What is an ingrown toenail?
An ingrown toenail is when the nail grows into the skin on the side of the toe, causing pain, redness, swelling, and sometimes infection. It happens when the nail curves and grows into the skin, instead of growing straight out. Tight shoes, injury to the toe, cutting your nails too short, and having nails that are curved can all cause ingrown toenails.
What are the symptoms of an ingrown toenail?
An ingrown toenail causes the following symptoms:
- Pain and tenderness along the side of the toenail
- Redness and swelling around the toenail
- Pus or fluid draining from around the nail
- Difficulty walking
The pain is often described as throbbing, sharp, or aching. It typically gets worse with pressure on the toe, such as when wearing shoes or socks. As the condition worsens, the pain may become constant. The skin next to the nail may thicken as well.
When should you see a doctor?
You should see a podiatrist or foot doctor if you have any symptoms of an ingrown toenail, including:
- Persistent pain that doesn’t get better with home treatment
- Increased redness, swelling, or drainage around the nail
- Fever, suggesting infection
- Difficulty walking normally
Seeking prompt medical treatment is important to prevent the condition from worsening. An untreated ingrown toenail can lead to a serious foot infection.
What causes ingrown toenails?
Common causes of ingrown toenails include:
- Cutting your nails too short. This allows the nail corners to dig into the skin.
- Wearing shoes that are tight or short. Pressure from tight footwear can cause the nail to grow into the skin.
- Injury to the nail or toe. Trauma can alter nail growth.
- Abnormally shaped nails. Curved or thick nails are more likely to become ingrown.
- Improperly trimming nails. Cutting nails unevenly or rounding the edges can allow them to dig into skin.
- Pressure on the toe. Activities like running or kicking can put repeated pressure on the toes and nails.
Certain factors increase the risk of developing ingrown toenails, including:
- Adolescence. Ingrown toenails frequently occur in teens and young adults.
- Heredity. Susceptibility can run in families.
- Gender. Males are more prone to ingrown toenails.
- Toenail deformities. Abnormally shaped nails can curve into the skin.
- Sweaty feet. Moisture softens skin and allows nails to pierce the skin.
- Diabetes or poor circulation. This can slow healing and worsen infections.
Home treatments
Mild ingrown toenail symptoms can often be managed at home using the following methods:
- Soak your foot in warm water 3-4 times a day. This helps reduce swelling and relieves pain.
- Place cotton or dental floss under the ingrown nail edge. This lifts up the nail and relieves pressure on the skin.
- Wear open-toed shoes or sandals to avoid pressure on the toe.
- Take over-the-counter pain relievers like acetaminophen or ibuprofen.
- Apply antibacterial ointment daily after soaking.
Your doctor may also trim or remove part of the ingrown nail, a procedure called nail avulsion, to pull the nail out of the skin. If home treatments don’t relieve discomfort within a few days, see your doctor.
When to consider ingrown toenail surgery
If an ingrown toenail persists despite home treatment and causes severe pain or infection, surgical removal may be necessary. Surgery is recommended when:
- There is intense pain that interferes with daily activities
- Signs of infection are present, like redness, heat, pus, swollen lymph nodes
- Home treatments and nail trimming don’t relieve symptoms
- The condition recurs and becomes chronic
Surgery to fully or partially remove the toenail (onychectomy) may be required to treat:
- A severely ingrown nail
- Chronic ingrown toenails that keep coming back
- Ingrown toenails in people with circulation problems or diabetes
- Ingrown nails that are severely infected
This is typically an outpatient procedure done under local anesthesia. After numbing the toe, the nail is removed and the skin is treated to prevent regrowth.
What happens during ingrown toenail surgery?
Ingrown toenail removal is usually done in a podiatrist’s office or outpatient surgery center. The steps are:
- Local anesthetic is injected to numb the toe.
- A tourniquet may be placed around the base of the toe to limit bleeding.
- The nail is pried out and removed, either partially or fully.
- The underlying nail bed is surgically destroyed to prevent regrowth.
- Antibiotic ointment and a bandage are applied.
Partial nail removal just takes out the ingrown section, while a total removal gets rid of the entire toenail. Destroying the nail matrix, or root, is key to prevent the ingrown portion from growing back. Chemical cauterization, electrosurgery, or laser ablation may be used.
