Ingrown Toenails

What is an Ingrown Toenail?

If you trim your toenails too short, particularly on the sides of your big toes, you may set the stage for an ingrown toenail, a common disorder. Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin. An ingrown toenail may also happen if you wear shoes that are too tight or too short. Any of your toenails can get ingrown, but it’s most likely with your big toes.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may get red and infected, and feel very sore. You may see pus drain from it. Finally, your skin may start to grow over the ingrown toenail.

Causes

While many things can cause ingrown toenails, the major causes are shoes that don’t fit well and improperly trimmed nails. Shoes that are too tight press the sides of the nail and make it curl into the skin. Nails that are peeled off at the edge or trimmed down at the corners are also more likely to become ingrown.

Treatment

To treat an infected ingrown toenail, soak your foot in warm, soapy water several times each day. You may need to gently lift the edge of the ingrown toenail from its embedded position and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day. If your infection is severe, your doctor may prescribe a course of antibiotics. Learn how to trim your toenails properly. Wear clean socks and open-toed shoes, such as sandals.

If you are in a lot of pain and/or the infection keeps coming back, I may remove part of your ingrown toenail (partial nail plate avulsion). Your toe is injected with an anesthetic and your doctor uses scissors to cut away the ingrown part of the toenail, taking care not to disturb the nail bed. An exposed nail bed may be very painful. Removing your whole ingrown toenail (complete nail plate avulsion) increases the likelihood your toenail will come back deformed. It may take 3-4 months for your nail to re-grow.

Ingrown toenails often recur. If you have a chronic problem with an ingrown toenail, your doctor may recommend another surgical procedure in which the toenail’s formative part is permanently removed.

Prevention

You can lower your risk of developing an ingrown toenail by trimming your toenails straight across with no rounded corners. The length of your toenail should extend out past your skin. The top of each nail should form a straight line across, level with the top of your toe. Some additional guidelines for preventing ingrown toenails include:

  • Don’t pick at your toenails or tear them off.
  • Make sure your shoes and socks are not too tight.
  • Keep your feet clean at all times.

Surgery

Your doctor will first numb your toe by injecting it with an anesthetic. Then he or she will cut your toenail along the edge that is growing into the skin and pull out the piece of nail. Finally, your doctor may apply a small electrical charge or a liquid solution to the exposed part of the nail bed. This keeps the toenail from growing into the skin again. This part of the surgery is called ablation, and your doctor will decide whether it needs to be done. Not all patients need ablation.

Care After Surgery

  • Soak your foot daily in warm water.
  • Apply antibiotic ointment to the site at least twice a day.
  • Keep a bandage over the site until it heals.
  • Take acetaminophen or ibuprofen as needed for pain.
  • Keep the wound clean and dry. It is okay to shower the day after surgery.
  • Wear loosely fitting shoes or sneakers for the first 2 weeks.
  • Avoid running or strenuous activity for the first 2 weeks.
  • Call the doctor if you have problems with the area, such as increasing pain, swelling, redness or drainage.
  • Avoid high heels and tight-fitting shoes now and in the future.
  • Trim nails straight across.
  • Don’t pick at your nails or tear them at the corners.