Nili N. Alai, MD, FAAD
Diplomat, American Board of Dermatology
Fellow, American Society of Mohs Surgery
Assistant Clinical Professor of Dermatology,UniversityofCalifornia,Irvine
What are ingrown toenails?
Ingrown toenails are a very common problem affecting primarily the great toenail. They are caused by sideways growth of the nail edge into the skin of the toe. The abnormal extension of the toenail pushes into the surrounding skin causing discomfort. Normal toenail growth should be vertical or outward toward the tip of the toe. The medical term for ingrown toenail is onychocryptosis. Ingrown toenails cause sore, often painful nail folds with various degrees of redness, swelling, and possible clear or yellow drainage. Frequently, ingrown toenails resolve without medical treatment. Complicated cases may require treatment by a physician.
What causes ingrown toenails?
The sideways growing portion of nail acts like a foreign body and pokes into or pinches off a small piece of skin at the outer edge of the toe. This may cause a break in the skin causing inflammation and possibly infection. The inflammation often causes more thickening of the nail skin fold further exacerbating the problem. The protruding piece of nail keeps pushing into the skin causing more injury and pain.
Are some people more prone to ingrown toenails?
Some people are simply more prone to ingrown toenails. Some risk factors include
- Athletic adolescents and children
- Tight or narrow shoes (poorly fitted shoes)
- Repeat injury or trauma to feet
- Poor foot hygiene
- Poor posture and gait
- Congenital foot deformity
- Congenital toenail malformation
- Very long toes
- Naturally short nails
- Toenail infections
- Fungal nail disease
- Prior nail surgery
- Abnormal nail growths
- Excessive foot sweating
Which nails are most commonly affected?
The great toes are the number one affected sites. Other toenails may less commonly become ingrown. Fingernails may rarely become affected.
What causes infections in ingrown toenails?
Bacteria and fungi can easily infect the skin of the feet and nails. The foot’s warm and moist environment is a great breeding ground for many kinds of infections including Staphylococcus, Pseudomonas, Candida, and Trichophyton. It is important to treat any secondary infections resulting from or following ingrown toenails.
What are possible complications?
Ingrown toenails may cause cellulitus (deeper bacterial tissue infection), paronychia (localized infection of the nail fold), and scarring of the nail fold and skin.
How do I treat an ingrown toenail at home?
- Use warm soaks 10 minutes 2-3 times a day during the flare.
Helpful soaks options include:
- dilute White vinegar (roughly 1 part household vinegar to 4 parts water)
- Epsom salts
- Very dilute Clorox bleach foot bath (approximately 1/3 teaspoon Clorox in 1 medium bucket of water or 1 capful of Clorox in 1 bathtub full of water)
- Elevate the foot and leg.
- Gently roll back the piece of overgrown skin after soaking the affected toenail.
- Gently slip a thin wisp of cotton or dental floss (tape) under the nail edge to help lift the nail off the skin.
- Trim toenails straight across (not too short) and avoid curving at the edges.
When should I see a physician?
It is important to see a physician for ingrown toenails that are very painful, infected, or not getting better after 5-10 days of conservative home treatments. Signs of infection include enlarging areas of redness or a red streak extending from the toe. Signs of cellulitus (tissue infection) include swelling, marked redness, throbbing, and pain. Yellow or green drainage from the wound is also concerning and may require drainage and oral antibiotics. Diabetic patients or any patient with a compromised immune system should immediately see a physician.
What kind of doctor treats ingrown toenails?
Many types of doctors can help with ingrown toenails. Family physicians, pediatricians, urgent care or walk-in physicians, dermatologists, and podiatrists are among the medical professionals who commonly treat this condition. Podiatrists are doctors who specialize in the diagnosis and treatment of foot and ankle disorders including ingrown toenails. Dermatologists specialize in the treatment of skin, hair, and nail disorders.
How are ingrown toenails treated?
Mild cases may be treated with conservative measures like warm daily soaks, avoidance of tight or ill fitting shoes, elevating the foot, topical antibiotics like Neosporin, and gently pushing back the piece of overgrown skin away from the nail.
More advanced cases may be treated with oral antibiotics. Resistant or recurrent cases of ingrown toenails may require minor in-office procedures by the physician. Surgical procedures aim to remove the imbedded nail away from the toe tissue. In some cases, the side 1/3 strip of nail is surgically removed using local anesthesia (numbing). Surgical procedures often require prolonged healing, local soaks, and wound care to prevent further infections during the healing phase.
What types of nail surgery are used for ingrown toenails?
Minor cases may require simply trimming back the protruding nail sliver or piece away from the nail fold. More aggressive, debilitating cases may require a minor surgical procedure called partial nail matricectomy. Surgery should be considered as last resort after conservative local treatments have failed. Nail surgery may cause permanent nail deformity, poor cosmetic appearance, and other possible complications.
Matricectomy is the process of surgically, chemically, or electrically destroying all or part of the base nail portion called the nail matrix. Complete destruction of the nail matrix results in permanent loss of that portion of the nail. Once the nail matrix is fully removed or destroyed, a new nail plate cannot ever be regenerated. This surgical procedure is commonly curative for recurrent cases of ingrown toenails. Often, only the lateral (side) 1/3 or 1/4 of the affected nail is removed in matricectomy. Much less commonly, both sides of the nail matrix are removed (bilateral matricectomy) or the entire nail matrix is removed (complete matricectomy).
Do I have to have surgery?
Surgical treatment is usually reserved for severe or recurrent cases of ingrown toenails. Surgery is not commonly required in most instances. If you keep getting an ingrown toenail, then a minor surgical procedure may be helpful to prevent recurrences.
How can I prevent recurrences?
Recurrent ingrown toenails may be preventable by wearing wider toe shoes and avoiding trauma and repeated injury to toenails. Further measures include protecting toes during sports and avoiding curving or over cutting toenails too short at the edges.
Ingrown Toenail Do’s
Do wear wider toe shoes
Do avoid repeated injury to toenails
Do protect toes during sports
Do maintain good foot hygiene
Do cut toenails straight across
Do keep toenails trim and clean
Ingrown Toenails Don’ts
Don’t cut toenails in a curved pattern
Don’t over-cut toenails at edges
Don’t wear narrow or poor fitting shoes
Don’t let a toenail infection go too long
Don’t try to do home surgery or remove an imbedded nail
Ingrown Toenails At a Glance
Common condition in the great toenail
Typical in adolescent athletes
Frequently associated with tight shoes and toe injuries
Recurrences are common
Treat with warm soaks, elevation, and foot hygiene
May resolve without medical treatment
Treat infections with antibiotics
Severe cases may require minor nail removal surgery