Recovery after ingrown toenail surgery
After the procedure, you can expect:
- Mild to moderate pain for several days, managed with medication
- Swelling and drainage around the nail
- Antibiotics for 7-10 days to prevent infection
- Daily bandage changes
- Keeping the foot dry and elevated when possible
- Wearing open-toed shoes until healed
- Limiting activity for 1-2 weeks
- Using crutches if weight-bearing is too painful
Proper wound care and foot soaks will be explained at discharge. Most people have uncomplicated healing within 2-3 weeks following surgery. However, it can take several months for the nail itself to fully grow back.
Can ingrown toenails return after surgery?
Ingrown toenails can recur if the nail root wasn’t fully removed during surgery. Other reasons for recurrence include:
- Not taking proper preventive nail care
- resumed wearing narrow shoes or socks that compress the toe
- Failing to properly care for the nail after regrowth
- Not correcting predisposing factors like improperly trimmed nails, diabetes, orthopedic abnormalities
Follow your podiatrist’s postoperative instructions to help prevent recurrence, including:
- Keeping nails neatly trimmed straight across
- Filing sharp nail edges smooth
- Wearing properly fitted shoes
- Treating underlying conditions like diabetes or foot deformities
- Regularly applying moisturizer to soften skin
- Using antifungal or antibiotic creams if prescribed
- Returning promptly if nails start growing into the skin again
Risks and complications of ingrown toenail surgery
All surgeries carry a small risk of complications. Potential risks and side effects of ingrown toenail removal include:
- Infection
- Bleeding
- Permanent nail loss (after full removal)
- Nail regrowth into skin
- Toenail deformity
- Persistent pain or sensitivity
- Damage to the nail bed or toe bones
- Reaction to the local anesthetic
- Recurrence of ingrown toenail
Your doctor will review the potential risks and your individual factors that could increase complications. Following all postoperative instructions can help reduce risks.
When can normal activities be resumed?
Your return to normal activity levels after surgery depends on the severity of your ingrown toenail and procedure performed. Here are general guidelines on recovery:
- After partial nail removal, normal activities can often resume within 3-4 days.
- With a total nail removal, plan on about 2 weeks before resuming exercise and sports.
- Wearing closed-toe shoes may be uncomfortable for 1-2 weeks.
- Avoid soaking the foot for 2 weeks after surgery.
- Driving can resume when you can wear shoes and walk normally.
- Limit standing or walking for prolonged periods for at least 1 week.
- Moderate activity and gentle exercise can start again after 2-3 weeks.
- All activity restrictions are lifted once the nail has fully regrown in 2-4 months.
Discuss your activity levels and needs with your surgeon, as you may be given customized recommendations based on your situation. Don’t resume activities before your foot has healed.
Preventing ingrown toenails from recurring
Preventing ingrown toenails from coming back involves:
- Wearing properly fitted shoes – Avoid narrow, tight, or high-heeled shoes.
- Cutting your nails properly – Cut them straight across and avoid rounding off the edges.
- Not cutting nails too short – Leave a small amount of white at the nail tip.
- Filing away sharp edges – Use an emery board to file the nail tip smooth.
- Treating underlying conditions – Control issues like diabetes, foot/nail infections, or deformities.
- Soaking feet and applying moisturizer – This keeps skin and nails soft.
- Seeing a podiatrist regularly – Get ingrown nails and predisposing factors corrected.
If you have severe or recurring ingrown nails, your doctor may recommend partial nail removal of the sides to create a narrower nail. Permanent removal is an option for severe cases that have not responded to other treatments.
When to call a doctor about an ingrown toenail
See your podiatrist or family doctor if you notice any symptoms of an ingrown nail, such as:
- Increased redness, swelling, pain, or drainage around the toenail
- Fever or chills, indicating a possible bacterial infection
- The ingrown nail does not improve with home treatment
- Difficulty walking from toenail pain
- Pus or foul-smelling discharge coming from the nail
- Diabetes or known circulation problems
Prompt medical care can treat infection and prevent complications. Severe or recurring ingrown nails may need to be removed. Seek emergency care for uncontrolled bleeding, intense pain, or signs of a spreading foot infection.
Takeaways
An ingrown toenail results when the nail grows into the skin beside it, causing pain and swelling. Mild cases can be treated at home with soaks and better nail care, but surgery may be required with severe or persistent ingrowns. Preventing recurrence involves proper nail trimming technique, well-fitted shoes, treating predisposing factors, and follow-up podiatry care. See your doctor promptly if home care doesn’t resolve symptoms or if signs of infection develop.