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Ingrown Toenail — Causes, Symptoms, and Treatment

Dr. Gennady Kolodenker

Reviewed by
Dr. Gennady Kolodenker

An ingrown toenail is a nail that grows inward, into the skin. In a patient who suffers from this condition—also known as onychocryptosis—one or both corners of the nail can curl downward and dig into the skin.

Ingrown toenails tend to jab the skin on the outer edge of the toe. Eventually the nail breaks the skin, allowing bacteria to enter and cause an infection in that area. Bacterial infections can cause inflammation, redness, foul odors, and pain. In most cases, the big toe is affected.

Onychocryptosis can occur once or twice in a person’s life, or they can be chronically recurrent. Treatment from a podiatrist is needed in order to avoid further complications if the problem is recurrent, if the pain is severe, or if an infection seems to be developing. A podiatrist will be able to clear the infection and help you prevent recurrence.

Onychocryptosis Symptoms To Watch For

Symptoms of onychocryptosis can be mild or severe. Either way, you should seek medical attention to prevent the problem from recurring and prevent the infection from reaching the underlying bone. Symptoms can include:

  • Soreness
  • Redness
  • Swelling
  • Pain when walking
  • Drainage of pus or fluid
  • Foul odor
  • Warm feeling within the toe

Why Did I Develop an Ingrown Toenail?

There are various reasons ingrown toenails develop, including:

  • Genetics
  • Trauma or injury to the nail
  • Infection of the nail
  • Toe jamming (usually caused by sports activities that require sudden stops)
  • Improper trimming of nails (the nail is trimmed too far back or not straight across)
  • Improper footwear

Unfortunately, some people suffer from chronic onychocryptosis due to genetics. Other people experience some form of trauma to the nail bed after stubbing a toe or having an object fall on it. Damage to the nail matrix is irreversible and can cause new nails to become ingrown.

Failure to trim your nails properly—not cutting the nail straight across, digging into corners, or cutting them too short—can also put you at a risk of developing an ingrown toenail.

Improper trimming is in fact the most common cause of onychocryptosis. Shoes that do not fit properly can also cause ingrown toenails, as can other nail conditions such as fungal infections or psoriasis.

When to See Your Doctor about an Ingrown Toenail

If you begin to experience discomfort in your toe, or if signs of infection such as pus or redness appear, you should seek medical attention for your onychocryptosis immediately.

People with diabetes and other blood diseases should see a podiatrist on a regular basis, especially if they begin experiencing ingrown toenails. If you are unable to trim your ingrown toenail properly, you should also contact your doctor.

Ignoring such a problem can lead to an infection that eventually penetrates the underlying bone, resulting in the need for long-term intravenous antibiotics, or even amputation.

Diagnosing an Ingrown Toenail — What to Expect

Your doctor will easily be able to tell whether or not you have an ingrown toenail. Usually a simple physical exam will be all that is necessary to determine the severity of the problem.

If it is a recurrent problem, your doctor will likely order x-rays of your foot in order to evaluate the underlying bone, but x-rays are typically not needed to diagnose an ingrown toenail.

Ingrown Toenail Treatment Options You Should Know About

The moment you realize you have an ingrown toenail, you should consider seeking medical attention. Self treatment can lead to complications. You should never attempt to cut your ingrown toenail, even if there is no infection.

You increase your chances of infection by trying to fix the problem yourself. Never cut a V shape into the middle of your nail. Many people believe this technique is useful for preventing ingrown toenails, but this method has been proven not to help at all.

A podiatrist will be able to determine the best treatment for you. If you have an infection, he or she might prescribe you antibiotics.

If you have a recurrent problem and no infection is present, doctors will remove the portion of nail that is causing the problem and then use a chemical to destroy or remove the nail matrix from which the offending nail grows.

This procedure is called partial nail avulsion with matrixectomy. The area is cleaned with an antiseptic and the offending portion of the nail is removed with surgical instruments. Once the nail is removed, phenol is applied to the matrix to stop the nail from growing.

If both borders are ingrown, you may need your entire toenail removed. This procedure is known as complete nail plate avulsion. If no chemical is used, the nail will grow back within nine to twelve months. There is a chance, however, that your nail may not grow in correctly.

Surgery is typically effective in preventing the nail border from growing into the skin.

Unfortunately, chemical matrixectomies may still fail to prevent recurrence, and your doctor may need to surgically remove the nail matrix. This procedure is reserved for adults and children with chronic, recurrent, infected ingrown toenails.

How Can I Prevent an Ingrown Toenail from Developing?

Here are some tips to help you avoid ingrown toenails:

  • Do not trim the nail borders. This could change the way the nail grows and could cause the condition to worsen.
  • Contrary to popular belief, cutting notches into the nail does not reduce its chances of curving downward.
  • Over-the-counter medications are typically inadequate to treat the problem. They may mask the pain, but they do little to help the underlying condition. Never use these products if you suffer from diabetes.
  • Place cotton under your nail after soaking your foot and before bandaging. Very small pieces of cotton should be wedged under the nail corners. This is to lift the nail and allow it to grow past the tissue it is digging into.
  • Cut all toenails in a straight line, and not too short.
  • Always wear proper-fitting footwear.
  • If you suffer from diabetes or blood vessel disease, be careful when trimming your nails.
  • If you handle heavy objects at work, consider using shoes with steel toe-boxes.
  • When trimming your nails, use a sharp, clean nail trimmer.
  • Avoid picking or tearing at the nails.
  • If you have diabetes, see a podiatrist regularly.

Ingrown Toenail Complications That May Develop

Onychocryptosis can cause several complications if medical treatment is delayed. The biggest risk is that the infection may spread to other parts of the foot or penetrate the bone.

Foul odors may become noticeable to you and others if the infection is severe enough. The infection can cause tenderness, drainage, redness, pain, and difficulty wearing shoes and walking.

Occasionally a bloody, cauliflower-like growth known as “proud flesh” builds up on the side of the nail, which also causes symptoms similar to an infection.

Keep in mind that you may also experience complications after surgery. For example, having your nail completely removed increases the likelihood the nail will grow back deformed.

Questions to Ask Your Doctor

Here are some questions you may want to ask your doctor about onychocryptosis:

  • Which symptoms should I watch for that may indicate the treatment is not working?
  • How long should I wait to contact you?
  • How long will my recovery period be?
  • Will I need to limit my activities during the healing process?
  • What temperature water should I bathe in during the healing process?
  • What additional treatment options would benefit me?
  • Can you examine my shoes? (Bring two or three pairs to appointment if possible)
  • Do you think the condition will go away on its own?
  • Do you have a brochure on proper nail-grooming techniques?
  • Is my condition temporary or chronic?

 

Medical References:

  1. M. Beers "Merck Manual of Medical Information" 2nd home edition (Pocket Books, 2003) 409
  2. American Medical Association "Family Medical Guide" 4th Edition (John Wiley & Sons, Inc. 2004) 892; 1078
  3. U.S. National Library of Medicine, Ingrown Toenail, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002217/
  4. American Academy of Orthopaedic Surgeons, Ingrown Toenail, http://orthoinfo.aaos.org/topic.cfm?topic=a00154
  5. H. Winter Griffith, MD "Complete Guide to Symptoms, Illness & Surgery" (The Berkeley Publishing Group, 2006) 655
  6. National Center for Biotechnology Information http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592332/
  7. http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=56885
  8. http://forums.studentdoctor.net/threads/vandenbos-procedure.745275/

This page was last updated on November 24th, 2015



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