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Ingrowing toe nail

What Is It?

An ingrown toenail is a toenail with an edge that pushes into the skin and soft tissue at the side of the nail. This causes redness, swelling and pain, and can lead to infection. Symptoms can be worse when you are wearing a shoe, which puts pressure on the nail. The nail on the big toe becomes ingrown more often than other toenails.

When the shape of your nail changes, the ridges that hold your nail in place can lose their connection. This can cause the nail to grow into the sides or corners of your skin. This is known as an ingrown nail. A number of things can cause this, including:

  • Shoes causing a bunching of the toes in the developmental stages of the foot (frequently in those under 21), which can cause the nail to curl and dig into the skin. This is particularly the case in ill-fitting shoes that are too narrow or too short, but any toed shoes may cause an ingrown nail.
  • Poor nail-care, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across, or breaking a toenail.
  • Trauma to the nail plate or toe, which can occur by stubbing the toenail, dropping things on the toe or going through the end of the shoes (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh
  • Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases, or a genetic susceptibility gives rise to a higher chance of an ingrown nail, but the ingrowth cannot occur without pressure from a shoe.
  • A bacterial infection

 

 Symptoms

Ingrown toenail symptoms include:

  • Pain and tenderness in your toe along one or both sides of the nail
  • Redness around your toenail
  • Swelling of your toe around the nail
  • Infection of the tissue around your toenail

Complications 

Left untreated or undetected, an ingrown toenail can infect the underlying bone and lead to a serious bone infection.

Complications can be especially severe if you have diabetes, which can cause poor blood flow and damage nerves in your feet. So a minor foot injury — a cut, scrape, corn, callus or ingrown toenail — may not heal properly and become infected. A difficult-to-heal open sore (foot ulcer) may require surgery to prevent the decay and death of tissue (gangrene).

Expected Duration

Ingrown toenails sometimes correct themselves as they grow out, but more advanced cases may need to be corrected with surgery. 

Prevention

You can do several things to prevent ingrown toenails from forming:

  • Cut your toenails straight across so that the corner of the nail is visible to you, not buried under skin at the side of your nail. If you are not able to see the corner of your nail as you trim it, your nail might have a jagged corner after it is trimmed, with a “forked” edge that can extend under your skin as it grows. Use clippers that are designed to cut toenails, or a nail file.
  • Wear shoes that are large enough that they don’t push your toes together.

If you are elderly, have diabetes or have other conditions that affect your circulation, be especially careful about how you cut your toenails and manage your foot health.

 

Treatment

If caught early

If the ingrowing part of the nail is small, it may be prevented from becoming worse, and sometimes cured, by the following. This treatment may be given by a podiatrist or GP, or you may be shown how to do it yourself:

  • Soak the toe in water for 10 minutes to soften the folds of skin around the affected nail.
  • Then, using a cotton wool bud, push the skin fold over the ingrown nail down and away from the nail. Do this starting at the root of the nail and move the cotton wool bud towards the end of the nail.
  • Repeat each day for a few weeks, allowing the nail to grow.
  • As the end of the nail grows forward, push a tiny piece of cotton wool or dental floss under it to help the nail grow over the skin and not grow into it. Change the cotton wool or dental floss each time you soak your foot.
  • Do not cut the nail but allow it to grow forward until it is clear of the end of the toe. Then cut it straight across and not rounded off at the end.

Self-Treatment

Unless you have diabetes or another medical condition that places you at special risk, you may be able to successfully treat an infected fingernail at home. The steps are simple. 

  1. Apply warm compresses or soak the finger in warm, soapy water for 10 to 20 minutes, at least twice a day.
  2. Apply antibiotic or antifungal cream.
  3. Keep the infected area covered with a sterile bandage.  

When an ingrown fingernail causes a severe infection, particularly if an abscess forms, your doctor may recommend one of several medical procedures.

Cotton Wedge

You or your doctor may gently lift up the nail and insert a small wedge of medicated cotton between your nail and the inflamed skin next to the nail. This can relieve pain and enable the nail to grow properly.

Draining an Abscess

If your ingrown fingernail has developed into an abscess, a doctor should drain it. Your finger will be numbed with local anesthesia in the doctor’s office before an incision is made to drain the pus. If there is significant drainage, the doctor may place a gauze piece, or wick, in the incision so it may continue to drain for a day or two.

Surgical Excision

Ingrown fingernails rarely require surgical treatment. Surgery is more common with ingrown toenails. However, if an ingrown nail doesn’t resolve on its own, you may need to see a family doctor or dermatologist for a surgical solution.

Doctors commonly use a procedure called nail avulsion. This involves removing a portion of the nail to allow the infected area to drain and heal. It’s performed in the doctor’s office using local anesthesia to keep the area numb.

 

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When To Call a Professional

Contact your doctor or foot care specialist if ingrown nail symptoms do not go away on their own in a reasonable period, if you are in pain or if you notice an infection. If you have diabetes or another health problem that affects your circulation, contact your doctor for treatment of your ingrown nail even if your symptoms are mild.

Prognosis

Once you learn the proper technique for cutting your nails, you may never have another ingrown toenail. If you need to have a vertical strip of your toenail removed, this side of your nail will take several months to replace itself. Usually, the new nail will not be an ingrown nail. 

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