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Ingrown Toenails: Why Do They Happen?

What are ingrown toenails?

Ingrown Toenails

Key points

  1. An ingrown toenail occurs when the edges or corners of a nail grow into the skin next to the nail.
  2. According to the National Health Services (NHS), ingrown toenails may be more common in people who have sweaty feet or thick toenails.
  3. If left untreated, an ingrown toenail can cause an infection in the bone in your toe or lead to foot ulcers, open sores, and a loss of blood flow to the infected area.

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.

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.

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Causes

What causes ingrown toenails?

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

Symptoms

What are the symptoms of ingrown toenails?

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.

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Diagnosis

How are ingrown toenails diagnosed?

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.

Treatment

What are the treatment options for ingrown toenails?

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.

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Complications

Complications of ingrown toenails

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.

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Prevention

Preventing ingrown toenails

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.
  • What is the best way to treat ingrown toenails in babies?
  • When ingrown toenails occurs in babies, soak the feet two to three times daily in warm, soapy water. Then dry the feet and apply a thin coat of an over-the-counter antibiotic cream or ointment. Try putting a piece of sterile gauze or dental floss under the nail to lift it over the skin edge, and change this several times daily. If there are signs of infection with increased redness, swelling, or pus, your doctor needs to evaluate the toe. 

    - William Morrison, MD
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