rougher and denser, it can rise above the nail bed, deform, and as a result, grow into soft tissues. With flat feet, the body weight is redistributed to the main reference points of the foot, due to which it changes its correct structure and configuration. Often this is accompanied by a deviation of the axis of the first toe to the outside. Along with this, there is a deformation of the growth of the nail plate and its ingrowth into the tissues, followed by their inflammation.

Solution: Special insoles for flat feet. With a fungus – treatment by a specialist, and not the use of grandmother’s methods.

Cause: Pregnancy. During this period, there is an increased load on the legs.

Solution: After giving birth, the problem may stop bothering you. It is important to monitor the condition of the nails, cut them correctly and wear only comfortable shoes. If your feet are swollen, then you will have to look at the shoes wider and possibly a size larger.

Important!

If you have diabetes, an ingrown toenail can be a disaster! They saw him immediately to the doctor so as not to lose a finger and not earn gangrene.